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Biomedical subjects

K Mohandas

Publications and source records attributed to K Mohandas.

At least 19 recordsLinked to original sources
PubMed2004

Intestinal cryptosporidiasis in living related renal transplant recipients.

Cryptosporidium infestations are common in immunocompromised AIDS patients. However, the literature in renal transplant recipients is scarce. We conducted a study to know the prevalence, disease manifestations, and management of cryptosporidial infestations in live related renal transplant recipients. Cryptosporidial infestations were observed in 20% of patients, including 16.6% who had symptomatic diarrhea. We conclude that the prevalence is high in the transplant population, but only a few patients are symptomatic. Clinicians should routinely request special stains to demonstrate cryptosporidium in stool specimens.

Adult↗
PubMed2001

WBC reduction in RBC concentrates by prestorage filtration: multicenter experience.

BACKGROUND: As universal leukocyte (WBC) reduction (ULR) is being considered as a new standard, few data are available on the performance of WBC-reduction filtration in routine practice. The performance of WBC-reduction in RBCs, using varied filtration practices, in meeting the current FDA requirement (<5 x 10(6)), Council of Europe (EC) recommendation, the proposed FDA requirement (<1 x 10(6)), and a more stringent proposal (<5 x 10(5)) for residual WBCs per RBC unit was assessed and compared. STUDY DESIGN AND METHODS: Participating facilities were the 11 sites of the Viral Activation Transfusion Study (VATS), a prospective study of the impact of transfusion with and without WBC-reduction on survival and HIV viral load in HIV-1-infected patients. Patients randomly assigned to undergo WBC reduction were required to receive RBCs < or =14 days old that had undergone prestorage (within 72 hours of collection) WBC-reduction filtration by a method devised to achieve a postfiltration WBC count of <5 x 10(6). Residual WBC quantitation was performed by PCR in the central VATS laboratory by using frozen WBC-reduced RBC samples obtained at issue for transfusion. RESULTS: A total of 1869 WBC-reduced RBC units were studied. Filtration practices varied within and between sites. There were significant differences in mean residual WBC counts at the 11 sites (p<0.001). Among the WBC-reduced RBC units, 0.8 percent exceeded 5 x 10(6) WBCs per unit, 8.3 percent exceeded 1 x 10(6) WBCs per unit, and 14.3 percent exceeded 5 x 10(5) WBCs per unit. CONCLUSION: Residual WBCs in WBC-reduced RBC units vary within and between sites. WBC reduction was successful, in that over 99 percent and 91 percent of VATS WBC-reduced RBC units met US and EC thresholds, respectively. However, the small but measurable failure rate indicates that not every unit will meet these guidelines.

Blood Component Removal↗
PubMed1998

Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery.

BACKGROUND: Allogeneic transfusion is associated with postoperative infections that significantly prolong hospital stays and increase costs. Recent studies suggest that filtering leukocytes from blood prior to transfusion reduces the risk of postoperative infection associated with blood transfusion. We compared the incidence of postoperative infections, hospital stays, and hospital charges of gastrointestinal surgery patients transfused with packed red cells or leukocyte-depleted cells. METHODS: Consecutive patients admitted for elective gastrointestinal surgery without previous blood transfusion were randomized to receive routine packed red cells or packed red cells filtered to remove leukocytes if transfusion was required. Multivariate analysis was used to assess the significance of the relationship between leukocyte-depleted blood and postoperative infectious complications, postoperative stay, and hospital charges. RESULTS: Fifty-nine (27%) of the 221 patients were transfused. The most significant variable related to transfusion was intraoperative blood loss (P <0.0001), followed by admission hematocrit (P <0.0001) and age (P = 0.0022). Infections were noted in 16% of the patients: 11% of untransfused patients, 16% of leukocyte-depleted blood recipients, and 44% of patients transfused with packed red cells. Both operative site and nosocomial infections were significantly (P <0.001) more frequent in patients transfused with packed red cells compared with patients transfused with leukocyte-depleted red cells. Postoperative stays averaged 9 days for untransfused patients, 12 days for leukocyte-depleted recipients, and 18 days for recipients of packed red cells. Hospital charges were $19,132, $33,954, and $41,002, respectively. Both transfusion and infection were significantly (P <0.001) related to postoperative stay in multivariate analysis. Hospital charges were significantly related to postoperative stay (P <0.001), blood loss (P <0.001), age (P <0.001), infection (P = 0.007), and randomization to packed red cells (P = 0.032). CONCLUSIONS: Filtering blood of leukocytes prior to transfusion for elective gastrointestinal surgery is associated with lower risk of postoperative infection, shorter postoperative stays, and lower hospital charges.

