Qualification: 
MSc
renjitha21339@aims.amrita.edu

Renjitha Bhaskaran who has M.Sc. degree in Biostatistics joined as Lecturer in the Department of Biostatistics, School of Medicine, Kochi on 10th November 2014. She had worked as Guest Lecturer in biostatistics at St.Thomas College Palai from 12-01-2011 to 02-11-2014 and undergone job training on Pharmacognosy as part of her  Bachelor Degree in Botany (Vocational Model-2) Course in Nagarjuna. She had done three research projects at Regional Cancer Center Thiruvananthapuram, St.Mary’s Hospital Thodupuzha and Newman College, Thodupuzha respectively.

Publications

Publication Type: Journal Article

Year of Publication Title

2021

Renjitha Bhaskaran, Harijee, Aa, Thankappan, K., Sharma, M., Rao, N., Noothanapati, N., and Patel, T., “Estimation of Health Utility and Quality Adjusted Life Years in Bilateral Hand Transplantation, A Time Trade-off Study”, Annals of Plastic Surgery, vol. 86, no. 3, 2021.[Abstract]


Background
Hand transplantation and advances in the field of prostheses have opened new frontiers in the restoration of hand function among bilateral hand amputees (BHA). There is only scarce literature evaluating the health utility (HU) and quality adjusted life years (QALY) gained by bilateral hand composite tissue allotransplantation (CTA) or prosthesis over amputation. The study was focused on BHA restored with prosthesis or CTA.

Methods
The HU of three different health states (HS) namely, BHA, using prosthesis or with CTA and net QALYs gained by hand transplantation or prosthesis over amputation were computed by time trade-off (TTO) method among 236 study participants.

Results
Among 236 study participants, medical professional (120), general public (89), BHA (23), and bilateral hand transplant recipients (4) were included. The mean HU by TTO method among the study participants (n = 232) as BHA, using prosthesis or CTA was 0.34 (±0.24), 0.50 (±0.26) and 0.69 (±0.26) respectively. Bilateral hand CTA imparted an expected gain of 12.57 (±11.43) mean QALYs over amputation among the study participants. The subgroup analysis displayed higher mean HU in hand CTA recipient HS along with maximum QALY gained by CTA over amputation.

Conclusions
Bilateral hand CTA HS stands above the other 2 HSs, namely BHA and prosthesis, in terms of the health utility. As demonstrated by QALY gain of 12.57, participants' valuation of health utility is notably higher for CTA with acceptance of lifelong immunosuppressant rather than for a state of uncompromised physical health with a bilateral hand amputation.

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2021

Renjitha Bhaskaran, Pillai, A. Vasudevan, Ramachandran, P. Riju, and Borkar, “Effectiveness of fine needle aspiration cytology versus excisional biopsy in cervical lymphadenopathy”, Formosan Journal of Surgery, no. 244.9.146.183, 2021.[Abstract]


Background: Cervical lymphadenopathy is a common cause of referral to the surgery department. In low-resource countries, fine-needle aspiration cytology (FNAC) has been advocated as an alternative to more expensive surgical excision biopsies. Although FNAC is a simple and effective procedure in many conditions, its sensitivity and specificity still remains a question.
The primary aim of our study was to evaluate the sensitivity and specificity of FNAC of head-and-neck lymph nodes using histopathology as the gold standard.
Methods: All patients clinically diagnosed with cervical lymphadenopathy were included in the study, and they underwent FNAC followed by surgical excision and histopathology. The results were tabulated and analyzed using IBM SPSS V.20.0 software. To test the statistical significance between benign and malignant groups, Chi-square test was used, and the difference in FNAC and histopathology were analyzed using McNemar's test.
Results: The mean age group in our study of 86 patients was 45.20 ± 18.20 years with equal sex distribution. Among 23 male patients with age above 45 years, 15 patients (65.2%) had malignancy in the lymph node. Level V lymph nodes were most commonly involved (n = 31 [36%]), of which 13 were diagnosed as malignancy and 10 as tuberculosis (TB). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of FNAC in comparison to histopathology for diagnosis of malignancy were found to be 79.4%, 98.1%, 96.4%, and 87.9%, respectively, and for TB was 77.8%, 87.5%, 87.5%, and 77.8%, respectively.
Conclusion: FNAC of head-and-neck lymph nodes has comparable sensitivity and specificity with histopathological examination. It has a very high (96.4%) PPV in detecting malignancy and 100% for detecting metastatic disease in cervical lymph nodes. In patients with suspected lymphoproliferative disorder and in patients above 45 years of age, open biopsy is recommended. For younger patients and in level V cervical lymphadenopathy, irrespective of age, FNAC should be the first invasive diagnostic tool of choice.

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2021

Renjitha Bhaskaran, Rahul, D. Palabatla, K, D. Smitha., and Pillai, D. M. G. K., “Non-Invasive Diagnosis of Liver Fibrosis and Cirrhosis: Role of Apri, Fib-4 and its Correlation with Liver Stiffness Measurements (LSM) by Fibroscan; ”, Annals of Medical and Health Sciences Research, vol. 11, no. 3, 2021.

