Publications by authors named "Nair Rajesh"

Background: There is no standard treatment to accelerate recovery from melphalan-induced thrombocytopenia in multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT). Romiplostim, a thrombopoietin receptor agonist, has been developed to upregulate platelet production.

Objective: This study aimed to assess the efficacy and safety of romiplostim in reducing platelet transfusions post-ASCT in MM patients.

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Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis (AS) and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exist a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomic variations, disparity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of AS in the Asia-Pacific region.

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: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon.

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Article Synopsis
  • The study examines urological complications in patients who underwent total pelvic exenteration (TPE) for locally advanced and recurrent rectal cancer, highlighting a significant occurrence of issues post-surgery.
  • A total of 128 patients were assessed, with common complications being transient acute kidney injury and urinary tract infections, resulting in an overall complication rate of 51.6%.
  • The findings indicate that the type of cancer (LARC vs RRC) and prior radiation treatment did not significantly influence the rates of urological complications.
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Background: Meningiomas are neoplasms primarily originating from arachnoid cells and are classified into 3 grades (1, 2, and 3) based on histological features according to the World Health Organization classification. However, this classification system is imperfect especially for grade 1 and 2 meningiomas as many grade 1 tumors recur. Meningiomas are hence a histologically diverse class of tumors exhibiting more unpredictable behavior.

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  • Transcatheter valve-in-valve (VIV) and valve-in-ring (VIR) therapies for failing mitral bioprosthetic valves are being researched to understand their effectiveness and safety over time.
  • A meta-analysis reviewed 34 studies involving 7,047 patients to assess short and long-term outcomes, focusing on complications like mortality, stroke, and procedural success rates.
  • Findings indicated high success rates of 94.8% for VIV and 80.5% for VIR, with varying short-term mortality and stroke risks across VIV, VIR, and traditional redo surgical mitral valve replacements (SMVR).
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No pan-India-specific guidelines exist for the management of urological cancers. Although western guidelines are useful for informing management strategies, they do not account for the nuances of management in the Indian context. A modified Delphi method was used to provide a framework for the systematic development of India-centric guidelines for the management of three uro-oncology disease states: small renal masses, non-muscle invasive bladder cancer and high-risk/locally advanced prostate cancer.

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Background: When faced with treatment options, patients are asked to participate in decision-making. We sought to determine which treatment aspects matter most for individuals treated for muscle invasive bladder cancer (MIBC), with an aim to improve understanding of patient preferences and what trade-offs patients are willing to accept. Our study consisted of a discrete choice experiment (DCE): a type of questionnaire used to elicit preferences in the absence of real-world choice.

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  • The CUT-less trial investigates whether patients diagnosed with low-risk non-muscle-invasive bladder cancers (NMIBCs) can safely skip a second transurethral resection of bladder tumor (Re-TURBT) by using advanced imaging and diagnostic techniques during their initial treatment.
  • The study involves 327 patients who will receive either standard care with a second TURBT or an experimental procedure using photodynamic diagnosis (PDD) without the second resection, to see if outcomes remain comparable.
  • Key measures of the trial include short-term recurrence rates of bladder cancer, as well as assessments of patients' quality of life and the economic impact of the treatment options.
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Background: Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal.

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Background: Increasing data suggests that androgen receptor signaling may play an important role in the carcinogenesis of urothelial cancers. While the chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results, the evidence regarding 5-ARi treatment, and the risk of incident Upper Tract Urothelial Carcinoma (UTUC) development is lacking. Therefore, our objective was to investigate the impact of the 5-ARi administration on the incidence of new UTUC cases using a large US database.

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  • VP shunts are commonly used to treat infants with aqueductal stenosis, but shunt migration can occur, including rare cases of migration into the thoracic cavity due to negative pressure.* -
  • A one-year-old infant with symptoms of raised intracranial pressure underwent emergency VP shunt placement, which initially went well but later resulted in acute breathing issues due to the shunt migrating into the pleural space.* -
  • Imaging showed that the shunt likely tunneled improperly during the first surgery, leading to its eventual migration over three months, necessitating an emergency revision to address the issue.*
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Advancements in machine learning offer promising avenues for the identification of ADHD symptoms in adults, an endeavour traditionally encumbered by the intricacies of human behavioural patterns. In this paper, we introduce three innovative dual-stream models. The proposed approach utilises a novel multi-modal dataset recorded for ADHD symptoms detection, leveraging RGB video alongside facial, body posture and hand landmark data.

