Skills (2)
Other
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LanguagesEnglish, Hindi, Malayalam, Tamil
Publications (3) View all
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Article: Four Decades of Chronic Haemodialysis: Lessons from the Past and Implications for the Future.
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ABSTRACT: Background: There have been substantial changes in the provision of chronic haemodialysis (HD) therapy over time, yet data regarding the impact of these differences on clinical outcomes are limited. Aim: To identify factors which have significantly changed over the last 40 years in relation to patients receiving maintenance HD therapy. Methods: All 2,647 patients who were established on the chronic HD programme in Northern Ireland between 1970 and 2010 were included. Clinical data and survival outcomes were obtained from a prospectively recorded database. The study period was divided into four decades in order to assess the temporal changes. Results: The total number of patients receiving HD therapy has risen, and the mean age of the HD population has increased significantly (39.0 years in the 1970s vs. 66.8 years in the 2000s, p < 0.001). Diabetic nephropathy has emerged as the commonest aetiology for ESRD (0% in the 1970s to 20.3% in the 2000s, p < 0.001). The median survival of patients on HD has improved significantly over time from 5.2 months (95% CI 2.6-15.5) in the 1970s to 41.7 months (95% CI 38-45.2) in the 2000s (p < 0.0001). Factors that remained significant in determining survival were age, primary renal diagnosis, and decade of commencement of dialysis. Conclusions: Survival on HD has significantly improved despite older patients with multiple co-morbidities being accepted for treatment reflecting both increased dialysis frequency and better management of cardiovascular risk factors. The increasing age of HD patients and their improved survival have implications for future planning and delivery of dialysis.Nephron Clinical Practice 10/2012; 121(1):c54-c59. · 2.04 Impact Factor -
Article: Bone marrow micrometastases in esophageal carcinoma: a 10-year follow-up study.
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ABSTRACT: Detection of bone marrow micrometastases (BMMs) in patients with esophageal carcinoma may indicate a metastatic phenotype. We assessed if the presence of BMMs had adverse prognostic significance in a 10-year follow-up study. Patients undergoing surgery for esophageal cancer were prospectively recruited between February 1999 and August 2000. Bone marrow aspirates were obtained from the iliac crest of patients under general anesthesia at the time of surgery. Immunocytochemical analysis using anticytokeratin antibodies CAM 5.2 and AE1/AE3 was undertaken to determine the presence of BMMs. Union International Contre le Cancer staging was recorded for all patients. Patient follow-up was completed over a 10-year period through analysis of the Northern Ireland Cancer Registry. Forty-two patients (male = 35) were included, with a mean age of 67.2 years (range 39-83). BMMs were detected in 19 patients (45.2%). International Contre le Cancer tumor staging was stage I = 6, stage II = 10, stage III = 24, and stage IV = 2. BMMs were associated with lymphovascular invasion (P= 0.02) and advanced T stage (P= 0.02). Overall, 10-year survival was 21.4% (n= 9), with a median follow-up of 877.5 days (interquartile range 391.5-2546.3). There was no statistically significant difference between the survival of patients with or without BMMs (1451.4 vs. 1431.6 days, P= 0.99). Univariate analysis demonstrated a trend toward decreased survival for patients with positive lymph nodes (P= 0.07), an increased T stage (P= 0.06), and lymphovascular invasion (P= 0.07). Multivariate analysis demonstrated that none of the variables were significant predictors of mortality. Although the presence of BMMs correlates with recognized adverse tumor characteristics in patients with esophageal cancer, micrometastases detected in the bone marrow at time of surgery does not influence long-term survival.Diseases of the Esophagus 01/2012; · 1.81 Impact Factor -
Article: Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit in India.
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ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a global pathogen and an important but seldom investigated cause of morbidity and mortality in lower and middle-income countries where it can place a major burden on limited resources. Quantifying nosocomial transmission in resource-poor settings is difficult because molecular typing methods are prohibitively expensive. Mechanistic statistical models can overcome this problem with minimal cost. We analyse the transmission dynamics of MRSA in a hospital in south India using one such approach and provide conservative estimates of the organism's economic burden. Fifty months of MRSA infection data were collected retrospectively from a Medical Intensive Care Unit (MICU) in a tertiary hospital in Vellore, south India. Data were analysed using a previously described structured hidden Markov model. Seventy-two patients developed MRSA infections and, of these, 49 (68%) died in the MICU. We estimated that 4.2% (95%CI 1.0, 19.0) of patients were MRSA-positive when admitted, that there were 0.39 MRSA infections per colonized patient month (0.06, 0.73), and that the ward-level reproduction number for MRSA was 0.42 (0.08, 2.04). Anti-MRSA antibiotic treatment costs alone averaged $124/patient, over three times the monthly income of more than 40% of the Indian population. Our analysis of routine data provides the first estimate of the nosocomial transmission potential of MRSA in India. The high levels of transmission estimated underline the need for cost-effective interventions to reduce MRSA transmission in hospital settings in low and middle income countries.PLoS ONE 01/2011; 6(7):e20604. · 4.09 Impact Factor
