Rajkumar Rajendram

King Saud bin Abdulaziz University for Health Sciences | KSAU-HS · College of Medicine (Riyadh)

Background Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinic...

Increased understanding of heart–lung interactions in the critically ill patients has reignited intensivists’ interest in the assessment of the right ventricle and pulmonary artery (PA) pressures. Recent studies have demonstrated the feasibility of using ultraportable ultrasound devices to perform advanced imaging studies at the beside of criticall...

The use of biomarkers to expedite diagnosis, prognostication, and treatment could significantly improve patient outcomes. The early diagnosis and treatment of critical illnesses can greatly reduce mortality and morbidity. Therefore, there is great interest in the discovery of biomarkers for critical illnesses. Micro-ribonucleic acids (miRNAs) are a...

Radiodermatitis in breast cancer patients varies from mild irritation to life-threatening lesions. Several studies suggest a role for topical corticosteroid ointments in the treatment of radiodermatitis. Yet, to avoid the adverse effects of corticosteroids, many authors recommend the use of topical herbal products instead. The therapeutic role of h...

Background: The prognosis of idiopathic pulmonary fibrosis (IPF) can be predicted by the gender, age, and physiology (GAP) index. However, antifibrotic therapy (i.e., nintedanib and pirfenidone) may improve survival. Aims: This study aimed to compare the outcomes of antifibrotic-treated IPF with the survival predicted by the GAP index. Methods:...

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published i...

BACKGROUND: Venous thromboembolism (VTE) causes significant morbidity and mortality. International studies have suggested poor public awareness of VTE, with a few data from Saudi Arabia. The aim of this study was to investigate the knowledge and awareness of VTE in the Saudi population. Awareness of other important diseases was also investigated to...

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive age-related lung disease causing relentless fibrosis of the lung parenchyma. Currently, pirfenidone and nintedanib are the two antifibrotic drugs, approved for the treatment of IPF. Both are shown to slow progression by preserving lung functions from rapid decline compared to...

Background: The increase in extended-spectrum β-lactamase (ESBL) producing microbes in recent years represents a major challenge. Aim: To study the risk factors for urinary tract infections (UTIs) caused by ESBL-producing Escherichia coli in patients requiring hospitalization for treatment. Materials and method: Electronic health records were...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Societies worldwide have been afflicted by neurological disorders. Yet, historically, research in this field has been hindered by social stigma, the prevailing scientific hypotheses, and the technology available at any given time. The cellular responses to drugs could not be investigated until expenditure on such research was deemed “acceptable,” a...

Background: Inflammatory bowel disease (IBD) is an important cause of morbidity in Saudi Arabia. Objectives: Determine the incidence, clinical profile, course and outcomes of IBD in Riyadh, Saudi Arabia. Design: Medical record review SETTING: Tertiary care center PATIENTS AND METHODS: Data were extracted from the medical records of all patient...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Nutritional status reflects supply and demand. Optimum nutritional requires sufficient nutrients to meet daily requirements. Dietary intake can be used to measure nutritional status but such records are subjective and strongly affected by recall bias. Thus, more accurate tools that can quantify nutritional status objectively are required. A biomark...

Individualizing fluid therapy is superior to a formulaic approach. Echocardiography can measure parameters relevant to volume status. The use of Doppler-based indices is preferable, but selecting the most appropriate index for the target population is of paramount importance. Yet, currently, few physicians are competent in advanced critical care ec...

Diabetes mellitus is a treatable disease characterized by persistent hyperglycemia. Its prevalence is spiraling out of control, resulting in significant morbidity and mortality worldwide. The early diagnosis of diabetes can reduce the risk of complications. The use of biomarkers may facilitate this. Indeed, several biomarkers are currently used in...

Background Pneumonia is a common respiratory infection that affects all ages, with a higher rate anticipated as age increases. It is a disease that impacts patient health and the economy of the healthcare institution. Therefore, machine learning methods have been used to guide clinical judgment in disease conditions and can recognize patterns based...

A man in his eighties with acute heart failure and cardiorenal syndrome developed severe hypernatraemia with diuresis. In this situation, palliation is often considered when renal replacement therapy is inappropriate. The literature to guide treatment of dysnatraemia in this setting is limited. Diuretics often worsen hypernatraemia and fluid replac...

Thoracic endovascular aortic repair (TEVAR) is currently the treatment of choice for thoracic aortic disease. In select cases, the TEVAR stent must occlude the left subclavian artery. This is usually well tolerated, but the subclavian steal syndrome (SCSS) may occur. Vertebrobasilar insufficiency can cause headaches, but reports of headache as the...

