Rajkumar Rajendram

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

** AKC BSc (Hons) MBBS (Dist) MRCP (UK) EDIC FRCA FFICM FRCP Edin FRCP Lond ** CCT Internal Medicine (Acute Medicine; Oxford); Anaesthesia and Intensive Care (London & Oxford)

About

382
Publications
77,110
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Introduction
I am a consultant internist, intensivist, anaesthetist & perioperative physician combining active clinical practice with my interests in point of care ultrasound, medical education and research. I involve patients in research to improve their outcomes and many of my projects are based on novel initiatives for service development, quality improvement and risk management. Striving for excellence in all that I do; I motivate my teams to deliver world class care and enhance pathways to improve patient experience and safety.
Additional affiliations
December 2018 - present
King Saud bin Abdulaziz University for Health Sciences
Position
  • Professor (Assistant)
August 2016 - present
King Abdulaziz Medical City, Ministry of National Gaurd Health Affairs, Riyadh, Saudi Arabia
Position
  • Consultant
December 2014 - August 2015
King Saud University
Position
  • Consultant
Education
August 2012 - August 2013
Oxford University Hospitals NHS Trust
Field of study
  • Intensive Care Medicine Post-Graduate Specialty Training
May 2010 - May 2014
Royal Free London NHS Foundation Trust
Field of study
  • Anaesthesia Post-Graduate Specialty Training
November 2007 - November 2009
University College London Hospitals NHS Foundation Trust
Field of study
  • Anaesthesia Core Training

Publications

Publications (382)
Article
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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...
Chapter
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...
Chapter
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...
Chapter
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...
Article
Full-text available
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...
Article
Full-text available
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...
Book
Full-text available
Treatment, mechanisms and adverse reactions of anaesthetics and analgesics
Book
Full-text available
The neurobiology, physiology and psychology of pain
Book
Full-text available
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...
Article
Full-text available
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...
Article
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...
Article
Full-text available
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...
Conference Paper
Full-text available
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...
Conference Paper
Full-text available
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...
Poster
Full-text available
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...
Conference Paper
Full-text available
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...
Article
Full-text available
Background: Ward rounds (WR) have been integral to the process of teaching and learning medicine and also provides a vital opportunity
Article
Right-to-left (RTL) interatrial shunt (IAS) may complicate select cases of COVID-19 pneumonia. We describe the use of serial imaging to monitor shunt in critically ill patients. A 52-year-old man presented with COVID-19 pneumonia. Hypoxia worsened despite maximal medical therapy and non-invasive ventilation. On day 8, saline microbubble contrast-en...
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 pulmonary TB cases who ar...
Poster
Full-text available
Can sputum induction aid in identifying micro-organisms that cause respiratory tract infections other than tuberculosis? Atertiary care hospital experience
Article
Full-text available
Background Enforced social distancing (i.e., lockdowns) greatly facilitated control of coronavirus disease-19 (COVID-19). While access to hospitals was restricted, outpatient care continued remotely. The aim of this study was to determine the satisfaction of patients with severe asthma with telemedicine, and the impact of COVID-19 lockdown on sever...
Article
Although, cardiac injury, pneumothorax and pneumomediastinum are associated with COVID-19, differentiation of their symptoms and signs from those of COVID-19 itself is challenging. Without a high index of suspicion, cardiomyopathy and anterior pneumothorax are easily missed. These complications may be underdiagnosed in patients with COVID-19. Cardi...
Article
CONTEXT: Coronavirus disease 2019 (COVID-19) has put a spotlight on point-of-care diagnostic lung ultrasound (POCDLUS). However, the spectra of respiratory disease and resources available for investigation vary internationally. The applicability of POCDLUS to internal medicine (IM) practice in Saudi Arabia and the current use by Saudi physicians ar...
Book
Full-text available
Zika virus is a member of the family Flaviviridae and was first identified in the 1940s. In 2007, the first outbreak of Zika virus disease was reported and this was followed by substantial outbreaks of the viral infection from 2013. In 2015, a large outbreak was reported in Brazil. Concomitant associations with Guillain-Barre syndrome and microceph...
Book
Full-text available
The effects of abnormal neurological development can have drastic consequences for the individual and also for the family unit. In the United States, about 10% of hospitalized children have a neurological diagnosis. In children, neurological conditions may include cerebral palsy, genetic abnormalities (e.g., Down syndrome), epilepsy and seizures, n...
