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Search Results: 1 - 10 of 138753 matches for " K. Navaratnam "
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Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival
K. Navaratnam,P. Ulaganathan,M. A. Akhtar,S. D. Sharma,M. G. Davies
Case Reports in Obstetrics and Gynecology , 2011, DOI: 10.1155/2011/426127
Abstract: Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.
Synergistic antimicrobial activity between pentacyclic triterpenoids and antibiotics against Staphylococcus aureus strains
Pooi Chung, Parasakthi Navaratnam, Lip Chung
Annals of Clinical Microbiology and Antimicrobials , 2011, DOI: 10.1186/1476-0711-10-25
Abstract: The activity of the standard antibiotics and compounds on reference methicillin-sensitive and resistant strains of S. aureus were determined using the macrodilution broth method. The minimum inhibitory concentration (MIC) of the compounds was compared with that of the standard antibiotics. The interaction between any two antimicrobial agents was estimated by calculating the fractional inhibitory concentration (FIC index) of the combination. The various combinations of antibiotics and compounds reduced the MIC to a range of 0.05 to 50%.Pentacyclic triterpenoids have shown anti-staphylococcal activities and although individually weaker than common antibiotics produced from bacteria and fungi, synergistically these compounds may use different mechanism of action or pathways to exert their antimicrobial effects, as implicated in the lowered MICs. Therefore, the use of current antibiotics could be maintained in their combination with plant-derived antibacterial agents as a therapeutic option in the treatment of S. aureus infections.The wide use of antibiotics in the treatment of bacterial infections has led to the emergence and spread of resistant strains. Staphylococcus aureus is an important pathogen both in community acquired and healthcare associated infections. The organism has successfully evolved numerous strategies for resisting the action to practically all antibiotics [1]. Resistance to methicillin is now widely described in the community setting (CMRSA), thus the development of new drugs or alternative therapies is urgently necessary.Plants are known to produce a variety of compounds to protect themselves against a range of microorganisms including plant pathogens and environmental organisms, an indication of the successful defense mechanisms developed. Therefore, plants and their secondary metabolites are a promising source to provide structurally diverse bioactive compounds as potentially therapeutic agents, including antimicrobials. However, plant-derived a
The impact of adherence and disease control on resource use and charges in patients with mild asthma managed on inhaled corticosteroid agents
P Navaratnam, HS Friedman, E Urdaneta
Patient Preference and Adherence , 2010, DOI: http://dx.doi.org/10.2147/PPA.S9800
Abstract: ct of adherence and disease control on resource use and charges in patients with mild asthma managed on inhaled corticosteroid agents Original Research (3290) Total Article Views Authors: P Navaratnam, HS Friedman, E Urdaneta Published Date June 2010 Volume 2010:4 Pages 197 - 205 DOI: http://dx.doi.org/10.2147/PPA.S9800 P Navaratnam1, HS Friedman2, E Urdaneta3 1Eympres Research, LLC, Hilliard, OH, USA; 2Analytic Solutions, LLC, New York, NY, USA; 3Schering-Plough Corporation, Kenilworth, NJ, USA Objective: Inadequate asthma control may affect asthma resource use and treatment charges, consequently contributing to the growing economic burden of asthma. The study objective was to determine the impact of medication adherence and asthma control on resource use and charges in mild asthmatic patients treated with inhaled corticosteroids (ICSs). Research design and methods: A claims database was analyzed retrospectively from October 2001–December 2007 to identify mild asthmatic patients aged 12–65 years who began ICS treatment. Demographics, drug utilization, and resource use for each patient were identified for the 365-day period before and after the index date (pre-index and post-index periods, respectively). Patients were designated as having high control high adherence (HCHA) or low control low adherence (LCLA) based on post-index exacerbations and the percentage of days covered; not all patients who qualified for study inclusion met adherence designation requirements. Differences between the HCHA and LCLA cohorts in resource use (eg, asthma treatment days) and asthma-related treatment charges were assessed. Results: Compared with the HCHA cohort (n = 483), the LCLA cohort (n = 258) had more asthma treatment days (2.9 vs 3.9, respectively; P < 0.0001) and higher overall asthma treatment charges ($2655 vs $3345, respectively; P < 0.0001) in the post-index period. An adjusted odds ratio suggested that patients receiving mometasone furoate (MF) were approximately 5 times more likely to belong to the HCHA cohort than patients receiving any other ICS (P < 0.0001). Conclusions: Better asthma control and adherence to prescribed ICSs are associated with lower asthma-related resource use and charges. Mild asthmatic patients receiving MF were more likely to be in the HCHA cohort than patients receiving other ICSs, perhaps due to the once-daily dosing of MF. Current NAEPP guidelines recommend low-dose ICS monotherapy for mild persistent asthma; thus, it is critical to optimize mild persistent asthma control and limit unnecessary resource use and charges.
