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Search Results: 1 - 10 of 378 matches for " Amay Parikh "
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Hepatorenal syndrome: one size does not fit all
Amay Parikh, Vivek K Moitra
Critical Care , 2012, DOI: 10.1186/cc11246
Abstract: Renal perfusion relies upon cardiac output, renal blood flow, and autoregulation. HRS influences cardiac output and systemic vascular resistance, and establishing a pressure gradient across the glomerulus ensures renal blood flow and glomerular filtration rate [2,3]. In fluid responsive patients, volume resuscitation is a key component of HRS management.The traditional target mean arterial pressure (MAP) of 65 mmHg to ensure renal perfusion assumes that 'one size fits all' in HRS. The kidneys are in the abdominal compartment, and intraabdominal pressure varies among individuals. The pressure of the compartment during disease states that cause ascites decreases renal perfusion pressure and should be overcome, especially when autoregulation is impaired [4]. In other words, the arbitrary suggestion of increasing the MAP by 10 mmHg (Table 6 in [1]) may not be enough (or may be too much).Titrating norepinephrine to a baseline MAP of 65 mmHg plus the intraabdominal pressure [4] and administering terlipressin or vasopressin (which may constrict the efferent glomerular arteriole [5]) may be an effective hemodynamic strategy to ensure renal perfusion pressure. Although this recommendation may not be based on grade A evidence, it is physiologically sound (establishes a pressure gradient) and may inspire further studies of hemodynamic management in patients with HRS.Andrew Davenport, Mitra K Nadim and John A Kellum, for the authorsWe thank Drs Parikh and Moitra for their letter concerning our paper reviewing the medical management of HRS [1]. We agree that the hemodynamic alterations of advanced liver disease are complex. Early in the course of cirrhosis the effects of increased splanchnic vasodilatation, primarily due to local nitric oxide synthesis, have limited systemic manifestations. As liver disease progresses, however, systemic vasodilatation develops despite increased visceral sympathetic tone, reninangiotensin-aldosterone activation, endothelin and vasopressin release
Clostridium difficile outcomes difficult to generalize
Naresh Nagella, Khenj-Jim Lim, Amay Parikh
Critical Care , 2013, DOI: 10.1186/cc11935
Abstract: The carrier effect, in which up to 20% of hospitalized patients can be chronic carriers of C. difficile, can affect results [2]. Unfortunately, chronic carriers are not identified. Furthermore, the 72-hour cutoff for ICU-acquired C. difficile seems somewhat arbitrary as it can be acquired faster and some patients were admitted to the ICU within the first 72 hours of hospital exposure [3]. In addition, variance in the first-line treatment of acquired CDI and its effect on treatment outcomes is unreported. Also, the detection immunoassay used a sensitivity well below (80%) those of the widely available cytotoxin neutralization assay (96%) and toxigenic culture (100%) [4]. Next, it is unclear whether the two populations were equally sick. The (younger) patients with diarrheal C. difficile were mechanically ventilated longer and received more proton pump inhibitors. Accordingly, unreported severity descriptors such as leukocytosis or renal insufficiency could influence mortality outcomes. Furthermore, total hospital length of stay should be compared since C. difficile diarrhea alone does not necessitate admission to the ICU. The retrospective cohort trial is appropriate, but testing stronger strains of C. difficile, using higher-sensitivity detection methods, and tracking the entire length of stay would more accurately support the authors' conclusions.Jean-Ralph Zahar and Jean-Fran?ois TimsitWe thank Nagella and colleagues for their kind comments about our study [1] and would like to address some of the issues they raise. As they pointed out, up to 20% of hospitalized patients can be chronic carriers. However, we wish to emphasize that, to avoid this bias, we restricted our study to patients with a new ICU-acquired CDI. We selected patients with CDI acquired after 72 hours as the exposed population. We agree that this arbitrary cut-point may have slightly decreased the incidence of ICU-acquired CDI. As stated by Zar and colleagues [5], vancomycin is the treatment of cho
Modelling Receiver Operating Characteristic Curves Using Gaussian Mixtures
Amay Cheam,Paul D. McNicholas
Statistics , 2014,
Abstract: The receiver operating characteristic curve is widely applied in measuring the performance of diagnostic tests. Many direct and indirect approaches have been proposed for modelling the ROC curve, and because of its tractability, the Gaussian distribution has typically been used to model both populations. We propose using a Gaussian mixture model, leading to a more flexible approach that better accounts for atypical data. Monte Carlo simulation is used to circumvent the issue of absence of a closed-form. We show that our method performs favourably when compared to the crude binormal curve and to the semi-parametric frequentist binormal ROC using the famous LABROC procedure.
Alternative therapy in glaucoma management: Is there any role?
Parikh Rajul,Parikh Shefali
Indian Journal of Ophthalmology , 2011,
Abstract: Glaucoma is one of the leading causes of blindness worldwide. Various randomized controlled clinical trials have shown that lowering intraocular pressure (IOP) does reduce progression of primary open-angle glaucoma. However, there is lots of interest in nonpharmacological options that includes lifestyle adjustment and alternative and complementary therapy (ACT). At least 5% glaucoma population uses ACT. Various lifestyle activities like exercise and alcohol can reduce IOP by 1 to 2 mm Hg but would have small effect on glaucoma. The psychological stress can increase IOP. Hypothetically and few studies do show neuroprotective effect (or effect on ocular blood flow) of alcohol, Gingko biloba, bilberry, but the current evidence is weak for its routine use. We must also remember the side effects of ′medications′ (e.g., marijuana, alcohol) before promoting as remedy for glaucoma. In current armamentarium of glaucoma management, ACT cannot substitute the conventional treatment available to lower IOP.
Novel therapies for treating atrial fibrillation  [PDF]
Raj Parikh, Philip J. Kadowitz
World Journal of Cardiovascular Diseases (WJCD) , 2012, DOI: 10.4236/wjcd.2012.24040
Abstract: Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strategies. Frequent INR checks associated with warfarin along with several adverse side effects of anti-arrhythmics have propelled investigations into novel treatments for atrial fibrillation. Research is focused not only on pioneering new pharmacological antico- agulation and anti-arrhythmic agents but also on improving surgical techniques in hopes of treating the arrhythmia. Here, we first briefly discuss the current treatment options, both pharmacological and non-pharmacological, for atrial fibrillation. We then present a focused review of recent animal and human investigations that examine the use of novel an-ticoagulation agents, mechanisms of new anti-arrhythmics, analyze potential triggers of atrial fibrillation, and highlight the role of genetics in atrial fibrillation.
Indian Society of Oncology, Secretary′s Message
Parikh Deepak
Indian Journal of Cancer , 2005,
Non Cardiac Surgery in Patients with Coronary Stents
Manoj Parikh
Indian Anaesthetists' Forum , 2012,
Abstract: Patients with cardiac interventions have been on the rise and anaesthesiologists are now likely to encounter more patients who have been treated with angioplasty and stent. Patients with Coronary Stents are at increased risk of major perioperative cardiovascular events.
Lamellar ichthyosis - An update
Parikh Deepak
Indian Journal of Dermatology, Venereology and Leprology , 2000,
Pediatric dermatology: Part II
Parikh Deepak
Indian Journal of Dermatology, Venereology and Leprology , 2010,
Pediatric dermatology
Parikh Deepak
Indian Journal of Dermatology, Venereology and Leprology , 2010,
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