Book
Full-text available
Description Zika Virus Impact, Diagnosis, Control, and Models: Volume Two: The Neuroscience of Zika examines diagnosis, vaccines, and potential therapy methods for Zika virus syndrome. The book also details the neuroscience of Guillain-Barré syndrome, its effects and neuromuscular rehabilitation. It is designed to help readers better understand det...
Book
Full-text available
The effects of abnormal neurological development can have drastic consequences for the individual and also for the family unit. In the United States, about 10% of hospitalized children have a neurological diagnosis. In children, neurological conditions may include cerebral palsy, genetic abnormalities (e.g., Down syndrome), epilepsy and seizures, n...
Book
Full-text available
This book discusses the mechanisms underlying neurological aging and provides readers with a detailed introduction to the aging of neural connections and complexities in biological circuitries, as well as the interactions between genetics, epigenetics and other micro-environmental processes. It also examines pharmacological and non-pharmacological...
Presentation
Full-text available
This presentation described how to perform saline microbubble contrast-enhanced echocardiography to screen for intracardiac and intrapulmonary shunt. The technique described in this presentation was used in the study: Rajendram R* and Hussain A,* Mahmood N, Kharal M. Feasibility of using a handheld ultrasound device to detect and characterize shun...
Conference Paper
Enforced social distancing (i.e. lockdowns) greatly facilitated control of Coronavirus Disease 2019 (COVID-19). Whilst access to hospitals was restricted, outpatient care continued remotely. At King Abdulaziz Medical City KAMC, the biologic therapy for asthma is only prescribed after evaluation by a pulmonologist specializing in severe asthma. The...
Poster
Whilst Coronavirus Disease 2019 (COVID-19) wreaked havoc, an expected increase in exacerbations of asthma did not materialize. This is intriguing. There was significant improvement in quality of air during lockdown period due to reduced traffic and industrial activity as per local metrological data. The aim of this study was to determine the impact...
Conference Paper
Full-text available
Enforced social distancing (i.e. lockdowns) greatly facilitated control of Coronavirus Disease 2019 (COVID-19). Whilst access to hospitals was restricted, outpatient care continued remotely. At King Abdulaziz Medical City, Riyadh (KAMC) biologic therapy for asthma is prescribed after evaluation by a consultant specialized in severe asthma. Followin...
Conference Paper
Full-text available
Whilst Coronavirus Disease 2019 (COVID-19) wreaked havoc, an expected increase in exacerbations of asthma did not materialize. This is intriguing. There was significant improvement in quality of air during lockdown period due to reduced traffic and industrial activity as per local metrological data. The aim of this study was to determine the impact...
Article
Full-text available
Introduction The use of point-of-care ultrasound (POCU) is increasing globally. However, owing to the epidemiology of diseases and local management strategies, POCU may not be universally applicable. Before developing a POCU training program, because of limited resources for medical education, it was pivotal to conduct a needs assessment and identi...
Book
Full-text available
There are currently dramatic changes in global demographics. The proportion of the aging population is increasing. In the United States, the current population of over 65 years old, approximately 45 million, will double in 30 years to between 80 and 90 million. Humankind is living longer due to reductions in communicable disease and advances in med...
Book
Full-text available
There are currently dramatic changes in global demographics. The proportion of the aging population is increasing. In the United States, the current population of over 65 years old, approximately 45 million, will double in 30 years to between 80 and 90 million. Humankind is living longer due to reductions in communicable disease and advances in med...
Conference Paper
Full-text available
The goal of IPF treatment is to stabilize or reduce the rate of disease progression. Pirfenidone and nintedanib are the only anti-fibrotic medications (AFM) available for idiopathic pulmonary fibrosis (IPF) as recommended by ATS/ERS/JRS/ALAT guidelines. Clinical trials have demonstrated a disease-stabilizing effect of these medications in controlle...
Conference Paper
Full-text available
Investigation for pulmonary tuberculosis (TB) usually includes sputum examination for acid fast bacilli (AFB) with Mycobacterial culture. At our institution, if patients are unable to expectorate sufficient sputum for microbiological assessment, nebulized hypertonic saline sputum induction (SI) is performed whenever bronchoscopy is considered to be...
Article
Introduction Diagnostic point of care ultrasound (POCUS) of the abdomen (APOCUS) is a fast, portable, non-invasive, diagnostic tool [1-4]. The diagnostic accuracy of APOCUS for the detection of many intra-abdominal pathologies (e.g., hepatomegaly [3], splenomegaly [4], hydronephrosis [1, 2], and ascites [3]) is excellent. Screening for hepatomegaly...