Cost-Benefit Analysis↗
PubMed1998

Two examples of an inseparable antibody that reacts equally well with DW+ and Rh32+ red blood cells.

BACKGROUND AND OBJECTIVES: Anti-DW is a rare specificity that detects an antigen on DVa red blood cells (RBCs). Some anti-DW contain an inseparable component that cross-reacts weakly with RBCs expressing the low-incidence Rh antigen Rh32. RH32 is expressed by RBCs with either the R=Nor the DBT phenotype. CASE REPORT: We describe here an antibody found in the serum of 2 patients that reacts equally well with RBCs possessing either DVa, R=N, or DBT phenotypes. The reactivity for DW and Rh32 antigens could not be separated by adsorption onto and elution from DW+Rh32- or from DW-Rh32+ RBCs. CONCLUSIONS: We suggest that amino acids encoded by nucleotides at the junction of exon 4 of RHD to exon 5 of RHCE may induce a conformation that is recognized by these equally reactive inseparable antibodies. Until such time that the epitope recognized by these antibodies is defined, we recommend use of the descriptive name anti-DW/Rh32.

Agglutinins↗
PubMed1997

Intraoperative hemodilution is more cost-effective than preoperative autologous donation for patients undergoing procedures associated with a low risk for transfusion.

STUDY OBJECTIVE: To determine the utilization and cost of autologous blood that was donated preoperatively, and to compare it to the cost of employing intraoperative hemodilution to provide autologous blood for patients undergoing surgical procedures with a low risk for the need for transfusion. DESIGN: Retrospective chart review. SETTING: University medical center. PATIENTS: All ASA physical status I and II patients who underwent nononcologic gynecologic procedures and preoperatively donated autologous blood between July 1993 and June 1994. MEASUREMENTS AND MAIN RESULTS: The utilization and overall cost of predonated autologous blood was determined. The cost for employing intraoperative hemodilution and potential cost saving was then calculated. Of the 234 units of preoperatively donated autologous blood, 38 units were returned to patients who had an estimated blood loss of at least 500 ml, 32 units returned to patients who had an estimated blood loss less than 500 ml, and 164 units were wasted. No patient received allogeneic blood. The estimated total cost for all preoperatively donated autologous blood was $23,274.62. Employing hemodilution for those same patients would have cost $5,574.74, and resulted in a potential 75.6% savings. CONCLUSIONS: Inappropriate selection of patients for preoperative blood donation is costly. For those patients scheduled to undergo surgical procedures associated with a low probability for the need for blood transfusion, but who desire that autologous blood be available, hemodilution provides fresh whole blood, free from the possibility of processing or clerical errors, while decreasing blood bank utilization and affording substantial cost savings.

Adult↗
PubMed1997

Prevention of hypertension during trans-sphenoidal surgery--the effect of bilateral maxillary nerve block with local anaesthetics.

BACKGROUND: Severe cardiovascular responses are known to occur during trans-sphenoidal excision of the pituitary gland despite adequate depth of anaesthesia. This study was undertaken to evaluate the effects of bilateral maxillary nerve block with local anaesthetics on the cardiovascular responses to various stimuli during this procedure. METHODS: In a group of 32 patients, 5-10 ml of a mixture of bupivacaine 0.5% and lignocaine 2% (1:1) was injected in the pterygopalatine fossa after induction of general anaesthesia. Seven control group patients did not receive any nerve block. In all the patients, general anaesthesia was induced with thiopentone and maintained with nitrous oxide-oxygen, pentazocine, boluses of thiopentone and halothane. Pancuronium was used for neuromuscular blockade. RESULTS: In both the groups, maximum hypertension occurred on opening the blades of the bivalve nasal speculum. In the study group, hypertensive response was significantly less following nasal infiltration with adrenaline containing solution (10.26% increase vs. 23.08% in the control group, P < 0.05), nasal dissection (2.82% vs. 9.45%, P < 0.01) and on application of the nasal speculum (14.93% vs. 35.16%, P < 0.01). The effect on heart rate response was not significant. CONCLUSION: The described technique is a useful adjunct to general anaesthesia for suppressing the haemodynamic responses during trans-sphenoidal surgery.

