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Fulltext Epidural blood patch for post dural puncture headache

Vijayan R, Chan L

Med J Malaysia, 1995 Jun;50(2):196-7.
PMID: 7565198
Fulltext Spinal cord stimulation for treatment of failed back surgery syndrome--two case reports

Vijayan R, Ahmad TS

Med J Malaysia, 1999 Dec;54(4):509-13.
PMID: 11072471

Severe, persistent back pain following back surgery is often referred to as Failed Back Surgery Syndrome (FBSS). Conservative measures such as physiotherapy, back strengthening exercises, transcutaneous electrical nerve stimulation and epidural steroids may be inadequate to alleviate pain. Spinal Cord Stimulators were implanted into two patients suffering from FBSS. Both patients responded successfully to spinal cord stimulation with reduction of pain and disability.
Epidural tramadol for postoperative pain relief

Delilkan AE, Vijayan R

Anaesthesia, 1993 Apr;48(4):328-31.
PMID: 8494137

The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. Blood pressure, pulse rate, respiratory rate, arterial blood gas analyses, pain scores, the interval between doses and the occurrence of any side effects were recorded. Pain scores (assessed using a visual analogue scale) were significantly less (p < 0.05) at 3, 12, and 24 h in patients receiving tramadol 100 mg than in those receiving tramadol 50 mg or bupivacaine. The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).
Fulltext First year's experience with an acute pain service--University Hospital Kuala Lumpur

Vijayan R, Delilkan AE

Med J Malaysia, 1994 Dec;49(4):385-400.
PMID: 7545779

An Acute Pain Service (APS) was started in University Hospital, Kuala Lumpur by the Department of Anaesthesiology in October 1992 for more effective control of postoperative pain. The main modalities of treatment included patient controlled analgesia (PCA) using morphine or pethidine with PCA devises, epidural opiate analgesia (EOA) using tramadol or fentanyl/bupivacaine mixture and subcutaneous administration of morphine or pethidine. Five hundred and fifty-one patients were managed in the first year, with an overall patient satisfaction score of 83%. The majority (98.5%) of them were after abdominal or major orthopaedic surgery. Eighty per cent of patients scored < 3 on the verbal numeric pain scale, where 0 is no pain and 10 is the worst imaginable pain, on the first postoperative day. Nausea and vomiting was an unpleasant side effect in 20% of patients.
Fulltext Pain relief with intravenous regional guanethedine in post-traumatic reflex sympathetic dystrophy--a case report

Vijayan R, Low KH

Med J Malaysia, 1993 Jun;48(2):236-9.
PMID: 8350804

Intravenous regional guanethedine (IVRG), using the Bier's block technique, was given to relieve pain in a 62 year old Indian woman suffering from reflex sympathetic dystrophy. The patient obtained complete pain relief with 2 injections and has remained pain-free for 18 months.
Fulltext Continuous spinal anaesthesia--early experience in University Hospital, Kuala Lumpur

Vijayan R, Chan L, Raveenthiran R

Med J Malaysia, 1995 Dec;50(4):401-10.
PMID: 8668064

Continuous spinal anaesthesia using the incremental technique was used in nineteen high risk patients with multiple medical problems, seventeen of whom were elderly, for lower limb orthopaedic and pelvic surgery. An intrathecal catheter (18G/28G) was inserted under local anaesthesia via the lumbar interspinous space. Spinal anaesthesia was induced with small incremental doses of 0.5% bupivacaine hydrochloride through the intrathecal catheter to achieve the level of analgesia required for surgery. The duration of surgery ranged from 45 to 300 minutes (mean + S.D 100 + 37 min). The initial volume of 0.5% bupivacaine required for surgery ranged from 0.8 ml-2.0 ml (1.2 + 0.7 ml) and the total volume ranged from 0.9 ml to 3.1 ml (mean + S.D 1.4 + 0.7 ml). Haemodynamic stability was well maintained perioperatively. Only two patients required 6 mg of ephedrine and 1 mg of aramine respectively for a greater than 25% reduction in systolic blood pressure with induction of spinal anaesthesia. Intrathecal morphine 0.1-0.3 mg was administered to 15 patients at the end of surgery for postoperative pain relief with good effect. One patient developed late respiratory depression from an inadvertent overdose of intrathecal morphine. No neurological sequelae were noted and no patient developed a postdural puncture headache. The use of the microcatheter was discontinued in the U.S.A and Australia following four case reports of cauda equina syndrome with this technique. Current opinion, however, is that the reported cauda equina syndrome was due to the neurotoxic effects of lignocaine 5% that was used and not due to the microcatheter per se. Continuous spinal anaesthesia is now used widely in Europe when cardiovascular stability is desired in poor risk patients undergoing lower limb and lower abdominal surgery.
Fulltext Survey of postoperative pain in University Hospital Kuala Lumpur

