MyMedR

Prediction of Acute Kidney Injury on Admission to Pediatric Intensive Care

Raman S, Tai CW, Le Marsney R, Schibler A, Gibbons K, Schlapbach LJ

Pediatr Crit Care Med, 2020 09;21(9):811-819.

PMID: 32516223 DOI: 10.1097/PCC.0000000000002411

OBJECTIVES: Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury.

DESIGN: Single-center retrospective observational study.

SETTING: Thirty-six-bed surgical/medical tertiary PICU.

PATIENTS: Children from birth to less than or equal to 16 years old admitted between 2015 and 2018.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as "high risk of acute kidney injury." Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3-5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5-9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6-4.2) and 3.1 (95% CI, 2.4-3.8), respectively.

CONCLUSIONS: The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.

Fulltext Bilateral spontaneous persistent open pneumothorax with chylothorax

Khajotia R, Raman S

Can Fam Physician, 2012 Jul;58(7):757-60.

PMID: 22859639

Intravaginal misoprostol for termination of midtrimester pregnancy

Lim JM, Soh EB, Raman S

Aust N Z J Obstet Gynaecol, 1995 Feb;35(1):54-5.

PMID: 7772001

Misoprostol seems to be a drug with many potential uses apart from the treatment of gastric and duodenal ulcers. The oral tablet appears to be effective for termination of midtrimester pregnancy when administered intravaginally. Further research should be carried out to determine its full range of action in order that the drug can be utilized to its maximum potential.

Fulltext Single-dose antibiotic prophylaxis in women undergoing elective caesarean section

Huam SH, Lim JM, Raman S

Med J Malaysia, 1997 Mar;52(1):3-7.

PMID: 10968046

This prospective, randomised, controlled trial was performed to evaluate the effectiveness of single-dose antibiotic prophylaxis in decreasing the infectious morbidity following elective caesarean section. Two hundred women undergoing elective caesarean section were randomly assigned to receive either 1.2 g of Augmentin intravenously, or no treatment, just before the start of their caesarean section. The two groups of women were comparable in terms of patient characteristics and operation variables. The overall postoperative morbidity rate was 19% in the Augmentin treated group versus 38% in the group that received no prophylaxis (p < 0.01). The incidence of wound sepsis was 3% in the Augmentin group versus 13% in the control group (p < 0.01). The incidence of febrile morbidity with no identifiable cause was 8% in the Augmentin group versus 18% in the control group (p < 0.05). The duration of hospital stay was significantly shorter in the Augmentin group (p < 0.05). A single-dose of prophylactic Augmentin significantly reduced the postoperative morbidity and duration of hospital stay in women who underwent elective caesarean sections.

Fulltext Early warning of fetal compromise--absent end diastolic flow?

Neoh HS, Kumarasamy S, Raman S

Med J Malaysia, 1990 Mar;45(1):37-41.

PMID: 2152067

This report deals with the use of a relatively new investigative technique (Doppler ultrasound) in the management of a case of early onset pre-eclampsia and discusses the benefit of this new technique over conventional methods of fetal monitoring.

Acute puerperal inversion of the uterus--an obstetric emergency

Rachagan SP, Sivanesaratnam V, Kok KP, Raman S

Aust N Z J Obstet Gynaecol, 1988 Feb;28(1):29-32.

PMID: 3214380

Over a 17-year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 deliveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.

Fulltext Ovarian hyperstimulation syndrome--two case reports

Wong KK, Raman S

Med J Malaysia, 1990 Mar;45(1):81-3.

PMID: 2152076

Two cases of ovarian hyperstimulation syndrome (OHSS) following the GIFT procedure are reported. This article highlights the potential dangers of this condition and discusses the classification and management.

Fulltext Sengstaken-Blakemore tube to control massive postpartum haemorrhage

Japaraj RP, Raman S

Med J Malaysia, 2003 Oct;58(4):604-7.

PMID: 15190639

Massive postpartum haemorrhage after Cesarean section for placenta previa is a common occurrence. The bleeding is usually from the placental bed at the lower uterine segment. Uterine tamponade has a role in the management of such patients especially when fertility is desired. We describe here a case of massive postpartum haemorrhage, which was managed, with the use of a Sengstaken-Blakemore tube. This allowed us to avoid a hysterectomy for a young primiparous patient.

Intraperitoneal haemorrhage from a ruptured corpus luteum. A cause of "acute abdomen" in women

Sivanesaratnam V, Singh A, Rachagan SP, Raman S

Med J Aust, 1986 Apr 14;144(8):411, 413-4.