Adult↗
PubMed1996

Plasmapheresis in primary dysfunction of hepatic transplants.

BACKGROUND: Primary dysfunction is a failure of graft function which occurs in approximately 5% of transplanted livers. Retransplantation is often required. The presence of elevated serum cytokines interleukin 6 and tumor necrosis factor with hepatic graft dysfunction, as well as the historical benefit of plasmapheresis in fulminant hepatic failure-associated coma suggest a possible role for plasmapheresis therapy in the management of primary graft dysfunction in liver transplantation. DESIGN AND METHODS: We evaluated the effectiveness of plasmapheresis in the management of primary graft dysfunction in 18 patients who underwent orthotopic liver transplantation in this institution. Patients who were diagnosed with primary dysfunction of hepatic grafts underwent a course of four daily plasma exchange procedures. The clinical outcome, patient and graft survival, was compared to that of historical controls. RESULTS: Graft survival at 10 days was 77.7% and 76.2% and patient survival at 100 days was 83.3% and 85.7% in the plasmapheresed and control groups, respectively. The patients who underwent plasmapheresis had a higher incidence of dialysis intervention, 38% versus 19%, indicating more severe graft dysfunction. In the small number of patients compared for concomitant dialysis therapy, patient survival in the plasmapheresed group was 85.7% versus 50% (control), and graft survival was 57.0% versus 50%. Serum cytokine levels of tumor necrosis factor and interleukin 6 were reduced by 66.0% and 55.2%, respectively, with a single procedure. CONCLUSION: Plasmapheresis did not significantly effect graft survival in patients with primary graft dysfunction. An increase in patient survival in severe graft dysfunction with renal failure was noted but was not significant. Removal of elevated serum cytokines TNF and IL-6 was documented.

Adult↗
PubMed1995

Transfusion requirements, risks, and costs for patients with malignancy.

BACKGROUND: Patients with cancer often develop significant anemia, which traditionally has been successfully managed by transfusion. Although substantially safer than in the past, transfusions continue to carry a variety of risks. The recent licensing of erythropoietin now provides a second treatment option, which indicates a need to reassess the use of transfusion to manage anemia in these patients. STUDY DESIGN AND METHODS: A 12-month retrospective chart review of all patients receiving outpatient transfusions at a large institution was used to identify patients with solid tumors (including lymphoma) requiring transfusions for any cause. Transfusions were considered as aberrations if they necessitated unusual laboratory monitoring or resulted in clinical evidence of a transfusion reaction. Patient charges proximately related to the transfusion were calculated. RESULTS: A total of 219 patients requiring transfusions were identified, with 483 transfusion episodes and the use of 812 units of red cells to manage anemia (mean, 3.71 units/patient). A total of 100 aberrations were recorded. Twenty-two (10%) of 219 patients had a positive antibody screen that required further work-up; transfusion reactions occurred in 19 patients (8.7%). CONCLUSION: Careful assessment by hematologists and oncologists of the risk:benefit ratio of erythropoietin and transfusion in patients with cancer is urged.

Adolescent↗
PubMed1994

Loss and reappearance of Rho(D) antigen on the red blood cells of an individual with acute myelogenous leukemia.

Complete loss of Rho(D) antigen from red blood cells (RBCs) of individuals with hematologic disorders, though not frequent, has been reported. This case reports the loss of D antigen on the RBCs of a patient with acute myelogenous leukemia and its reappearance when he was in remission. Loss of D antigen expression coincided with worsening clinical and cytogenetic disease. At the time of D antigen loss, the patient also had cytogenetic abnormalities in the bone marrow cells. When he was in remission, the chromosomal abnormalities were no longer detectable, and his RBCs regained D antigen expression.

Journal Article↗
PubMed1992

Oral clonidine pretreatment for haemodynamic stability during craniotomy.

