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Article: Epidemiology of Community-Acquired Sepsis: Data from an E-Sepsis Registry of a Tertiary Care Center in South India.

Edathadathil, Fabia / Alex, Soumya / Prasanna, Preetha / Sudhir, Sangita / Balachandran, Sabarish / Moni, Merlin / Menon, Vidya / Sathyapalan, Dipu T / Singh, Sanjeev

Pathogens (Basel, Switzerland)

2022 Volume 11, Issue 11

Abstract: The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The ... ...

Abstract	The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The prospective observational study recruited 1009 adult sepsis patients presenting to the emergency department at the center based on Sepsis-2 criteria for a period of three years. Of the patients, 41% were between 61 and 80 years with a mean age of 57.37 ± 13.5%. A total of 13.5% (136) was under septic shock and in-hospital mortality for the study cohort was 25%. The 3 h and 6 h bundle compliance rates observed were 37% and 49%, respectively, without significant survival benefits. Predictors of mortality among patients with bloodstream infections were septic shock (
Language	English
Publishing date	2022-10-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens11111226
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients.

Krishnakumar, Radhika T / Asok, Amrita / Mohamed, Zubair U / Padma, Uma D / Sathyapalan, Dipu T / Moni, Merlin / Balachandran, Sabarish / Kumar, Anil V / Nair, Rajesh / Sudhindran, Surendran / Singh, Sanjeev K

Journal of pharmacy practice

2022 Volume 36, Issue 4, Page(s) 761–768

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Humans ; Colistin/adverse effects ; Anti-Bacterial Agents/adverse effects ; Transplant Recipients ; Organ Transplantation/adverse effects ; Bacterial Infections/drug therapy
Chemical Substances	Colistin (Z67X93HJG1) ; Anti-Bacterial Agents
Language	English
Publishing date	2022-02-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	1027474-1
ISSN	1531-1937 ; 0897-1900
ISSN (online)	1531-1937
ISSN	0897-1900
DOI	10.1177/08971900221074967
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Article: Long term outcome of medical and surgical co-management of craniospinal aspergillosis in an immunocompromised patient

Sathyapalan, Dipu / Balachandran, Sabarish / Kumar, Anil / Mangalath Rajamma, Bindu / Pillai, Ashok / Menon, Vidya P

Medical mycology case reports. 2016 Dec., v. 14

2016

Abstract: 35yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she ... ...

Abstract	35yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she developed persistent fever, and altered mental status. Brain MRI and CSF study including multiplex PCR evaluation confirmed cerebral aspergillosis. Voricanozole was changed to intravenous lipid complex Amphotericin B to achieve sustained clinical and radiological response after six months of therapy.
Keywords	Aspergillus fumigatus ; abscess ; amphotericin B ; aspergillosis ; brain ; case studies ; collaborative management ; debridement ; fever ; histopathology ; intravenous injection ; lipids ; magnetic resonance imaging ; mycology ; patients ; polymerase chain reaction
Language	English
Dates of publication	2016-12
Size	p. 33-37.
Publishing place	Elsevier B.V.
Document type	Article
ISSN	2211-7539
DOI	10.1016/j.mmcr.2016.11.008
Database	NAL-Catalogue (AGRICOLA)

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Article: A comparison of clinical outcomes between vaccinated and vaccine-naive patients of COVID-19, in four tertiary care hospitals of Kerala, South India.

Balachandran, Sabarish / Moni, Merlin / Sathyapalan, Dipu T / Varghese, Prinoj / Jose, Manoj P / Murugan, Mithun R / Rajan, C / Saboo, Dhanraj / Nair, Sooraj S / Varkey, Reshmi Ann / Balachandran, Parvathy / Menon, Geetha R / Vasudevan, Beena K / Banerjee, Amitava / Janakiram, Chandrasekhar / Menon, Jaideep C

Clinical epidemiology and global health

2022 Volume 13, Page(s) 100971

Abstract: The problem considered: This multi-centric study analyzed data of COVID-19 patients and compared differences in symptomatology, management, and outcomes between vaccinated and vaccine-naive patients.: Methods: All COVID-19 positive individuals ... ...

