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Article: Possible Ambiguity in Interpretation Between Immunoglobulin G4-Related Disease (IgG4-RD) and Sarcoidosis in a Post-COVID-19 Pandemic.

Gurunathan, Rajesh / Dhanasekaran, Pavithra / Devaprasad, Dedeepiya / Jacob, Sheba Sk / Abraham, Babu K

2023 Volume 15, Issue 4, Page(s) e38124

Abstract: A 36-year-old lady presented with fever, cough, maculopapular rash, painless sialadenitis, episcleritis, and arthralgia of more than 10 months, occurring in episodes since she tested positive for COVID-19 in 2020. Her symptoms were well controlled with ... ...

Abstract	A 36-year-old lady presented with fever, cough, maculopapular rash, painless sialadenitis, episcleritis, and arthralgia of more than 10 months, occurring in episodes since she tested positive for COVID-19 in 2020. Her symptoms were well controlled with corticosteroid and immunosuppressant therapy. Her clinical presentation and findings on bronchoscopy resembled that of sarcoidosis. However, the bronchial biopsy histopathology ruled out sarcoidosis. An increased serum immunoglobulin G4 level and its possible association with COVID-19 raises the question of whether the possibility of immunoglobulin G4-related disease (IgG4-RD) could be entertained.
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.38124
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Incidence and Impact of Healthcare-associated Infections on Patients Primarily Admitted with Sepsis and Non-sepsis Diagnoses.

Abhishek, Chintamani / Prakash, Bala / Abraham, Babu K / Kumar, Senthil / Ramakrishnan, Nagarajan / Venkataraman, Ramesh

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2020 Volume 25, Issue 3, Page(s) 292–295

Abstract: Objectives: ...

Abstract	Objectives:
Language	English
Publishing date	2020-11-20
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-23760
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Extracorporeal Membrane Oxygenation in Drug Overdose: A Clinical Case Series.

Vignesh, C / Kumar, Madhan / Venkataraman, Ramesh / Rajagopal, Senthilkumar / Ramakrishnan, Nagarajan / Abraham, Babu K

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2018 Volume 22, Issue 2, Page(s) 111–115

Abstract: Overdose of cardiovascular medications such as beta blockers and calcium channel blockers cause impaired cardiac contractility, vasoplegia, and/or rhythm disturbances. In addition to conventional management of limiting absorption, increasing elimination ... ...

Abstract	Overdose of cardiovascular medications such as beta blockers and calcium channel blockers cause impaired cardiac contractility, vasoplegia, and/or rhythm disturbances. In addition to conventional management of limiting absorption, increasing elimination and hemodynamic support intravenous (IV) calcium infusion, hyperinsulinemia-euglycemia therapy, glucagon infusion, and IV lipid emulsion have been tried. Extracorporeal circulatory assist device support has been reported as a rescue therapy in overdose refractory to maximal medical therapy. We report three patients with cardiovascular medication overdose presenting with profound cardiovascular instability refractory to medical therapy. Venoarterial extracorporeal membrane oxygenation support (VA ECMO) was initiated to provide hemodynamic support. Despite the occurrence of device-associated complications, the outcome was good and all patients survived. VA ECMO may be considered in patients with severe refractory shock due to cardiotoxic medication overdose.
Language	English
Publishing date	2018-02-15
Publishing country	India
Document type	Case Reports
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.4103/ijccm.IJCCM_417_17
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: What Happens to Patients Discharged Against Medical Advice?

Ramakrishnan, Nagarajan / Ranganathan, Lakshmi / Abraham, Babu K / Rajagopalan, Senthilkumar / Venkataraman, Ramesh

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2018 Volume 22, Issue 8, Page(s) 580–584

Abstract: Introduction: Discharge against medical advice (DAMA) when requested by family members of patients in Indian Critical Care Units (CCUs) leads to loss of follow-up and unknown patient outcomes. Exclusion of these patients from research analysis and ... ...