We have studied the effect of clonidine pretreatment on cardiovascular responses to various stimuli during craniotomy. Fifty-eight patients (ASA Class I-II), scheduled for supratentorial surgery, were randomly given either oral clonidine, mean dose 3.6 micrograms/kg (n = 28), or oral diazepam, 0.2 mg/kg (n = 30), ninety to one hundred minutes before surgery. Anaesthesia was induced with thiopentone and maintained with nitrous oxide:oxygen, pentazocine and halothane. Pancuronium was used as a neuromuscular blocker. Mean arterial pressure and heart rate were recorded before and after several stimuli. In the clonidine group hypertensive response was significantly less on laryngoscopy (6.5% increases versus 11.2% in the diazepam group), intubation (9.2% versus 16.5%), Mayfield clamp application (14.5% versus 29.91%) and after skin infiltration with lignocaine-adrenaline solution (2.95% versus 5.42%). Heart rate response to laryngoscopy, intubation and skin infiltration was also significantly attenuated in the clonidine group. The sleep dose of thiopentone was smaller in patients pretreated with clonidine. Patients in the diazepam group required more medical intervention. No adverse effect occurred in any patient.

Administration, Oral↗
PubMed1992

Cardiopulmonary resuscitation--training and certification in Malaysia.

Cardiopulmonary resuscitation training in Malaysia was started at the General Hospital Kuala Lumpur in 1986. Now the programme has been extended to all the General Hospitals in the country and is fully supported by the Ministry of Health. The American Heart Association curriculum for Basic Life Support is followed. From February 1986 till March 1991, the programme has trained 3982 in Basic Life Support and 548 in Advanced Cardiac Life Support. We are making efforts to translate some of the American manuals into the National language. A preliminary survey on early defibrillation indicates that majority of the physicians will allow defibrillation by non-physician.

Cardiopulmonary Resuscitation↗
PubMed1989

The effect of histamine-receptor blockade on the hemodynamic responses to protamine.

A prospective randomized study was undertaken to evaluate the use of histamine-receptor blockade to prevent protamine-induced hypotension in patients undergoing elective aortocoronary artery bypass graft surgery. Normotensive patients with good left ventricular function who did not receive vasoactive or inotropic agents after cardiopulmonary bypass (CPB) were allocated to either a study or a control group. After CPB, patients in the study group received 10 mg of chlorpheniramine, and 400 mg of cimetidine, intravenously, five minutes before infusion of protamine. In both groups, protamine was injected via a central venous cannula at 2.5 mg/sec. Hypotension in the control group was significantly more severe and prolonged than in the study group. Systolic and mean arterial blood pressures in the control group fell 35% and 34%, differing significantly (P less than 0.01) from the study group in whom the reduction was 24% for both systolic and mean pressures. In addition, the control group showed significant falls in central venous pressure and increases in heart rate following protamine. In conclusion, it appears that the hemodynamic changes are only partially mediated through histamine action, and the normal response to protamine may be modified, but not abolished, by H1 and H2 receptor blockade. This blockade may, however, prevent the reduction in right heart preload and increase in heart rate following protamine.

Blood Pressure↗
PubMed1988

The effects of an intravenous infusion of isosorbide dinitrate during open heart surgery.

Recent awareness of right ventricular dysfunction during open heart surgery has focused attention upon the importance of protection of the right ventricle and control of right ventricular afterload for the maintenance of the cardiac output. Conventional doses of systemic vasodilators, when used to reduce pulmonary vascular resistance, may produce systemic hypotension, reduce coronary arterial perfusion and even lower the cardiac output. A study of the effects of bolus intravenous isosorbide dinitrate during open heart surgery showed that following cardiopulmonary bypass intravenous isosorbide dinitrate produced highly significant falls in pulmonary artery pressure and induced active pulmonary vasodilatation without systemic side-effects or reduced atrial filling procedures. Treatment with intravenous isosorbide dinitrate by low-dose infusion during and after open heart surgery significantly lowered mean pulmonary artery pressure and pulmonary vascular resistance (P less than 0.001) in patients receiving no sympathomimetic drug support. The results suggest that possibly the effect of low-dose isosorbide dinitrate following cardiopulmonary by-pass is exerted predominantly on the right ventricular afterload if systemic arterial pressure is not elevated. This may have applications in the management of pulmonary hypertension and of acute right heart failure following cardiac surgery.

Adult↗