Abstract	The problem considered: This multi-centric study analyzed data of COVID-19 patients and compared differences in symptomatology, management, and outcomes between vaccinated and vaccine-naive patients. Methods: All COVID-19 positive individuals treated as an in-or out-patient from the 1 Results: The analysis was of 1446 patients after exclusion of 156 with missing data of which males were 57.3% and females 42.7%. 346 were vaccinated; 189 received one dose and 157 both doses. Hospitalization was more in vaccinated (38.2% vs 27.4%); ICU admissions were less in vaccinated (3.5% vs 7.1%). More vaccinated were symptomatic (OR = 1.5); half less likely to be on non-invasive ventilation (OR = 0.5) while vaccine naive patients had 4.21 times the risk of death. Conclusion: Severe infection, duration of hospital stays, need for ventilation and death were significantly less among vaccinated when compared with vaccine naive patients.
Language	English
Publishing date	2022-01-19
Publishing country	India
Document type	Journal Article
ISSN	2452-0918
ISSN	2452-0918
DOI	10.1016/j.cegh.2022.100971
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Article: Long term outcome of medical and surgical co-management of craniospinal aspergillosis in an immunocompromised patient.

Sathyapalan, Dipu / Balachandran, Sabarish / Kumar, Anil / Mangalath Rajamma, Bindu / Pillai, Ashok / Menon, Vidya P

Medical mycology case reports

2016 Volume 14, Page(s) 33–37

Abstract: 35 yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she ... ...

Abstract	35 yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she developed persistent fever, and altered mental status. Brain MRI and CSF study including multiplex PCR evaluation confirmed cerebral aspergillosis. Voricanozole was changed to intravenous lipid complex Amphotericin B to achieve sustained clinical and radiological response after six months of therapy.
Language	English
Publishing date	2016-11-29
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-7539
ISSN	2211-7539
DOI	10.1016/j.mmcr.2016.11.008
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Article: Waiting for Godot: A cross sectional survey based analysis of the hydroxychloroquine prophylaxis strategy against COVID-19 in India.

Moni, Merlin / Madathil, Thushara / Palabatla, Rahul / Balachandran, Sabarish / Edathadathil, Fabia / Gutjahr, Georg / Madathil, Sai B / Pai, Rajesh / Kv, Beena / Jayant, Aveek / Sathyapalan, Dipu T

Journal of public health research

2020 Volume 9, Issue 4, Page(s) 1888

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-12-30
Publishing country	Italy
Document type	Journal Article
ISSN	2279-9028
ISSN	2279-9028
DOI	10.4081/jphr.2020.1888
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Article ; Online: Clinical efficacy and pharmacokinetics of colistimethate sodium and colistin in critically ill patients in an Indian hospital with high endemic rates of multidrug-resistant Gram-negative bacterial infections: A prospective observational study.

Moni, Merlin / Sudhir, A Sangita / Dipu, T S / Mohamed, Zubair / Prabhu, Binny Pushpa / Edathadathil, Fabia / Balachandran, Sabarish / Singh, Sanjeev K / Prasanna, Preetha / Menon, Veena P / Patel, Twisha / Patel, Payal / Kaye, Keith S / Menon, Vidya P

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2020 Volume 100, Page(s) 497–506

Abstract: Background: Safe and effective use of colistin requires robust pharmacokinetic (PK) and pharmacodynamic (PD) data to guide dosing.: Aim: To evaluate the pharmacokinetics of colistimethate sodium and colistin in critically ill patients and correlate ... ...