Abstract	Introduction: Discharge against medical advice (DAMA) when requested by family members of patients in Indian Critical Care Units (CCUs) leads to loss of follow-up and unknown patient outcomes. Exclusion of these patients from research analysis and quality audits confounds these results. We hence explored the proportion of patients leaving DAMA, reasons, and their outcomes at 30 and 90 days. Methods: This was a prospective study of CCU patients admitted from July 2013 to February 2014. All patients, who were DAMA during this period, were included in this study. Demographics, APACHE data, and outcomes were collected and compared to patients discharged regularly during the same period. Outcomes of DAMA patients at 30 and 90 days were gathered by telephone follow-up. Results: Among the 663 patients admitted to the CCU, 15.1% (100 patients) were DAMA. The baseline APACHE score of the DAMA group was higher than the regular discharge group (29.5 ± 8.6 vs. 26.1 ± 10.3; Conclusion: A significant proportion of patients in the CCU get DAMA despite high severity of illness. Understanding the outcomes of these patients will help refine CCU quality audit reports and research study results.
Language	English
Publishing date	2018-08-28
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.4103/ijccm.IJCCM_101_18
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Mortality Prediction Using Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation IV Scoring Systems: Is There a Difference?

Venkataraman, Ramesh / Gopichandran, Vijayaprasad / Ranganathan, Lakshmi / Rajagopal, Senthilkumar / Abraham, Babu K / Ramakrishnan, Nagarajan

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2018 Volume 22, Issue 5, Page(s) 332–335

Abstract: Background: Mortality prediction in the Intensive Care Unit (ICU) setting is complex, and there are several scoring systems utilized for this process. The Acute Physiology and Chronic Health Evaluation (APACHE) II has been the most widely used scoring ... ...

Abstract	Background: Mortality prediction in the Intensive Care Unit (ICU) setting is complex, and there are several scoring systems utilized for this process. The Acute Physiology and Chronic Health Evaluation (APACHE) II has been the most widely used scoring system; although, the more recent APACHE IV is considered an updated and advanced prediction model. However, these two systems may not give similar mortality predictions. Objectives: The aim of this study is to compare the mortality prediction ability of APACHE II and APACHE IV scoring systems among patients admitted to a tertiary care ICU. Methods: In this prospective longitudinal observational study, APACHE II and APACHE IV scores of ICU patients were computed using an online calculator. The outcome of the ICU admissions for all the patients was collected as discharged or deceased. The data were analyzed to compare the discrimination and calibration of the mortality prediction ability of the two scores. Results: Out of the 1670 patients' data analyzed, the area under the receiver operating characteristic of APACHE II score was 0.906 (95% confidence interval [CI] - 0.890-0.992), and APACHE IV score was 0.881 (95% CI - 0.862-0.890). The mean predicted mortality rate of the study population as given by the APACHE II scoring system was 44.8 ± 26.7 and as given by APACHE IV scoring system was 29.1 ± 28.5. The observed mortality rate was 22.4%. Conclusions: The APACHE II and IV scoring systems have comparable discrimination ability, but the calibration of APACHE IV seems to be better than that of APACHE II. There is a need to recalibrate the scales with weights derived from the Indian population.
Language	English
Publishing date	2018-06-15
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.4103/ijccm.IJCCM_422_17
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Funding sources for continuing medical education: An observational study.

Venkataraman, Ramesh / Ranganathan, Lakshmi / Ponnish, Arun S / Abraham, Babu K / Ramakrishnan, Nagarajan

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2014 Volume 18, Issue 8, Page(s) 513–517

Abstract: Aims: Medical accreditation bodies and licensing authorities are increasingly mandating continuing medical education (CME) credits for maintenance of licensure of healthcare providers. However, the costs involved in participating in these CME activities ...

Abstract	Aims: Medical accreditation bodies and licensing authorities are increasingly mandating continuing medical education (CME) credits for maintenance of licensure of healthcare providers. However, the costs involved in participating in these CME activities are often substantial and may be a major deterrent in obtaining these mandatory credits. It is assumed that healthcare providers often obtain sponsorship from their institutions or third party payers (i.e. pharmaceutical-industry) to attend these educational activities. Data currently does not exist exploring the funding sources for CME activities in India. In this study, we examine the relative proportion of CME activities sponsored by self, institution and the pharmaceutical-industry. We also wanted to explore the characteristics of courses that have a high proportion of self-sponsorship. Materials and methods: This is a retrospective audit of the data during the year 2009 conducted at an autonomous clinical training academy. The details of the sponsor of each CME activity were collected from an existing database. Participants were subsequently categorized as sponsored by self, sponsored by institution or sponsored by pharmaceutical-industry. Results: In the year 2009, a total of 2235 participants attended 40 different CME activities at the training academy. Of the total participants, 881 (39.4%) were sponsored by self, 898 (40.2%) were sponsored by institution and 456 (20.3%) by pharmaceutical-industry. About 47.8% participants attended courses that carried an international accreditation. For the courses that offer international accreditation, 63.3% were sponsored by self, 34.9% were sponsored by institution and 1.6% were sponsored by pharmaceutical-industry. There were 126 participants (5.6%) who returned to the academy for another CME activity during the study period. Self-sponsored (SS) candidates were more likely to sponsor themselves again for subsequent CME activity compared with the other two groups (P < 0.001). Conclusions: In our study, majority of healthcare professionals attending CME activities were either self or institution sponsored. There was a greater inclination for self-sponsoring for activities with international accreditation. SS candidates were more likely to sponsor themselves again for subsequent CME activities.
Language	English
Publishing date	2014-07-23
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.4103/0972-5229.138152
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Noninvasive ventilation: Are we overdoing it?