Vijayan R, Tay KH, Tan LB, Loganathan

Singapore Med J, 1994 Oct;35(5):502-4.
PMID: 7701371

One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.
Open gastrostomy under ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a case series

Hasan MS, Ling KU, Vijayan R, Mamat M, Chin KF

Eur J Anaesthesiol, 2011 Dec;28(12):888-9.
PMID: 21857518 DOI: 10.1097/EJA.0b013e32834ad9bd
Identification and molecular docking study of novel cholesterol esterase inhibitory peptides from camel milk proteins

Mudgil P, Baby B, Ngoh YY, Vijayan R, Gan CY, Maqsood S

J Dairy Sci, 2019 Dec;102(12):10748-10759.
PMID: 31548068 DOI: 10.3168/jds.2019-16520

Novel bioactive peptides from camel milk protein hydrolysates (CMPH) were identified and tested for inhibition of cholesterol esterase (CEase), and their possible binding mechanisms were elucidated by molecular docking. Papain-generated CMPH showed the highest degree of hydrolysis. All CMPH produced upon enzymatic degradation demonstrated a dramatic enhancement of CEase inhibition compared with intact camel milk proteins, with papain-generated hydrolysate P9 displaying the highest inhibition. Peptide identification and their modeling through PepSite 2 revealed that among 20 potential bioactive peptides in alcalase-generated hydrolysate A9, only 3 peptides, with sequences KFQWGY, SQDWSFY, and YWYPPQ, showed the highest binding toward CEase catalytic sites. Among 43 peptides in 9-h papain-generated hydrolysate P9, 4 peptides were found to be potent CEase inhibitors. Molecular docking revealed that WPMLQPKVM, CLSPLQMR, MYQQWKFL, and CLSPLQFR from P9 hydrolysates were able to bind to the active site of CEase with good docking scores and molecular mechanics-generalized born surface area binding energies. Overall, this is the first study reporting CEase inhibitory potential of peptides generated from milk proteins.
New insights into the cholesterol esterase- and lipase-inhibiting potential of bioactive peptides from camel whey hydrolysates: Identification, characterization, and molecular interaction

Baba WN, Mudgil P, Baby B, Vijayan R, Gan CY, Maqsood S

J Dairy Sci, 2021 Jul;104(7):7393-7405.
PMID: 33934858 DOI: 10.3168/jds.2020-19868

Novel antihypercholesterolemic bioactive peptides (BAP) from peptic camel whey protein hydrolysates (CWPH) were generated at different time, temperature, and enzyme concentration (%). Hydrolysates showed higher pancreatic lipase- (PL; except 3 CWPH) and cholesterol esterase (CE)-inhibiting potential, as depicted by lower half-maximal inhibitory concentration values (IC50 values) compared with nonhydrolyzed camel whey proteins (CWP). Peptide sequencing and in silico data depicted that most BAP from CWPH could bind active site of PL, whereas as only 3 peptides could bind the active site of CE. Based on higher number of reactive residues in the BAP and greater number of substrate binding sites, FCCLGPVPP was identified as a potential CE-inhibitory peptide, and PAGNFLPPVAAAPVM, MLPLMLPFTMGY, and LRFPL were identified as PL inhibitors. Molecular docking of selected peptides showed hydrophilic and hydrophobic interactions between peptides and target enzymes. Thus, peptides derived from CWPH warrant further investigation as potential candidates for adjunct therapy for hypercholesterolemia.
Anti-acne, anti-dandruff and anti-breast cancer efficacy of green synthesised silver nanoparticles using Coriandrum sativum leaf extract

Sathishkumar P, Preethi J, Vijayan R, Mohd Yusoff AR, Ameen F, Suresh S, et al.