PMID: 3959969

During the 10-year period 1974-1983, 68 patients with intraperitoneal haemorrhage as a result of the rupture of a corpus luteum were managed at the University Hospital, Kuala Lumpur, Malaysia. Most of the patients were aged between 18 and 35 years. In 63% of the patients the rupture occurred between the 14th and the 35th day of the menstrual cycle, and 10 patients had intraperitoneal bleeding severe enough (450-1500 mL) to require blood transfusion. The condition is often confused with other surgical emergencies such as appendicitis and ectopic pregnancy. An increased awareness of the problem in women of reproductive age and the use of laparoscopy, when indicated, will allow a more conservative approach to be adopted for those patients with minimal bleeding. The performance of an appendicectomy in the presence of blood in the peritoneal cavity did not appear to increase morbidity in those patients with a preoperative diagnosis of "appendicitis".

Fulltext Refractive outcome after cataract surgery in Hospital Keningau, Sabah

Yahya AN, Sit JA, Raman S

Borneo Journal of Medical Sciences, 2019;2(101):19-20.

MyJurnal

The success of cataract surgery is accessed by the improvement in visual acuity and accuracy of the post-operation refractive outcome against the pre-operation refractive target. Hence, the benchmark of 85% of patients achieving a final spherical equivalent within 1D of the desired target is used to monitor the refractive outcome. Meanwhile, the unaided visual acuity threshold of 6/12 after cataract operation is chosen as a yardstick because it allows patients to perform instrumental activities of daily living (IADL) independently without relying on spectacles.

Acute kidney injury: epidemiology and course in critically ill children

Tai CW, Gibbons K, Schibler A, Schlapbach LJ, Raman S

J Nephrol, 2021 Jun 02.

PMID: 34076880 DOI: 10.1007/s40620-021-01071-5

BACKGROUND: Acute kidney injury (AKI) is a major cause of morbidity and mortality in critically ill children. The aim of this paper was to describe the prevalence and course of AKI in critically ill children and to compare different AKI classification criteria.

METHODS: We conducted a retrospective observational study in our multi-disciplinary Pediatric Intensive Care Unit (ICU) from January 2015 to December 2018. All patients from birth to 16 years of age who were admitted to the pediatric ICU were included. The Kidney Disease Improving Global Outcomes (KDIGO) definition was considered as the reference standard. We compared the incidence data assessed by KDIGO, pediatric risk, injury, failure, loss of kidney function and end- stage renal disease (pRIFLE) and pediatric reference change value optimised for AKI (pROCK).

RESULTS: Out of 7505 patients, 9.2% developed AKI by KDIGO criteria. The majority (59.8%) presented with stage 1 AKI. Recovery from AKI was observed in 70.4% of patients within 7 days from diagnosis. Both pRIFLE and pROCK were less sensitive compared to KDIGO criteria for the classification of AKI. Patients who met all three-KDIGO, pRIFLE and pROCK criteria had a high mortality rate (35.0%).

CONCLUSION: Close to one in ten patients admitted to the pediatric ICU met AKI criteria according to KDIGO. In about 30% of patients, AKI persisted beyond 7 days. Follow-up of patients with persistent kidney function reduction at hospital discharge is needed to reveal the long-term morbidity due to AKI in the pediatric ICU.

Unilateral diffuse lung opacification in an asymptomatic woman

Khajotia RR, Raman S

Aust Fam Physician, 2017 Nov;46(11):845-846.

PMID: 29101921

Fulltext Current trends in polymer microneedle for transdermal drug delivery

Ahmed Saeed Al-Japairai K, Mahmood S, Hamed Almurisi S, Reddy Venugopal J, Rebhi Hilles A, Azmana M, et al.

Int J Pharm, 2020 Sep 25;587:119673.

PMID: 32739388 DOI: 10.1016/j.ijpharm.2020.119673

Transdermal drug delivery using microneedles is increasingly gaining interest due to the issues associated with oral drug delivery routes. Gastrointestinal route exposes the drug to acid and enzymes present in the stomach, leading to denaturation of the compound and resulting in poor bioavailability. Microneedle transdermal drug delivery addresses the problems linked to oral delivery and to relieves the discomfort of patients associated with injections to increase patient compliance. Microneedles can be broadly classified into five types: solid microneedles, coated microneedles, dissolving microneedles, hollow microneedles, and hydrogel-forming microneedles. The materials used for the preparation of microneedles dictate the different applications and features present in the microneedle. Polymeric microneedle arrays present an improved method for transdermal administration of drugs as they penetrate the skin stratum corneum barrier with minimal invasiveness. The review summarizes the importance of polymeric microneedle and discussed some of the most important therapeutic drugs in research, mainly protein drugs, vaccines and small molecule drugs in regenerative medicine.

Fulltext Prenatal diagnosis of intestinal obstruction due to ileal atresia

Raman S, Chan LL, Chang KW, Rachagan SP

Med J Malaysia, 1992 Sep;47(3):228-30.

PMID: 1491650

A case of intestinal obstruction due to ileal atresia where the diagnosis was made prenatally by ultrasound is presented. Close monitoring of the fetus was done ultrasonographically to look for any evidence of meconium peritonitis. The baby was delivered preterm but weighed 3.3 kg. Laparotomy and enterostomy was done and the baby is currently well.