Purwar, Sankalp / Venkataraman, Ramesh / Senthilkumar, R / Ramakrishnan, Nagarajan / Abraham, Babu K

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2014 Volume 18, Issue 8, Page(s) 503–507

Abstract: Background: Use of noninvasive ventilation (NIV) outside guideline recommendations is common. We audited use of NIV in our tertiary care critical care unit (CCU) to evaluate appropriateness of use and patient outcomes when used outside level I ... ...

Abstract	Background: Use of noninvasive ventilation (NIV) outside guideline recommendations is common. We audited use of NIV in our tertiary care critical care unit (CCU) to evaluate appropriateness of use and patient outcomes when used outside level I recommendations. Materials and methods: Prospective observational study of all patients requiring NIV. Clinical parameters and arterial blood gases were recorded at initiation of NIV and 2 h later (or earlier if clinically warranted). NIV titration and decision to intubate were left to the discretion of treating intensivist. Patients were categorized into two groups: Group 1: Those with level I indications for use of NIV and group 2: All other levels of indications. Patients were followed until hospital discharge. Results: From January 2010 to June 2010, 1120 patients were admitted to the CCU. Of these 106 patients required NIV support with 40.6% (n = 43/106) being in group 1 and 59.4% (n = 63/106) in group 2. Of these 35.8% patients (38/106) failed NIV and required endotracheal intubation. NIV failure rates (41.27% vs. 27.91%; P = 0.02) and mortality (30.6% vs. 18.6%; P = 0.03) were significantly higher in group 2 patients. In a logistic regression analysis Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.02), time on NIV before intubation (P = 0.001) and baseline PaCO2 levels (P = 0.01) were strongly associated with mortality. Conclusion: Noninvasive ventilation failure and mortality rates were significantly higher when used outside level I recommendations. APACHE II score, baseline PaCO2 and duration on NIV prior to intubation were predictors of increased mortality.
Language	English
Publishing date	2014-07-23
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.4103/0972-5229.138147
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Critical care: Are we customer friendly?

Venkataraman, Ramesh / Ranganathan, Lakshmi / Rajnibala, V / Abraham, Babu K / Rajagopalan, Senthilkumar / Ramakrishnan, Nagarajan

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2013 Volume 19, Issue 9, Page(s) 507–512

Abstract: Objective: Assessing and enhancing family satisfaction are imperative for the provision of comprehensive intensive care. There is a paucity of Indian data exploring family's perception of Intensive Care Unit (ICU) patients. We wanted to explore family ... ...

Abstract	Objective: Assessing and enhancing family satisfaction are imperative for the provision of comprehensive intensive care. There is a paucity of Indian data exploring family's perception of Intensive Care Unit (ICU) patients. We wanted to explore family satisfaction and whether it differed in families of patients admitted under intensivists and nonintensivists in our semi-open ICU. Methodology: We surveyed family members of 200 consecutive patients, between March and September 2009 who were in ICU for >3 days. An internationally validated family satisfaction survey was adapted and was administered to a family member, on day 4 of the patient's stay. The survey consisted of 15 questions in five categories - patient care, medical counseling, staff interaction, visiting hours, and facilities and was set to a Likert scale of 1-4. Mean, median, and proportions were computed to describe answers for each question and category. Results: A total of 515 patients were admitted during the study period, of which 200 patients stayed in the ICU >3 days. One family member each of the 200 patients completed the survey with 100% response rate. Families reported the greatest satisfaction with patient care (94.5%) and least satisfaction with visiting hours (60.5%). Chi-square tests performed for each of the five categories revealed no significant difference between satisfaction scores of intensivists and nonintensivists' patients. Conclusion: Family members of ICU patients were satisfied with current care and communication, irrespective of whether they were admitted under intensivists or nonintensivists. Family members preferred open visiting hours policy than a time limited one.
Language	English
Publishing date	2013-11-06
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.4103/0972-5229.164796
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Natural course of left atrial thrombi after bioprosthetic mitral valve replacement in a patient with heparin-induced thrombocytopenia.