The impact of adherence and disease control on resource use and charges in patients with mild asthma managed on inhaled corticosteroid agents
P Navaratnam,HS Friedman,E Urdaneta
Patient Preference and Adherence , 2010,
Abstract: P Navaratnam1, HS Friedman2, E Urdaneta31Eympres Research, LLC, Hilliard, OH, USA; 2Analytic Solutions, LLC, New York, NY, USA; 3Schering-Plough Corporation, Kenilworth, NJ, USAObjective: Inadequate asthma control may affect asthma resource use and treatment charges, consequently contributing to the growing economic burden of asthma. The study objective was to determine the impact of medication adherence and asthma control on resource use and charges in mild asthmatic patients treated with inhaled corticosteroids (ICSs).Research design and methods: A claims database was analyzed retrospectively from October 2001–December 2007 to identify mild asthmatic patients aged 12–65 years who began ICS treatment. Demographics, drug utilization, and resource use for each patient were identified for the 365-day period before and after the index date (pre-index and post-index periods, respectively). Patients were designated as having high control high adherence (HCHA) or low control low adherence (LCLA) based on post-index exacerbations and the percentage of days covered; not all patients who qualified for study inclusion met adherence designation requirements. Differences between the HCHA and LCLA cohorts in resource use (eg, asthma treatment days) and asthma-related treatment charges were assessed.Results: Compared with the HCHA cohort (n = 483), the LCLA cohort (n = 258) had more asthma treatment days (2.9 vs 3.9, respectively; P < 0.0001) and higher overall asthma treatment charges ($2655 vs $3345, respectively; P < 0.0001) in the post-index period. An adjusted odds ratio suggested that patients receiving mometasone furoate (MF) were approximately 5 times more likely to belong to the HCHA cohort than patients receiving any other ICS (P < 0.0001).Conclusions: Better asthma control and adherence to prescribed ICSs are associated with lower asthma-related resource use and charges. Mild asthmatic patients receiving MF were more likely to be in the HCHA cohort than patients receiving other ICSs, perhaps due to the once-daily dosing of MF. Current NAEPP guidelines recommend low-dose ICS monotherapy for mild persistent asthma; thus, it is critical to optimize mild persistent asthma control and limit unnecessary resource use and charges.Keywords: adherence, asthma control, beclomethasone dipropionate, budesonide, fluticasone propionate, mometasone furoate, retrospective claims analysis
SHV-5 extended-spectrum beta-lactamases in clinical isolates of Escherichia coli in Malaysia
Subramaniam G,Palasubramaniam S,Navaratnam P
Indian Journal of Medical Microbiology , 2006,
Abstract: Escherichia coli isolates resistant to ceftazidime isolated in the University Malaya Medical Center (UMMC) Kuala Lumpur, Malaysia, between the years 1998 and 2000 were studied for extended-spectrum β -lactamase (ESBL) production. All strains were analysed phenotypically and genotypically and found to be ESBL-producing organisms harbouring SHV-5 β-lactamase. This was confirmed by PCR-SSCP and nucleotide sequencing of the blaSHV amplified gene. As there was no evidence of ESBL activity in E. coli prior to this, coupled with the fact that there was a predominance of SHV-5 β-lactamases in Klebsiella pneumoniae isolates in UMMC, we postulate that the E. coli obtained the SHV-5 β-lactamase genes by plasmid transfer from the ESBL-producing K. pneumoniae.
Random Perturbations of a Periodically Driven Nonlinear Oscillator: Escape from a resonance zone
Nishanth Lingala,Navaratnam Sri Namachchivaya,Ilya Pavlyukevich
Mathematics , 2015,
Abstract: The phase space for a periodically driven nonlinear oscillator consists of many resonance zones. Let the strength of periodic excitation and the strength of the damping be indexed by a small parameter $\varepsilon$. It is well known that, as $\varepsilon \to 0$, the measure of the set of initial conditions which lead to 'capture in a resonance zone' goes to zero. In this paper we study the effect of weak noise on the escape from a resonance zone and obtain the large-deviation rate function for the escape.