Abstract	Background: Safe and effective use of colistin requires robust pharmacokinetic (PK) and pharmacodynamic (PD) data to guide dosing. Aim: To evaluate the pharmacokinetics of colistimethate sodium and colistin in critically ill patients and correlate with clinical efficacy and renal function. Materials and methods: Twenty critically ill adult patients with colistin-susceptible multidrug-resistant (MDR) infections and normal renal function treated with intravenous colistimethate sodium - at a 9 million units (270 mg CBA) loading dose followed by maintenance (MD) of 3 million units t.i.d, 24 hours later - were evaluated for clinical cure (CC) at the end of therapy. Patient characteristics and plasma colistin levels at 0, 0.5, 1, 2, 4, 8 and 12 hours after the loading dose and at 1, 2 and 8 hours after the eighth and ninth infusion of MD were evaluated. Colistimethate sodium and colistin levels were measured by high-performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS). Results: Among the 20 patients who were evaluated, 60% had pneumonia. Predominant pathogens were Klebsiella pneumoniae and Acinetobacter spp. Clinical cure was 50% (10/20). Mean peak loading dose concentrations were 3 ± 1.1 mg/L (1.75-5.14) and 2.37 ± 1.2 mg/L (1.52-5.54) for 'cure' and 'failure' groups, respectively (p = 0.13), while mean steady-state (Cssavg) concentrations were 2.25 ± 1.3 mg/L and 1.78 ± 1.1 mg/L in 'cure' and 'failure' groups, respectively (p = 0.19). Nephrotoxicity was 5% on day 7 of therapy. However, bacteriological cure could not be correlated with PK/PD. Conclusions: Subtherapeutic Cssavg with clinical failure and lower efficacy without significant nephrotoxicity highlights the need for therapeutic drug monitoring to guide colistin dosing.
MeSH term(s)	Administration, Intravenous ; Adult ; Aged ; Anti-Bacterial Agents/pharmacokinetics ; Anti-Bacterial Agents/therapeutic use ; Colistin/analogs & derivatives ; Colistin/pharmacokinetics ; Colistin/therapeutic use ; Drug Resistance, Multiple, Bacterial ; Female ; Gram-Negative Bacteria/classification ; Gram-Negative Bacteria/drug effects ; Gram-Negative Bacteria/genetics ; Gram-Negative Bacteria/isolation & purification ; Gram-Negative Bacterial Infections/drug therapy ; Gram-Negative Bacterial Infections/microbiology ; Hospitals/statistics & numerical data ; Humans ; India/epidemiology ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents ; colistinmethanesulfonic acid (DL2R53P963) ; Colistin (Z67X93HJG1)
Language	English
Publishing date	2020-08-08
Publishing country	Canada
Document type	Journal Article ; Observational Study
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2020.08.010
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Zs.A 4516: Show issues

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Article ; Online: A Quality Improvement Initiative to Reduce "Out-of-ICU" Cardiopulmonary Arrests in a Tertiary Care Hospital in India: A 2-Year Learning Experience.

Menon, Vidya P / Prasanna, Preetha / Edathadathil, Fabia / Balachandran, Sabarish / Moni, Merlin / Sathyapalan, Dipu / Pai, Rajesh D / Singh, Sanjeev

Quality management in health care

2017 Volume 27, Issue 1, Page(s) 39–49

Abstract: Quality problem or issue: To assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization.: Initial assessment: Frequently observed critical clinical signs and ... ...

Abstract	Quality problem or issue: To assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization. Initial assessment: Frequently observed critical clinical signs and laboratory values of "out-of-ICU" crashes were used to develop Amrita Early Warning Criteria. Choice of solution: A physician-led MET was established to respond to code MET, activated by a primary nurse. Implementation: Rates of "out-of-ICU" cardiopulmonary arrests per 1000 admissions were compared in pre-MET (2013-2014) and post-MET periods (2014-2016) along with disposition following MET and mortality. Descriptive statistics and logistic regression were used for comparative analysis. Evaluation: For continued quality improvement, a Likert agreement scale questionnaire collated the nurse's feedback on MET. 386 Code MET were recorded with an activation rate of 18.8 per 1000 inpatients for 2014-2016. Common MET triggers were desaturation (53%), seizure (10%), and syncope (9%). Seventy-one percent of activations were attended within 5 minutes, with 45% reported during nurse's night shift hours. Medical emergency team interventions resulted in 59% being shifted to ICU. In the "post-MET" period, "Cold Blue" dose reduced from 6.9 in 2013-2014 to 2.6 (P = .0002) in 2014-2015 and 3.2 (P = .01) in 2015-2016. Ninety-three percent of the Code Blues with prior MET calls were "delayed MET" and 28% of the Code Blues without prior MET activation were "missed MET." Nurse's feedback revealed that 46% lacked knowledge of correct MET activation process while 31% expressed a fear of reprisal for inappropriate activation. Lessons learned: Although MET intervention was successful in significantly reducing "out-of-ICU" Code Blues, focused training of nurses is required for continued quality improvement.
MeSH term(s)	Adolescent ; Adult ; Aged ; Attitude of Health Personnel ; Cardiopulmonary Resuscitation ; Clinical Deterioration ; Female ; Heart Arrest/mortality ; Heart Arrest/therapy ; Hospital Mortality/trends ; Hospital Rapid Response Team/organization & administration ; Humans ; India ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Patient Care Team/organization & administration ; Quality Improvement/organization & administration ; Tertiary Care Centers/organization & administration ; Time Factors ; Young Adult
Language	English
Publishing date	2017-12-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1162319-6
ISSN	1550-5154 ; 1063-8628
ISSN (online)	1550-5154
ISSN	1063-8628
DOI	10.1097/QMH.0000000000000160
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Zs.A 3806: Show issues

