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Prognostic factors associated with hospital survival in comatose survivors of cardiac arrest

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World Journal of Critical Care Medicine 2016年第1期5卷 103-110页

作者： Kushaharan Sathianathan ravindranath tiruvoipati Sanjiv Vij Critical Care Unit Latrobe Regional Hospital Department of Intensive Care Medicine Frankston Hospital School of Public Health Faculty of Medicine Nursing and Health Sciences Monash University Intensive Care Unit Dandenong Hospital Intensive Care Unit Royal Melbourne Hospital

AIM: To identify patient, cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac ***: A retrospective, single centre study of comatose patients admitted to our intensive care unit(ICU) following cardiac arrest during the twenty year period between 1993 and 2012. This study was deemed by the Human Research Ethics Committee(HREC) of Monash Health to be a quality assurance exercise, and thus did not require submission to the Monash Health HREC(Research Project Application, No. 13290Q). The study population included all patients admitted to ourICU between 1993 and 2012, with a discharge diagnosis including "cardiac arrest". Patients were excluded if they did not have a cardiac arrest prior to ICU admission(i.e.,if their primary arrest was during their admission to ICU),or were not comatose on arrival to ICU. Our primary outcome measure was survival to hospital *** outcome measures were ICU and hospita length of stay(LOS), and factors associated with surviva to hospital ***: Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest, with 35% surviving to hospital discharge. The median ICU and hospital LOS was 3 and 5 d *** was no survival difference between in-hospital and out-of-hospital cardiac arrests. Males made up 62% of our cardiac arrest population, were more likely to have a shockable rhythm(56% vs 37%, P < 0.001), and were more likely to survive to hospital discharge(40%vs 28%, P = 0.006). On univariate analysis, therapeutic hypothermia, regardless of method used(e.g., rapid infusion of ice cold fluids, topical ice, "Arctic Sun", passive rewarming, "Bair Hugger") and location initiated(e.g.,pre-hospital, emergency department, intensive care) was associated with increased survival. There was however no difference in survival associated with target temperature,time at target temperature, location of initial cooling,method

关键词： Cardiac arrest Hypothermia Hyperthermia Arrhythmia Resuscitation

Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums

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World Journal of Critical Care Medicine 2015年第3期4卷 202-212页

作者： Sachin Gupta ravindranath tiruvoipati Cameron Green John Botha Huy Tran Department of Intensive Care Medicine Frankston Hospital School of Public Health Faculty of Medicine Nursing and Health Sciences Monash University Department of Oncology Frankston Hospital

Thrombocytopenia is often noted in critically ill patients. While there are many reasons for thrombocytopenia, the use of heparin and its derivatives is increasingly noted to be associated with thrombocytopenia. Heparin induced thrombocytopenia syndrome(HITS) is a distinct entity that is characterised by the occurrence of thrombocytopenia in conjunction with thrombotic manifestations after exposure to unfractionated heparin or low molecular weight heparin. HITS is an immunologic disorder mediated by antibodies to heparin-platelet factor 4(PF4) complex. HITS is an uncommon cause of thrombocytopenia. Reported incidence of HITS in patients exposed to heparin varies from 0.2% to up to 5%. HITS is rare in ICU populations, with estimates varying from 0.39%-0.48%. It is a complex problem which may cause diagnostic dilemmas and management conundrum. The diagnosis of HITS centers around detection of antibodies against PF4-heparin complexes. Immunoassays performed by most pathology laboratories detect the presence of antibodies, but do not reveal whether the antibodies are pathological. Platelet activation assays demonstrate the presence of clinically relevant antibodies, but only a minority of laboratories conduct them. Several anticoagulants are used in management of HITS. In this review we discuss the incidence, pathogenesis, diagnosis and management of HITS.

关键词： Heparin Thrombocytopenia Critically ill Diagnosis Management

Serum bicarbonate may independently predict acute kidney injury in critically ill patients:An observational study

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World Journal of Critical Care Medicine 2015年第1期4卷 71-76页

作者： Anuksha Gujadhur ravindranath tiruvoipati Elizabeth Cole Saada Malouf Erum Sahid Ansari Kim Wong Department of Renal Medicine Frankston HospitalFrankston VIC 3199Australia School of Public Health Faculty of MedicineNursing and Health SciencesMonash University Department of Intensive Care Medicine Frankston HospitalFrankston VIC 3199Australia

AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 2010 to 2012).The ICU has a case mix of medical and surgical patients excluding cardiac surgical,trauma and neurosurgical *** analysed 2035 consecutive patients admitted to ICU during the study *** were collected by two investigators independently and in duplicate using a standardised spread sheet to ensure *** data were checked for accuracy where *** was defined using the Kidney Disease Improving Global Outcomes *** were divided into two groups;patients who developed AKI or those who did not,in order to compare the baseline characteristics,and laboratory and physiologic data of the two *** analysis was used to identify if serum bicarbonate on admission predicted the development of ***:Of 2036 patients 152(7.5%)were excluded due to missing *** developed in 43.1%of the *** AKI group,compared to the nonAKI group,was sicker based on their lower systolic,diastolic and mean arterial pressures and a higher acutephysiology and chronic health evaluation(APACHE)Ⅲand SAPSⅡ***,patients who developed AKI had more co-morbidities and a higher proportion of patients who developed AKI required mechanical *** multi-regression analysis of independent variables showed that serum bicarbonate on admission(OR=0.821;95%CI:0.796-0.846;P<0.0001),APACHEⅢ(OR=1.011;95%CI:1.007-1.015;P<0.0001),age(OR=1.016;95%CI:1.008-1.024;P<0.0001)and presence of sepsis at ICU admission(OR=2.819;95%CI:2.122-23.744;P=0.004)were each significant independent predictors of *** area under the ROC curve was 0.8(95%CI:0.78-0.83),thereby demonstrating that the predictive model has relatively good discriminating power for predicting ***:Serum bicarbonate on admission may indepen

关键词： Acute kidney injury Bicarbonate Mortality Sepsis

Portal Cavernoma Cholangiopathy in Children and the Management Dilemmas

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Journal of Clinical and Translational Hepatology 2020年第1期8卷 61-68页

作者： Moinak Sen Sarma Aathira ravindranath Department of Pediatric Gastroenterology Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknowUttar PradeshIndia

Portal cavernoma cholangiopathy(PCC)is one of the most harrowing complications of extrahepatic portal venous obstruc-tion,as it determines the long-term hepatobiliary *** symptomatic PCC is rare in children,asymptomatic PCC is as common as that in ***,there are major gaps in the literature with regard to the best imaging strategy and management modality in ***,natural history of PCC and effect of portosystemic shunt surgeries in children are *** PCC would lead to difficult or recalcitrant biliary strictures that will require endoscopic ther-apy or bilioenteric anastomosis,both of which are challenging in the presence of extensive *** are limited studies on the effect of portosystemic shunt surgeries on the outcome of PCC in children compared to *** this review,we aimed to collate all existing literature on PCC in childhood and also compare with adult *** highlight the difficul-ties of this disease to provide a comprehensive platform to foster further research on PCC exclusively in children.

关键词： Extra-hepatic portal vein obstruction Portal cavernoma cholangiopathy Portosystemic shunt

Bile acid synthetic defects: Simplified approach in a nutshell

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 80-84页

作者： Aathira ravindranath Moinak Sen Sarma Surender Kumar Yachha Department of Pediatric Gastroenterology Sanjay Gandhi Post Graduate Institute of Medical Sciences

Bile acid synthetic defects(BASD)constitute a rare group of disorders with manifestations in children as well as *** the individual BASD mandates a lucid understanding of the bile acid synthetic ***,the synthesis pathway is complex,consisting of numerous enzymes and intermediate products that are volatile in the physician’s *** paucity of literature,a simplified approach to the BASD is presented in this paper.

关键词： synthetic simplified approach

Pediatric acute viral hepatitis with atypical variants:Clinical dilemmas and natural history

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World Journal of Hepatology 2022年第5期14卷 944-955页

作者： Moinak Sen Sarma Aathira ravindranath Department of Pediatric Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014Uttar PradeshIndia Division of Pediatric Gastroenterology Apollo BGS HospitalsMysuru 570023KarnatakaIndia

Classical acute viral hepatitis(AVH)has an uncomplicated *** liver failure has a grave *** manifestations of AVH are a group of disorders that causes significant morbidity and dilemmas in *** include prolonged cholestasis,relapsing hepatitis,ascitic form of AVH,late-onset hepatic failure(LOHF),intravascular hemolysis,and provoking an autoimmune trigger leading to autoimmune *** entities cause significant liver dysfunction or worsening and are often difficult to differentiate from chronic liver disease(CLD).Ascitic form of AVH,LOHF,decompensated CLD and acute-onchronic liver failure have significant overlapping features that need to be carefully dissected *** many cases,only on long-term follow-up,these clinical entities can be separately *** hemolysis is usually caused by associated glucose-6-phosphate dehydrogenase *** CLD such as Wilson disease and autoimmune hepatitis can also present with hemolysis in the initial presentation,which can mimic AVH with *** deviations from typical manifestations aid in avoiding unnecessary investigations,allowing focused therapy and alleviating anxiety.