J. Photochem. Photobiol. B, Biol., 2016 Oct;163:69-76.
PMID: 27541567 DOI: 10.1016/j.jphotobiol.2016.08.005

In this present investigation, AgNPs were green synthesised using Coriandrum sativum leaf extract. The physicochemical properties of AgNPs were characterised using UV-visible spectrophotometer, field emission scanning microscopy/energy dispersive X-ray (FESEM/EDX), Fourier transformed infrared spectroscopy (FT-IR), X-ray diffraction (XRD) and Brunauer-Emmett-Teller (BET) analysis. Further, in vitro anti-acne, anti-dandruff and anti-breast cancer efficacy of green synthesised AgNPs were assessed against Propionibacterium acnes MTCC 1951, Malassezia furfur MTCC 1374 and human breast adenocarcinoma (MCF-7) cell line, respectively. The flavonoids present in the plant extract were responsible for the AgNPs synthesis. The green synthesised nanoparticles size was found to be ≈37nm. The BET analysis result shows that the surface area of the synthesised AgNPs was found to be 33.72m(2)g(-1). The minimal inhibitory concentration (MIC) of AgNPs for acne causative agent P. acnes and dandruff causative agent M. furfur was found to be at 3.1 and 25μgmL(-1), respectively. The half maximal inhibitory concentration (IC50) value of the AgNPs for MCF-7 cells was calculated as 30.5μgmL(-1) and complete inhibition was observed at a concentration of 100μgmL(-1). Finally, our results proved that green synthesised AgNPs using C. sativum have great potential in biomedical applications such as anti-acne, anti-dandruff and anti-breast cancer treatment.
Sesame indicum, a nutritional supplement, elicits antiamnesic effect via cholinergic pathway in scopolamine intoxicated mice

Chidambaram SB, Pandian A, Sekar S, Haridass S, Vijayan R, Thiyagarajan LK, et al.

Environ Toxicol, 2016 Dec;31(12):1955-1963.
PMID: 26434561 DOI: 10.1002/tox.22196

PURPOSE: Present study was undertaken to evaluate the antiamnesic effect of Sesamum indicum (S. indicum) seeds (standardized for sesamin, a lignan, content) in scopolamine, a muscarinic antagonist intoxicated mice.
METHODS: Male Swiss albino mice (18-22 g bw) were pretreated with methanolic extract of sesame seeds (MSSE) (100 and 200 mg/kg/day, p.o) for a period of 14 days. Scopolamine (0.3 mg/kg, i.p.) was injected on day 14, 45 ± 10 min after MSSE administration. Antiamnesic effect of MSSE was evaluated using step-down latency (SDL) on passive avoidance apparatus and transfer latency (TL) on an elevated plus maze. To unravel the mechanism of action, we examined the effects of MSSE on the genes such as acetyl cholinesterase (AChE), muscarinic receptor M1 subtype (mAChRM1 ), and brain derived neurotrophic factor (BDNF) expression within hippocampus of experimental mice. Further, its effects on bax and bcl-2 were also evaluated. Histopathological examination of hippocampal CA1 region was performed using cresyl violet staining.
RESULTS: MSSE treatment produced a significant and dose dependent increase in step down latency in passive avoidance test and decrease in transfer latency in elevated plus maze in scopolamine intoxicated injected mice. MSSE down-regulated AChE and mAChRM1 and up-regulated BDNF mRNA expression. Further, it significantly down-regulated the bax and caspase 3 and up-regulated bcl-2 expression in scopolamine intoxicated mice brains. Mice treated with MSSE showed increased neuronal counts in hippocampal CA1 region when compared with scopolamine-vehicle treated mice.
CONCLUSION: Sesame seeds have the ability to interact with cholinergic components involved in memory function/restoration and also an interesting candidate to be considered for future cognitive research. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 1955-1963, 2016.
Establishment of multidisciplinary pain management clinics and training programs in the developing world: experiences from Southeast Asia

Chaudakshetrin P, Cardosa MS, Goh CR, Javier FO, Musba AMT, Prateepavanich P, et al.

Pain, 2020 09;161 Suppl 1:S87-S94.
PMID: 33090741 DOI: 10.1097/j.pain.0000000000001871
Fulltext Tramadol: a valuable treatment for pain in Southeast Asian countries

Vijayan R, Afshan G, Bashir K, Cardosa M, Chadha M, Chaudakshetrin P, et al.

J Pain Res, 2018;11:2567-2575.
PMID: 30425567 DOI: 10.2147/JPR.S162296

Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain.

Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic.

Results: Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain.

Conclusions: In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline.

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