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  • The exact causes and development of bladder endometriosis are not completely understood, but it can lead to various urinary and pain symptoms, which have complex origins.
  • Diagnosis can be accurately made through imaging, and treatment options include medical management and surgery, with excisional surgical procedures being effective and associated with low complications and recurrence rates.
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  • Brown tumors, associated with secondary hyperparathyroidism in chronic kidney disease (CKD), are uncommon but can lead to significant issues, such as neurological deficits and paraplegia.
  • A case study highlights a 35-year-old man with CKD on dialysis who experienced acute paraplegia due to a T8 vertebral body lesion, requiring emergency surgery to relieve spinal cord compression.
  • Diagnosis of brown tumors must be considered in CKD patients, as they can resemble other serious spinal conditions and may cause acute hemorrhage, emphasizing the need for prompt surgical treatment for better recovery outcomes.
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Background: Coronary endarteritis and stent abscess following percutaneous coronary intervention (PCI) are rare and challenging conditions with no clear treatment guidelines available.

Aims: This retrospective study aims to present the clinical features, patient and procedural factors, management strategies, and outcomes in 11 consecutive cases referred between 2018 and 2022.

Methods: We retrospectively analysed 11 cases of coronary endarteritis and stent abscess post-PCI that were referred from various centres.

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Background: The benefits of a robot-assisted radical cystectomy (RARC) compared to an open approach is still under debate. Initial data on RARC were from trials where urinary diversion was performed by an extracorporeal approach, which does not represent a completely minimally invasive procedure. There are now updated data for RARC with intracorporeal urinary diversion that add to the evidence profile of RARC.

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Background: The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).

Methods: Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan Research Databases between 2007 and 2021.

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Inclusion complexes require higher concentration of Beta cyclodextrins (βCD) resulting in increased formulation bulk, toxicity, and production costs. This systematic review offers a comprehensive analysis using Quality by design (QbD) as a tool to predict potential applications of Polyvinylpyrrolidone (PVP) as a ternary substance to address issues of inclusion complexes. We reviewed 623 documents from 2013 to 2023 and Eighteen (18) research papers were selected for statistical and meta-analysis using the QbD concept to identify the most critical factors for selecting drugs and effect of PVP on inclusion complexes.

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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder commonly seen in childhood that leads to behavioural changes in social development and communication patterns, often continues into undiagnosed adulthood due to a global shortage of psychiatrists, resulting in delayed diagnoses with lasting consequences on individual's well-being and the societal impact. Recently, machine learning methodologies have been incorporated into healthcare systems to facilitate the diagnosis and enhance the potential prediction of treatment outcomes for mental health conditions. In ADHD detection, the previous research focused on utilizing functional magnetic resonance imaging (fMRI) or Electroencephalography (EEG) signals, which require costly equipment and trained personnel for data collection.

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Background And Objective: Venous thromboembolism (VTE) is a significant predictor of worse postoperative morbidity in cancer surgeries. No data have been available for patients with preoperative VTE and upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Our aim was to assess the impact of a preoperative VTE diagnosis on perioperative outcomes in the RNU context.

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Study Objective: To highlight a case where a nephroureterectomy and partial bladder cystectomy needed to be done due to endometriosis.

Design: A video article demonstrating a case study and the surgical management.

Setting: Ureteral endometriosis is a complex form of endometriosis [1].

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Abstract: Secondary correction for aesthetic purposes can be more challenging as the fractured segments may be united in abnormal positions and would require osteotomy procedures before mobilizing the segments for reconstruction. Such maneuvers require adequate exposure and visibility. The subcranial approach is an effective alternate to classical approaches, which required frontal lobe retraction.

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