2020

Renjitha Bhaskaran, Indu,, R, S. K., Jaya, A. Chandrabab, Thankappan, K., Iyer, S., Pavithran, J., Madhumita Kumar, and V, A., “Exploring the utility of fibreoptic endoscopic evaluation of swallowing in young children- a comparison with vediofluoroscopy”, International Journal of Pediatric Otorhinolaryngology, vol. Volume 138, 2020.[Abstract]


Objectives/hypothesis: In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy.

Study design: Prospective, observational.

Methodology: Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used.

Results: FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05).

Conclusion: FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.

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2020

Renjitha Bhaskaran, Joy, R. Anne, Thelakkattusserry, S. Kamalasana, Vikkath, N., Krishnan, S., Vasudevan, D., and Ariyannur, P. S., “Somatic mutation detection efficiency in EGFR: a comparison between high resolution melting analysis and Sanger sequencing”, Joy et al. BMC Cancer , 2020.[Abstract]


Background
High resolution melting curve analysis is a cost-effective rapid screening method for detection of somatic gene mutation. The performance characteristics of this technique has been explored previously, however, analytical parameters such as limit of detection of mutant allele fraction and total concentration of DNA, have not been addressed. The current study focuses on comparing the mutation detection efficiency of High-Resolution Melt Analysis (HRM) with Sanger Sequencing in somatic mutations of the EGFR gene in non-small cell lung cancer.

Methods
The minor allele fraction of somatic mutations was titrated against total DNA concentration using Sanger sequencing and HRM to determine the limit of detection. The mutant and wildtype allele fractions were validated by multiplex allele-specific real-time PCR. Somatic mutation detection efficiency, for exons 19 & 21 of the EGFR gene, was compared in 116 formalin fixed paraffin embedded tumor tissues, after screening 275 tumor tissues by Sanger sequencing.

Results
The limit of detection of minor allele fraction of exon 19 mutation was 1% with sequencing, and 0.25% with HRM, whereas for exon 21 mutation, 0.25% MAF was detected using both methods. Multiplex allele-specific real-time PCR revealed that the wildtype DNA did not impede the amplification of mutant allele in mixed DNA assays. All mutation positive samples detected by Sanger sequencing, were also detected by HRM. About 28% cases in exon 19 and 40% in exon 21, detected as mutated in HRM, were not detected by sequencing. Overall, sensitivity and specificity of HRM were found to be 100 and 67% respectively, and the negative predictive value was 100%, while positive predictive value was 80%.

Conclusion
The comparative series study suggests that HRM is a modest initial screening test for somatic mutation detection of EGFR, which must further be confirmed by Sanger sequencing. With the modification of annealing temperature of initial PCR, the limit of detection of Sanger sequencing can be improved.

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2020

H. Bhaskaran, Balan, S., Subramaney, G., Renjitha Bhaskaran, and V.Easwar, S., “Association Between Mucocutaneous Manifestations And Systemic Involvement In Childhood Onset Systemic Lupus Erythematosus”, Indian Journal Of Applied Research, vol. 10, no. 8, 2020.[Abstract]


Childhood ons et systemic l upu s e ryt hem ato sus (cSLE) is an autoim mune and autoina mmato ry multis ystem di sea se with heterogeneous presentation [1,2]. The symptoms, signs and laboratory manifestations can occur either simultaneously or sequentially in cSLE. In some cases, mucocutaneous (mc) manifestations develop rst followed by systemic manifestations; in some, they develop simultaneously. It is possible for the phenotype to remain as mc manifestations only without any systemic manifestations or there could be only systemic manifestations without any mc manifestations at all. Studies have shown that cSLE can have severe disease with greater activity and abrupt onset as compared to adult onset SLE [1,2]. In the case of cSLE it is prudent to perform accurate and prompt diagnosis as the clinical presentation can vary from acute disease, rapidly fatal disease to a chronic disease with intermittent or continuous course.

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2020

Renjitha Bhaskaran, Anand, A., Deepak Balasubramanian, Jayasankaran, S. C., Milind, K., Murthy, S., Narayana Subramaniam, Renjitha Bhaskaran, Jimmy Mathew, Sharma, M., Thankappan, K., and Iyer, S., “The use of tumor-to-tongue thickness ratio to predict the need for microvascular flap reconstruction following glossectomy in carcinoma tongue”, Journal of Head & Neck Physicians and Surgeons , vol. Vol 8(1) , no. pp. 34, 2020.[Abstract]