关键词： Viral Hepatitis Atypical Cholestasis Relapsing Hemolysis Ascites

Mitochondrial hepatopathy: Anticipated difficulties in management of fatty acid oxidation defects and urea cycle defects

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World Journal of Hepatology 2022年第1期14卷 180-194页

作者： Aathira ravindranath Moinak Sen Sarma Division of Pediatric Gastroenterology Institute of Gastrointestinal SciencesApollo BGS HospitalsMysore 570023KarnatakaIndia Pediatric Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014Uttar PradeshIndia

Fatty acid oxidation defects(FAOD)and urea cycle defects(UCD)are among the most common metabolic liver *** of these disorders is dotted with challenges as the strategies differ based on the type and severity of the *** those with FAOD the cornerstone of management is avoiding hypoglycemia which in turn prevents the triggering of fatty acid *** this review,we discuss the role of carnitine supplementation,dietary interventions,newer therapies like triheptanoin,long-term treatment and approach to positive newborn *** UCD the general goal is to avoid excessive protein intake and indigenous protein ***,one size does not fit all and striking the right balance between avoiding hyperammonemia and preventing deficiencies of essential nutrients is a formidable *** issues during the acute presentation including differential diagnosis of hyperammonemia,dietary dilemmas,the role of liver transplantation,management of the asymptomatic individual and monitoring are described in detail.A multi-disciplinary team consisting of hepatologists,metabolic specialists and dieticians is required for optimum management and improvement in quality of life for these patients.

关键词： Mitochondrial hepatopathy Metabolic liver disease Liver transplantation Hyperammonemia Hypoglycemia Carnitine

Electromagnetic Torque Analysis of Wind-Driven SRG with Ferrite Magnet

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CES Transactions on Electrical Machines and Systems 2020年第3期4卷 172-179页

作者： Kitaba Tefera Praveen Tripathy ravindranath Adda Indian Institute of Technology Guwahati India Department of Electronics and Electrical Engineering Indian Institute of Technology GuwahatiIndia

The present paper analyses the effect of placing the ferrite magnet into the rotor air barrier of synchronous reluctance generators(SRG)on its electromagnetic *** paper uses a difference of average electromagnetic torque and ripple torque as a measure of the performance ***,in the analysis,a magnetic material is placed in the middle of each air barrier,and its size is symmetrically increased on both sides to increase the percentage of the volume of the magnetic *** effect of an increase in the volume of the magnetic material on its performance is ***,the variation in electromagnetic features such as the d−and q-axes inductance and flux linkage are also explored and compared for different volumes and ferrite *** the present work,finite element analysis is used to get the electromagnetic *** paper also includes hardware validation on the fabricated prototype of SRG(without ferrite magnet),but SRG with a ferrite magnet only includes the results with FEA simulation.

关键词： Ferrite material FEA Torque Synchronous reluctance generator

Electromagnetic and Mechanical Stress Analysis of Wind-Driven Synchronous Reluctance Generator

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CES Transactions on Electrical Machines and Systems 2019年第1期3卷 107-114页

作者： Kitaba Tefera Praveen Tripathy Senior ravindranath Adda the Department of Electronics and Electrical Engineering Indian Institute of TechnologyGuwahatiAssam

The investigation explores the mechanical stress and electromagnetic performance for a wind-driven synchronous reluctance generator(SRG).The change in the mechanical stress due to the presence of centripetal force,wind speed,and rotor speed are evaluated for different thickness of tangential and radial ***,the variation in the electromagnetic feature such as the q−and d−axes flux,reactance ratio,inductance,torque and torque ripple are discussed for different thickness of tangential and radial *** both tangential and radial ribs thickness has an effect on the electromagnetic performance,but it is observed that effect is significantly more with the variation of tangential rib ***,the mechanical stress analysis for rotor design has been explored in this *** is observed that high concentration of peak stress on the rotor ribs,which limits the range of rotor speed.

关键词： Electromagnetic mechanical integrity synchronous reluctance generator stress and safety factor wind speed.