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Article ; Online: Efficacy & safety of Carica papaya leaf extract (CPLE) in severe thrombocytopenia (≤30,000/μl) in adult dengue - Results of a pilot study.

Sathyapalan, Dipu T / Padmanabhan, Athira / Moni, Merlin / P-Prabhu, Binny / Prasanna, Preetha / Balachandran, Sabarish / Trikkur, Sreekrishnan P / Jose, Soumya / Edathadathil, Fabia / Anilkumar, Jagan O / Jayaprasad, Rekha / Koramparambil, Gireeshkumar / Kamath, Ravindra C / Menon, Veena / Menon, Vidya

PloS one

2020 Volume 15, Issue 2, Page(s) e0228699

Abstract: Severe thrombocytopenia in dengue often prompts platelet transfusion primarily to reduce bleeding risk. In India, about 11-43% of dengue patients report receiving platelet transfusions which is considered scarce and expensive especially in resource ... ...

Abstract	Severe thrombocytopenia in dengue often prompts platelet transfusion primarily to reduce bleeding risk. In India, about 11-43% of dengue patients report receiving platelet transfusions which is considered scarce and expensive especially in resource limited settings. Herein, we evaluated the efficacy and safety of Carica papaya leaf extract (CPLE) in the management of severe thrombocytopenia (≤30,000/μL) in dengue infection. 51 laboratory confirmed adult dengue patients with platelet counts ≤30,000/μL were randomly assigned to either treatment (n = 26) or placebo (n = 24) group. By day 3, CPLE treated patients reported significantly (p = 0.007) increased platelet counts (482%± 284) compared to placebo (331%±370) group. In the treatment group, fewer patients received platelet transfusions (1/26 v/s 2/24) and their median time for platelets to recover to ≥ 50,000/μL was 2 days (IQR 2-3) compared to 3 days (IQR 2-4) in placebo. Overall, CPLE was safe and well tolerated with no significant decrease in mean hospitalization days. Plasma cytokine profiling revealed that by day 3, mean percent increase in TNFα and IFNγ levels in treatment group was less compared to that observed in placebos; (TNFα: 58.6% v/s 127.5%; p = 0.25 and IFNγ: 1.93% v/s 62.6% for; p = 0.12). While a mean percent increase in IL-6 levels occurred in placebos (15.92%±29.93%) by day 3, a decrease was noted in CPLE group (12.95%±21.75%; p = 0.0232). Inversely, CPLE treated patients reported a mean percent increase compared to placebo by day 3 (143% ±115.7% v/s 12.03%± 48.4%; p = 0.006). Further, by day 3, a faster clearance kinetics of viral NS1 antigenemia occurred-mean NS1 titers in treatment group decreased to 97.3% compared to 88% in placebos (p = 0.023). This study demonstrates safety and efficacy of CPLE in increasing platelet counts in severe thrombocytopenia in dengue infections. A possible immunomodulatory and antiviral activity may be attributed to CPLE treatment. These findings merit validation in larger prospective studies. Trial registration Name of the registry: Clinical Trials Registry-India (CTRI) Registration No.: CTRI-REF/2017/02/013314.
MeSH term(s)	Adult ; Carica/chemistry ; Cohort Studies ; Cytokines/metabolism ; Dengue/complications ; Female ; Hematocrit ; Humans ; Length of Stay ; Male ; Middle Aged ; Pilot Projects ; Plant Extracts/adverse effects ; Plant Extracts/pharmacology ; Plant Extracts/therapeutic use ; Plant Leaves/chemistry ; Platelet Count ; Safety ; Thrombocytopenia/blood ; Thrombocytopenia/complications ; Thrombocytopenia/drug therapy ; Thrombocytopenia/metabolism ; Treatment Outcome ; Viral Nonstructural Proteins/metabolism
Chemical Substances	Cytokines ; Plant Extracts ; Viral Nonstructural Proteins
Language	English
Publishing date	2020-02-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0228699
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Article ; Online: Myocardial injury after noncardiac surgery-incidence and predictors from a prospective observational cohort study at an Indian tertiary care centre.