Congenital chloride losing diarrhoea (CCLD) is a rare disease caused by mutations in an intestinal chloride/ bicarbonate ion exchange channel. Few reports describe CCLD in adults and none has described the impact of a parasitic infection on CCLD. Severe diarrhoea may result in hypokalaemia with QT interval prolongation. Treatment with antiemetics m...

Background The COVID-19 pandemic created many challenges for healthcare systems. Frontline workers and especially healthcare professionals were the most severely affected through increased working hours, burnout and major psychological distress Objectives To evaluate the changes in standard care elements which occurred during the COVID-19 pandemic...

BACKGROUND: With growth of the use of point of care ultrasound (PoCUS) around the world, some medical schools have incorporated this skill into their undergraduate curricula. However, because of epidemiology of disease and regional differences in approaches to patient care, global application of PoCUS might not be possible. Before creating a PoCUS...

Every year millions of complex surgical procedures are performed worldwide. Anesthetic agents and analgesics are required to ensure that patients having surgery do not experience pain and have no recollection of the procedure. Since Morton demonstrated the utility of diethyl-ether 170 years ago, anesthesia has progressed significantly. A broad rang...

Year on year millions of people receive anesthesia for a variety of reasons. The vast majority of patients are apparently unharmed by the anesthetic agents. However, around the beginning of the 21st Century it was suggested that the exposure to general anesthetics could be neurotoxic. Animal and epidemiological data suggest that exposure to several...

Spinal cord injuries (SCI) cause permanent, life-changing, and devastating disabilities. Thus, this cohort is often faced with significant therapeutic nihilism. This is inappropriate as their survival to discharge home is very good and recent technological advances have significantly improved the quality of life of these patients. The inability of...

Original Article Background: Sputum smear microscopy examination and culture for tuberculosis (TB) remain a fundamental tool of diagnosis but may be negative up to 50% case of active pulmonary TB. Bronchoscopy to obtain sputum is invasive and not readily available. Alternative methods of obtaining sputum specimens are crucial in suspected pulmonar...

Background Training in procedural skills is often suboptimal. The aim of this study was to quantify the needs of residents in internal medicine (IM), critical care (CC), and emergency medicine (EM) for instruction in ultrasound-guided procedures. Methods All IM, EM and CC residents ( n = 200) at King Abdulaziz Medical City, Riyadh, Saudi Arabia, w...

Treatment, mechanisms and adverse reactions of anaesthetics and analgesics

The neurobiology, physiology and psychology of pain

Features and Assessments of Pain, Anaesthesia and Analgesia examines the syndromes of pain and how they interlink with anesthesia and analgesics. The book covers assessments, screening and resources, and provides applications to related areas of medicine. It explores how the perception of pain results from a multifaceted interaction between illness...

Background: The curfews and lockdowns imposed during the COVID-19 pandemic may decreased the volume of traffic and reduced air pollution. In addition, social distancing measures may contribute to reducing infection and asthma exacerbation. Objective: The objective of this study was to assess asthma control and asthma medication use among severe...

Background: Several aspects of daily life changed suddenly and significantly during the Coronavirus Disease 2019 (COVID-19) pandemic. The strict enforcement of social distancing and home confinement severely restricted physical interaction and travel. The aim of this international study was to explore the impact of the COVID-19 pandemic on adolesce...

Curriculum document for the fellowship in hospital medicine.

Emphysematous pyelitis (gas within the excretory system) is a rare infection with a mortality of 20%. Although, it may resolve with antibiotics alone, the presence of gas within the kidney must be detected and clearly distinguished from uncomplicated pyelonephritis or calculi. Acoustic shadowing on ultrasound (i.e. the drop in echo strength under a...

Systolic heart failure (SHF) causes significant morbidity and mortality. Regrettably, an audit of patients with SHF whom were admitted to King Abdulaziz Medical City, Riyadh (KAMCR) revealed suboptimal use of evidence-based therapies. To address this, a checklist was designed. This incorporated the interventions recommended by the Saudi Heart Assoc...

Cardiovascular disease is a major cause of morbidity and mortality in patients with end stage renal failure (ESRF). Left ventricular hypertrophy (LVH) is an important risk factor for morbidity and mortality in this setting. This is often found in patients with end stage renal failure. AIM: To identify modifiable risk factors associated with LVH in...

The cardiovascular complications of Coronavirus Disease 2019 (COVID-19) contribute to its morbidity and mortality. Whilst, cardiac injury is associated with Coronavirus Disease 2019 (COVID-19), differentiation of their symptoms and signs from those of COVID-19 itself is challenging. Without a high index of suspicion cardiomyopathy is easily missed...