Abraham, Babu K / Chow, Chi-Ming / Latter, David A / Mazer, C David

The Canadian journal of cardiology

2005 Volume 21, Issue 14, Page(s) 1307–1308

Abstract: Left atrial (LA) clots involving prosthetic mitral valves are unusual complications of heparin-induced thrombocytopenia (HIT), and little is known about their natural history. A 73-year-old woman underwent bioprosthetic mitral valve replacement, which ... ...

Abstract	Left atrial (LA) clots involving prosthetic mitral valves are unusual complications of heparin-induced thrombocytopenia (HIT), and little is known about their natural history. A 73-year-old woman underwent bioprosthetic mitral valve replacement, which was complicated by atrial fibrillation and LA thrombus due to HIT. She was treated medically and followed up for 18 months. The present case provides unique insights into the natural history of HIT-related LA thrombus involving a bioprosthetic valve. It highlights the importance of having a high index of suspicion for this condition and avoiding the use of warfarin early in the course of the condition.
MeSH term(s)	Aged ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Atrial Fibrillation/chemically induced ; Atrial Fibrillation/physiopathology ; Bioprosthesis/adverse effects ; Female ; Heart Atria/physiopathology ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis Implantation ; Heparin/adverse effects ; Heparin/therapeutic use ; Humans ; Mitral Valve/surgery ; Mitral Valve Insufficiency/surgery ; Thrombocytopenia/chemically induced ; Thrombosis/physiopathology
Chemical Substances	Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2005-12
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Prone ventilation following witnessed pulmonary aspiration: the effect on oxygenation.

Easby, Jason / Abraham, Babu K / Bonner, Stephen M / Graham, Stephen

Intensive care medicine

2003 Volume 29, Issue 12, Page(s) 2303–2306

Abstract: Objective: Pulmonary aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS ... ...

Abstract	Objective: Pulmonary aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on pulmonary aspiration. Design: A prospective crossover study. Setting: Twelve-bed ITU. Patients and participants: Eleven patients admitted to ITU with respiratory failure secondary to witnessed pulmonary aspiration requiring ventilation and an FIO(2) >0.50 after 12 h. Interventions: Patients were placed in a prone position for 8 h and then turned supine for 8 h. Prone positioning was repeated if the FIO(2) remained >0.50. Ventilator settings were not altered in the study period. Measurements and results: Arterial blood gas analysis was performed every 2 h. The PaO(2)/FIO(2) gradient was calculated. Oxygenation improved on turning prone, with a significant increase in the PaO(2)/FIO(2) ratio ( P<0.01). There was a fall in this gradient on return to the supine position. There was a significant improvement in oxygenation on turning prone for the second period ( P<0.01). Overall, there was a significant improvement in the PaO(2)/FIO(2) ratio in the final supine position when compared to the first ( P<0.05). Conclusion: This study demonstrates a significant improvement in oxygenation in the prone position in pulmonary aspiration. Early prone positioning in patients with pulmonary aspiration requiring ventilation may improve oxygenation by altering V/Q relationships similarly to ARDS, but also may aid drainage of secretions, opening up alveoli and preventing progression to established pneumonitis.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Blood Gas Analysis ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Aspiration/etiology ; Pneumonia, Aspiration/therapy ; Prone Position ; Prospective Studies ; Pulmonary Gas Exchange ; Respiration, Artificial/methods
Language	English
Publishing date	2003-08-28
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	80387-x
ISSN	1432-1238 ; 0342-4642 ; 0340-0964 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0342-4642 ; 0340-0964 ; 0935-1701
DOI	10.1007/s00134-003-1983-9
Database	MEDical Literature Analysis and Retrieval System OnLINE

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