George, Rubin / Menon, Vidya P / Edathadathil, Fabia / Balachandran, Sabarish / Moni, Merlin / Sathyapalan, Dipu / Prasanna, Preetha / S, Gokuldas / Paul, Jerry / K K, Chandrababu / Kumar, Lakshmi / Pillai, Ashok

Medicine

2018 Volume 97, Issue 19, Page(s) e0402

Abstract: Asymptomatic myocardial injury following noncardiac surgery (MINS) is an independent predictor of 30-day mortality and may go unrecognized based on standard diagnostic definition for myocardial infarction (MI). Given lack of published research on MINS in ...

Abstract	Asymptomatic myocardial injury following noncardiac surgery (MINS) is an independent predictor of 30-day mortality and may go unrecognized based on standard diagnostic definition for myocardial infarction (MI). Given lack of published research on MINS in India, our study aims to determine incidence of MINS in patients undergoing noncardiac surgery at our tertiary care hospital, and evaluate the clinical characteristics including 30-day outcome.The prospective observational study included patients >65 years or >45 years with either hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), cerebrovascular accident (CVA), or peripheral arterial disease undergoing noncardiac surgery. MINS was peak troponin level of ≥0.03 ng/dL at 12-hour or 24-hour postoperative. All patients were followed for 30 days postoperatively. Predictors of MINS and mortality were analyzed using multivariate logistic regression. Patients categorized based on peak troponin cut-off values determined by receiver operating characteristic curve were analyzed by Kaplan-Meir test to compare the survival of patients between the groups.Among 1075 patients screened during 34-month period, the incidence of MINS was 17.5% (188/1075). Patients with DM, CAD, or who underwent peripheral nerve block anaesthesia were 1.5 (P < .01), 2 (P < .001), and 12 (P < .001) times, respectively, more likely to develop MINS than others. Patients with heart rates ≥96 bpm before induction of anesthesia were significantly associated with MINS (P = .005) and mortality (P = .02). The 30-day mortality in MINS cohort was 11.7% (22/188, 95% CI 7.5%-17.2%) vs 2.5% (23/887, 95% CI 1.7%-3.9%) in patients without MINS (P < .001). ECG changes (P = .002), peak troponin values >1 ng/mL (P = .01) were significantly associated with mortality. A peak troponin cut-off of >0.152 ng/mL predicted mortality among MINS patients at 72% sensitivity and 58% specificity. Lack of antithrombotic therapy following MINS was independent predictor of mortality (P < .001), with decreased mortality in patients who took post-op ASA (Aspirin) or Clopidogrel. Mortality among MINS patients with post-op ASA intake is 6.7% vs 12.1% among MINS patients without post-op ASA intake. Mortality among MINS patients with post-op Clopidogrel intake is 10.5% vs 11.8% among MINS patients without post-op Clopidogrel intake.A higher (17.5%, 95% CI 15-19%) incidence of MINS was observed in our patient cohort with significant association with 30-day mortality. Serial postoperative monitoring of troponin following noncardiac surgery as standard of care, would identify "at risk" patients translating to improved outcomes.
MeSH term(s)	Asymptomatic Diseases/epidemiology ; Female ; Humans ; Incidence ; India/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/epidemiology ; Myocardial Infarction/etiology ; Outcome Assessment, Health Care ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Prognosis ; Prospective Studies ; Risk Assessment ; Risk Factors ; Surgical Procedures, Operative/adverse effects ; Surgical Procedures, Operative/statistics & numerical data ; Tertiary Care Centers/statistics & numerical data
Language	English
Publishing date	2018-04-30
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000010402
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