Article
Background: Renal, gastrointestinal, and hepatic pathology, and the resources available for their management vary internationally. Whilst abdominal point-of-care ultrasound (APOCUS) should enhance management, uptake by physicians, worldwide, has been poor. So, the aim of this study was to explore the applicability of APOCUS to medical practice in S...
Article
Introduction: Since the COVID-19 pandemic began, conflicting reports have emerged regarding its association with hypertension in various populations worldwide. However, there is paucity of data regarding the association between the severity of COVID-19 and hypertension phenotypes and hypertension-mediated organ damage (HMOD Methods: Patients from a...
Book
Full-text available
The Neuroscience of Depression is a comprehensive reference to the diagnosis and treatment of depression. This book provides readers with the mechanisms of depression reflecting on the interplay between depression and the biological and psychosocial processes. A detailed introduction to various episodes of depression, from PTSD to post-partum depre...
Book
Full-text available
The Neuroscience of Depression: Features, Diagnosis and Treatment, is a comprehensive reference to the diagnosis and treatment of depression. This book provides readers with the mechanisms of depression reflecting on the interplay between depression and the biological and psychosocial processes. A detailed introduction to various episodes of depres...
Poster
Full-text available
A prospective evaluation of the usage of all devices available for difficult airway management in adults was performed over a 2 month period (18/11/18-19/01/19) in the theatre suites and ICU of Stoke Mandeville Hospital (SMH), Aylesbury.
Conference Paper
Full-text available
Introduction Whilst Coronavirus Disease 2019 (COVID-19) wreaked havoc, an expected increase in exacerbations of asthma did not materialize. There was significant improvement in quality of air during lockdown period due to reduced traffic and industrial activity as per local metrological data. The aim of this study was to determine the impact of enf...
Conference Paper
Full-text available
Introduction Enforced social distancing (i.e. lockdowns) greatly facilitated control of Coronavirus Disease 2019 (COVID-19). Whilst access to hospitals was restricted, outpatient care continued remotely. At our institute, the biologic therapy for asthma is only prescribed after evaluation by a pulmonologist specializing in severe asthma. The treatm...
Article
Learning Objectives 1. Recognize the harm caused by medication errors 2. Understand root cause analysis and action (RCA2) 3. Learn when RCA2 should be used to investigate medication errors 4. Learn how to perform RCA2 for medication errors
Article
Introduction A full root cause analysis (RCA) such as that required following a sentinel event is time-consuming, labor-intensive, and expensive. This quality improvement project used a similar but abbreviated process (mini-RCA and action; mini-RCA2) in response to medication errors that caused less serious harm. Methods In 2018, all medication er...
Article
Full-text available
Objectives: To describes the epidemiology of cancer in patients with idiopathic inflammatory myopathies (IIM) treated at 2 tertiary centers in Riyadh, Saudi Arabia. Methods: This was a retrospective multi-center study evaluating the prevalence and the type of malignancy in an IIM population in King Saud University Medical City and King Abdulaziz...
Chapter
Any substance, even an essential nutrient or medication, may harm a living organism and thus be toxic. The first description of this paradox is credited to Paracelsus, the “father of toxicology.” One potential mechanism for dose-related toxicity is through the generation of oxidative stress. Oxidative stress reflects an imbalance between the system...
Chapter
The skin, the largest organ of the human body, performs many functions. Perhaps, the most important of which is protecting the internal organs from environmental toxins and pathogens. Diseases of the skin are now a global public health issue. Xerosis (dry skin) and pruritis (itch), the most common dermatological conditions, result from damage to th...
Chapter
Reactive oxygen species (ROS) which are produced during normal cellular metabolism can damage a variety of structures and macromolecules including nucleic acids. As a result, disruption of cellular homeostasis occurs. Oxidative damage to DNA is implicated in carcinogenesis. However, ROS also modulate intracellular signal transduction. Indeed, malig...
Chapter
Hippocrates used “mania” and “melancholia” to describe depression around 400 BC. So, clinicians, researchers, and philosophers have been challenged by depression for over a 1000 years. Yet, while diagnostic criteria for depression are available, there is still an ongoing debate about this definition. However, the true enigma of depression lies not...