Rapid detection of non-enterobacteriaceae directly from positive blood culture using fluorescent In situ hybridization
Wong E,Subramaniam G,Navaratnam P,Sekaran S
Indian Journal of Medical Microbiology , 2007,
Abstract: Fluorescent in situ hybridization (FISH) was carried out using two different oligonucleotide probes specific for Pseudomonas spp. and Acinetobacter spp. These probes were tested against different organisms and were found to be highly specific. Sensitivity testing showed that the probes were able to detect as low as 10 3 CFU/mL. In addition, FISH was carried out directly on positive blood culture samples and the detection of microorganisms took less than 2 h. We believe that FISH is a rapid method that can be used as a routine laboratory diagnostic technique for the detection of Acinetobacter spp. and Pseudomonas spp. in clinical samples.
Molecular characterization of genes encoding the quinolone resistance determining regions of Malaysian Streptococcus pneumoniae strains
Kumari N,Subramaniam G,Navaratnam P,Sekaran S
Indian Journal of Medical Microbiology , 2008,
Abstract: Genes encoding the quinolones resistance determining regions (QRDRs) in Streptococcus pneumoniae were detected by PCR and the sequence analysis was carried out to identify point mutations within these regions. The study was carried out to observe mutation patterns among S. pneumoniae strains in Malaysia. Antimicrobial susceptibility testing of 100 isolates was determined against various antibiotics, out of which 56 strains were categorised to have reduced susceptibility to ciprofloxacin (≥2 μg/mL). These strains were subjected to PCR amplification for presence of the gyrA, parC , gyrB and parE genes. Eight representative strains with various susceptibilities to fluoroquinolones were sequenced. Two out of the eight isolates that were sequenced were shown to have a point mutation in the gyrA gene at position Ser81. The detection of mutation at codon Ser81 of the gyrA gene suggested the potential of developing fluoroquinolone resistance among S. pneumoniae isolates in Malaysia. However, further experimental work is required to confirm the involvement of this mutation in the development of fluoroquinolone resistance in Malaysia.
Outcomes of a chronic heart failure training program for health professionals
Rosemary Higgins,Hema S Navaratnam,Barbara M Murphy,Sandra Walker
Journal of Nursing Education and Practice , 2013, DOI: 10.5430/jnep.v3n7p68
Abstract: The recent proliferation of chronic heart failure (CHF) disease management programs has created a need for greater provision of high quality training for health professionals in this area. Greater practitioner self-efficacy and positive practice change are both indicators of training impact. This study investigated the effects of health professional training by examining health professionals’ self-efficacy and practice changes. In addition, perceived barriers to setting up a program for CHF patients were explored. A sample of 46 health professionals completed a questionnaire prior to and immediately after participation in the training program. Telephone interviews with participants were undertaken four months after training. Participants’ self-efficacy significantly improved over the course of the training. This improvement was maintained four months later. Positive practice changes included translating knowledge into clinical practice, changing or setting up a program, improving patient management and education, implementing clinical pathways and using action plans. The major barriers experienced when setting up a program were limited funding and insufficient staff. One of the main highlights of this study was the increased self-efficacy of practitioners over the four month period, indicating the positive boost professional training can provide. This finding highlights participants’ motivation to change professional practice and to set goals for practice change. More CHF training programs need to be developed and a stronger emphasis towards evaluating these programs is necessary to ensure a prepared and proactive workforce in this area.
Real Time Measures of Prestin Charge and Fluorescence during Plasma Membrane Trafficking Reveal Sub-Tetrameric Activity
Shumin Bian, Dhasakumar Navaratnam, Joseph Santos-Sacchi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0066078
Abstract: Prestin (SLC26a5) is the outer hair cell integral membrane motor protein that drives cochlear amplification, and has been described as an obligate tetramer. We studied in real time the delivery of YFP-prestin to the plasma membrane of cells from a tetracycline-inducible cell line. Following the release of temperature block to reinstate trans Golgi network delivery of the integral membrane protein, we measured nonlinear capacitance (NLC) and membrane fluorescence during voltage clamp. Prestin was delivered exponentially to the plasma membrane with a time constant of less than 10 minutes, with both electrical and fluorescence methods showing high temporal correlation. However, based on disparity between estimates of prestin density derived from either fluorescence or NLC, we conclude that sub-tetrameric forms of prestin contribute to our electrical and fluorescence measures. Thus, in agreement with previous observations we find that functional prestin is not an obligate tetramer.
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