Browsing by Author "R. Vohra"

Now showing 1 - 3 of 3

Acute renal failure in the intensive care unit
(2006) J. Prakash; A.S. Murthy; R. Vohra; M. Rajak; S.K. Mathur
Background: Acute renal failure (ARF) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to devise methods to improve the final outcome due to this problem. Aims and Objectives: The aim of the present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of ARF in the setting of ICU. Method: This prospective study involved patients admitted to ICU during the period between September 2003 to January 2005 (17 months). Patients who developed ARF during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded included; patient characteristics, underlying medical conditions responsible for ICU admission, dialytic status, need for ventilation, total duration of ICU stay, APACHE-III score and final outcome, and these data were analyzed for predicting survival using univariate and multivariate analysis. Results: Twelve hundred and fifteen (1215) patients were admitted to ICU from September 2003 to January, 2005 and 46 (3.79%) patients developed ARF after admission to ICU. Mean age of patients was 44.9 ± 17 years and 56.5% were males. Comorbidity was seen in 24 (52%) patients; hypertension (34.7%), diabetes mellitus (28.3%), coronary artery disease (30.4%) and chronic kidney disease (13%). ARF had developed complicating medical and surgical conditions in 33 (71.7%) and 11 (23.7%) patients respectively. The etiology of ARF was multifactorial and included; hypotension (71.74%), volume depletion (17.4%), nephrotoxic drugs (67.39%), and sepsis (69.5%). Multiple organ system failure (MOSF) was noted in 63% of cases and dialysis was required in 25 (54.3%) patients. Mortality occurred in 63% of patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. Conclusions: ARF was seen in 3.79% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE - III scores and ventilation need were correlated with higher mortality in ARF patients in the intensive care unit. © JAPI.
Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years
(Medknow Publications, 2016) J. Prakash; P. Pant; S. Prakash; M. Sivasankar; R. Vohra; P.K. Doley; L. Pandey; U. Singh
The incidence of acute kidney injury (AKI) in pregnancy is declining in developing countries but still remains a major cause of maternal and fetal morbidity and mortality. The aim of the study was to analyze the changing trends in pregnancy related AKI (PR-AKI) over a period of thirty-three years. Clinical characteristics of PR-AKI with respect to incidence, etiology and fetal and maternal outcomes were compared in three study periods, namely 1982-1991,1992-2002 and 2003-2014. The incidence of PR-AKI decreased to 10.4% in 1992-2002, from 15.2% in 1982-1991, with declining trend continuing in 2003-2014 (4.68%).Postabortal AKI decreased to 1.49% in 2003-2014 from 9.4% in 1982-1991of total AKI cases.The AKI related to puerperal sepsis increased to 1.56% of all AKI cases in 2003-2014 from 1.4% in 1982-1991. Preeclampsia/eclampsia associated AKI decreased from 3.5% of total AKI cases in 1982-1991 to 0.54% in 2003-2014. Pregnancy associated - thrombotic microangiopathy and acute fatty liver of pregnancy were uncommon causes of AKI. Hyperemesis gravidarum associated AKI was not observed in our study. Incidence of renal cortical necrosis (RCN) decreased to 1.4% in 2003-2014 from 17% in 1982-1991.Maternal mortality reduced to 5.79% from initial high value 20% in 1982-1991. The progression of PR-AKI to ESRD decreased to1.4% in 2003-2014 from 6.15% in 1982-1991. The incidence of PR-AKI has decreased over last three decades, mainly due to decrease in incidence of postabortal AKI. Puerperal sepsis and obstetric hemorrhage were the major causes of PR-AKI followed by preeclampsia in late pregnancy. Maternal mortality and incidence and severity of RCN have significantly decreased in PR-AKI. The progression to CKD and ESRD has decreased in women with AKI in pregnancy in recent decade. However, the perinatal mortality did not change throughout study period.
Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection
(Oxford University Press, 2023) A. Mukherjee; G. Kumar; A. Turuk; A. Bhalla; T.C. Bingi; P. Bhardwaj; T.D. Baruah; S. Mukherjee; A. Talukdar; Y. Ray; M. John; J.R. Khambholja; A.H. Patel; S. Bhuniya; R. Joshi; G.R. Menon; D. Sahu; V.V. Rao; B. Bhargava; S. Panda; P. Mishra; Y. Panchal; L.K. Sharma; A. Agarwal; G.D. Puri; V. Suri; K. Singla; R. Mesipogu; V.S. Aedula; M.A. Mohiuddin; D. Kumar; S. Saurabh; S. Misra; P.K. Kannauje; A. Kumar; A. Shukla; A. Pal; S. Chakraborty; M. Dutta; T. Mondal; S. Chakravorty; B. Bhattacharjee; S.R. Paul; D. Majumder; S. Chatterjee; A. Abraham; D. Varghese; M. Thomas; N. Shah; M. Patel; S. Madan; A. Desai; M.L. Kala Yadhav; R. Madhumathi; G.S. Chetna; U.K. Ojha; R.R. Jha; A. Kumar; A. Pathak; A. Sharma; M. Purohit; L. Sarangi; M. Rath; A.D. Shah; L. Kumar; P. Patel; N. Dulhani; S. Dube; J. Shrivastava; A. Mittal; L. Patnaik; J.P. Sahoo; S. Sharma; V.K. Katyal; A. Katyal; N. Yadav; R. Upadhyay; S. Srivastava; A. Srivastava; N.N. Suthar; N.M. Shah; K. Rajvansh; H. Purohit; P.R. Mohapatra; M.K. Panigrahi; S. Saigal; A. Khurana; M. Panchal; M. Anderpa; D. Patel; V. Salgar; S. Algur; R. Choudhury; M. Rao; D. Nithya; B.K. Gupta; B. Kumar; J. Gupta; S. Bhandari; A. Agrawal; M. Shameem; N. Fatima; S. Pala; V. Nongpiur; S. Chatterji; S. Mukherjee; S.K. Shivnitwar; S. Tripathy; P. Lokhande; H. Dandu; A. Gupta; V. Kumar; N. Sharma; R. Vohra; A. Paliwal; M. Pavan Kumar; A. Bikshapathi Rao; N. Kikon; R. Kikon; K. Manohar; Y. Sathyanarayana Raju; A. Madharia; J. Chakravarty; M. Chaubey; R.K. Bandaru; M. Ali Mirza; S. Kataria; P. Sharma; S. Ghosh; A. Hazra
Objectives: This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). Methods: NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. Results: Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6–7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4–0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3–0.7)] were protected from in-hospital mortality. Conclusions: WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality. © The Author(s) 2022.