Article
Full-text available
Silent or ‘happy’ hypoxemia has been noticed in patients with Coronavirus Disease 2019 (COVID-19). In some of the hypoxemic COVID-19 patients, there was no correlation between the degree of hypoxemia and the severity of parenchymal lung injury on chest imaging. The presence of micro thrombi in the peripheral pulmonary vasculature, endotheliitis, va...
Chapter
Scientists have been fascinated by the nervous system since ancient times. Alkmaion (circa 450 BCE) was the first scientist to dissect and study the anatomy of the brain and peripheral nerves. The paradigm shift that occurred when he ascribed a specific function to a defined region of the brain was fundamental to the birth of neuroscience. However,...
Chapter
Falling birth rates and increased longevity both contribute to the inexorable aging of the global population. Aging is associated with loss of organ function. As individuals age, information processing speed, working memory, and long-term memory become less efficient. So, aging is associated with many neurodegenerative diseases including mild cogni...
Chapter
The Zika virus, a flavivirus is related to viruses that cause dengue and yellow fever and is spread by Aedes mosquitoes. The virus was first isolated in 1947, during studies conducted in the Zika Forest of Uganda. During the first 60 years of Zika’s discovery (i.e., until 2007), epidemic infections were unheard of. Less than 20 cases of confirmed h...
Conference Paper
Full-text available
Can handheld ultrasound detect & characterize right-to-left shunt? An observational study of feasibility. Rajkumar Rajendram, FRCP Lond;1,2*and Arif Hussain, MD FRCA FCCP;3* Naveed Mahmood, FRCP Edin;1,2 Mubashar Kharal, MD1,2 *These authors contributed equally to this study and are joint first authors Departments of Medicine1 and Cardiac Sciences...
Poster
Full-text available
Background The use of point-of-care ultrasound (POCU) is increasing worldwide. However, in Saudi Arabia although the curriculum for critical care medicine (CC) includes POCU, the curriculum for internal medicine (IM) does not. This study aimed to establish the educational priorities for training internists and intensivists in POCU in Saudi Arabia....
Article
Full-text available
Background Coronavirus disease 2019 (COVID-19) causes an atypical acute respiratory distress syndrome associated with thromboembolism and high shunt fraction. Shunt may be intrapulmonary, or extrapulmonary. Handheld devices are increasingly being used for point-of-care ultrasound, but their use to characterize shunt has not been reported. Objectiv...
Article
The respiratory effects of COVID-19 are unusual; some patients are more hypoxic and have greater shunt than expected for the apparent lung injury. Shunt may be intrapulmonary or extrapulmonary. Patients with COVID-19 pneumonia will have intrapulmonary shunt.2 However, some patients may also have extrapulmonary shunt — the most common anatomic subst...
Article
Full-text available
Context: Coronavirus Disease 2019 (COVID-19) put a spotlight on focused cardiac ultrasound (FoCUS). However, the spectra of cardiac disease, and the resources available for investigation vary internationally. The applicability of FoCUS to internal medicine (IM) and critical care medicine (CCM) practice in Saudi Arabia and their current use of FoCUS...
Chapter
Full-text available
The chapter provides a question-based review of high yield topics in anaesthesia and critical care relevant to those preparing for the Intercollegiate General Surgery FRCS examination viva.
Article
Full-text available
Background and objective The use of point-of-care ultrasound (POCUS) is generally on the rise worldwide. However, as the epidemiology of diseases and the approach to their management vary internationally, POCUS may not be universally applicable. The resources available for medical education are generally limited. Thus, when considering the developm...
Article
There is increasing evidence that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection causes an unusual pneumonia and a pro-coagulant state that significantly increases the risk of arterial and venous thromboembolism. We hypothesize that, in select patients, some complications of COVID-19 may be due to right-to-left (RTL) shunt....
Article
Full-text available
Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert-response study was conducted to elicit projections for the proportion of elective su...
Article
Full-text available
The form of ARDS cause by COVID-19 (i.e. CARDS) is thought to be atypical. There is debate about whether phenotyping of CARDS is appropriate. In this context is important to consider the findings of the landmark ARDSNet trial that was published in 2000 and has defined the ventilatory management of ARDS for the past 20 years. However the COVID-19 pa...
Article
Full-text available
Bladder scanning is a fast, non-invasive method of detecting the residual volume within the bladder with no risk of infection or trauma. Although highly sensitive, the post void residual volumes reported by bladder scanning is not specific for urine retention; false positive rates of up to 9% have been reported. To increase the awareness of this ph...