Fulltext Hypertensive encephalopathy in eclampsia - a case report

Raman S, Rachagan SP

Med J Malaysia, 1983 Mar;38(1):57-8.

PMID: 6633338

A case of hypertensive encephalopathy in eclampsia is described. Complete recovery from the neurological deficits took three and a half weeks.

The use of intrapartum fetal pulse oximetry in the presence of fetal cardiac arrhythmia due to a cardiac tumour

Raman S, Lim JM, Hanifullah K, Omar A

J Obstet Gynaecol, 1999 Mar;19(2):200-1.

PMID: 15512273

Fulltext Thyrotoxicosis in pregnancy--a six year review

Lim BH, Raman S, Sivanesaratnam V, Ngan A

Singapore Med J, 1989 Dec;30(6):539-41.

PMID: 2635396

Twenty eight patients with hyperthyroidism complicating their pregnancies were seen at the Obstetrics and Gynaecology Department, University Hospital, Kuala Lumpur, Malaysia in a six-year period. All patients were treated with antithyroid drugs, carbimazole being the mainstay of treatment. The incidence of the disease was 0.9 per 1000 births and was similar with other series. No cases of fetal goitre were noted. The mean birth weight was 2952 g; there was no significant difference in the birth weight of term live births in patients treated with carbimazole alone or carbimazole combined with propranolol.

Fulltext Advances in obstetric ultrasound

Raman S, Tai C, Neoh HS

Med J Malaysia, 1991 Dec;46(4):314-9.

PMID: 1840438

Growth patterns of the humeral and femur length in a multiethnic population

Raman S, Teoh T, Nagaraj S

Int J Gynaecol Obstet, 1996 Aug;54(2):143-7.

PMID: 9236312

OBJECTIVES: To study whether there are any differences in growth of the femoral and humeral length between the three major ethnic groups in Malaysia viz Malays, Chinese and Indians. The effect on fetal growth by gender of the baby and parity of the mother was also studied.

METHODS: The setting was the University of Kuala Lumpur. Thirty-four Malay, 35 Chinese and 34 Indian normal pregnant middle-class women were studied longitudinally by monthly ultrasound scans for 18 to 38 weeks of gestation. The data were subjected to regression analysis; the quadratic curve was found to be the most adequate. Dummy variables were used to determine any effects by gender, parity as well as ethnicity on the length of limb growth. There was no difference in birth weights of the three ethnic groups studied, nor in gender or parity.

RESULTS: There were found to be significant differences in limb lengths of the Indians (longer) when compared with the Malays and Chinese. Parity seems to affect only Indians in whom the multiparous fetuses have shorter limb lengths than the primaparous. There appears to be no effect by gender.

CONCLUSION: There appear to be definite differences in growth of limb length between the different Malaysian ethnic groups and this should be taken into account when growth charts are used and when fetal weight formulas are calculated using limb lengths. The limitation of this study was that the numbers of subjects studied were small. Larger studies will be able to confirm or refute the findings.

Fulltext Budesonide/formoterol combination therapy as both maintenance and reliever medication in moderate-to-severe asthma: a real-life effectiveness study of Malaysian patients

Loh LC, Lim BK, Raman S, Vijayasingham P, Mohd Yusuf S

Med J Malaysia, 2008 Aug;63(3):188-92.

PMID: 19248687

Budesonide/Formoterol (Symbicort) combination therapy as both maintenance and reliever treatment (SMART) is a novel approach in asthma management. We examined its 'real-life effectiveness' in treating Malaysian patients with moderate-to-severe asthma in whom despite on combined inhaled corticosteroids and long-acting beta2-agonist, were still inadequately controlled. In a retrospective study, 22 eligible adult patients on SMART [mean (range) age: 49 (36-65) years; FEV1: 41 (21-74)% predicted] were identified from medical records of an urban-based university hospital chest clinic, and their clinical outcomes studied at three months. Another 16 patients [50 (14-66) years; 48 (20-91)% predicted] of similar severity and treatment (i.e. Symbicort maintenance treatment plus short-acting beta2-agonist as reliever), but not on SMART, were used as comparator over the same assessment period. In addition, the patients were separately interviewed with standard questionnaire on their satisfaction and compliance to the SMART approach. In SMART group, rescue treatment requirement (p<0.001) and FEV1 [median difference = 2.5%, p=0.015; mean difference: 90 ml, p=0.013] showed significant improvement while in comparator, there was significant improvement only in the requirement for rescue treatment (p=0.023). Hospital admission rates were significantly reduced in SMART group compared to the other (p=0.039), but not in emergency treatment. Five patients asked to discontinue SMART while all others were satisfied, compliant and perceived improvement of their asthma with SMART. The maximum daily doses of inhaled budesonide and formoterol were 1400 microg and 31.5 microg respectively. Our preliminary findings suggest that SMART approach can be attempted as an effective and safe treatment option for patients with inadequately controlled moderate-to-severe asthma in Malaysian setting.
Study site: Chest clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Displaying publications 21 - 40 of 62 in total