Background: Microvascular flap reconstruction (MFR) of medium–large tongue defects following ablative surgery is the standard of care. The decision for MFR is often made prior to surgery or intraoperatively depending on the extent of the defect and the volume of remnant tongue. However, there exists no objective technique to predict this requirement preoperatively. This knowledge is crucial for counseling and planning. We aimed to identify an objective magnetic resonance imaging (MRI) measurement tool to predict the need for MFR of tongue tumors. Materials and Methods: This was a retrospective analysis of patients undergoing surgery (with or without reconstruction) for squamous cell carcinoma of the tongue. Patients had a preoperative MRI as part of their assessment. As per our institution protocol, the decision for the requirement of MFR was made by a consensus of two experienced reconstructive surgeons intraoperatively. This decision was correlated with the ratio of tumor volume to the total tongue volume (tv) as observed in the MRI. Results: A total of 47 patients were identified. Twenty-eight patients underwent reconstruction, while 19 did not. The ratio of tumor thickness to tongue thickness (Tt/tt) was calculated, and a cutoff of >0.395 (sensitivity 89.3% and specificity 89.5%) was found to significantly correlate with the decision for MFR (P < 0.001). The volume of a tumor to total tv ratio was calculated from the data of 22 cases, and a cutoff of >4.2 (sensitivity 83.3 and specificity 90) was found to be correlated significantly with the decision for MFR (P < 0.001). Conclusion: Tt/tt ratio is a useful tool to determine the need for MFR of tongue tumor excision defects in the preoperative setting and can help guide counseling.

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2020

S. Dilip, Bendapudi, P., Renjitha Bhaskaran, and Roshni P. R., “Assessment of amikacin Induced Ototoxicity in a Neonatal ICU Setup-An experience from tertiary care Teaching Hospital in South India”, Research Journal of Pharmacy and Technology, vol. 13, no. 3, pp. 1467-1473, 2020.[Abstract]


Objectives

This study aimed to assess the prevalence of Amikacin induced ototoxicity in neonates in a tertiary care hospital and to elucidate the possible risk factors. Design: A retroprospective study on two hundred and sixty neonates admitted to the neonatal intensive care unit (NICU), who were treated with Amikacin. Ototoxicity was assessed by measuring the hearing impairment in neonates using Brainstem Evoked Response Audiometry (BERA) at the time of discharge. A repeat BERA was done for those who failed during the initial BERA.

Results

The prevalence of Amikacin induced ototoxicity in neonates was found to be 11.2% (29 out of 260). Among these 29, only 16 had a follow up BERA and 8 of them showed persistent hearing impairment at the 3 months BERA. Genetic anomalies had showed a significant association with hearing impairment (P value = 0.001). Among the 16 who were diagnosed with a genetic condition 43.8% of them had hearing impairment.. The value of CRP (mg/dl) during the 1st course of Amikacin therapy had shown a border line significance (P value =0.067) with hearing impairment. Conclusion: Genetic abnormalities have shown a significant relationship with hearing impairment, hence the use of Amikacin in such neonates should be monitored. We attribute the low prevalence rate of ototoxicity in the NICU population, even in the absence of a therapeutic drug monitoring system for Amikacin to the dosage regimen being used and to the good clinical practices being followed in the NICU.

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2019

R. Ahamed D, U., V., P, G. Kumar K., S, D. B., P, S. T., Naveen,, ,, Arun,, Indiresh,, Abhiram,, Sona,, Manu,, and Renjitha Bhaskaran, “Point-of-Care versus Central Laboratory Haemoglobin comparison in Emergency Room”, Amrita Journal of Medicine, vol. 15, no. 2, pp. 1 –44, 2019.

2019

S. Haridas, M Pillai, G., S, D. B., Kumar, G., P, S. T., B, S., Sudhi, M., and Renjitha Bhaskaran, “Evaluation of the association between parenteral Noradrenaline and arterial lactate levels in the critically ill patients with and without sepsis”, Amrita Journal of Medicine, vol. 15, no. 4, pp. 1 - 44, 2019.

2019

P. T, T, F. Louis, .P, R., N, A., Pillai, A., N, J., KR, S., and Renjitha Bhaskaran, “Ante Mullerian Hormone versus Antral Follicle Count as a predictor of ovarian response to controlled ovarian hyper stimulation in Assisted Reproductive Technique- A prospective study”, JMSCR (Journal of Medical Science And Clinical Research), vol. 7, no. 7, pp. 2455-0450, 2019.[Abstract]


Background: Ovarian reserve assessment in Assisted Reproductive techniques (ART) and the decision based on its value is a diagnostic dilemma. Among the tests available to assess ovarian reserve, the most commonly used tests include FSH, AFC and AMH.

Objectives: To assess whether AMH or AFC is a better predictor of ovarian response (as evidenced by folliculogenesis) and cycle outcome in ART and also to see the correlation between AMH and AFC.

Material and Methods: This was a prospective comparative study conducted in the Department of Reproductive Medicine and Surgery at Amrita Fertility Centre, Kochi from July 2017 to September 2018. The study group comprised of 80 women recruited for ICSI. The number of follicles more than 12 mm on day of trigger was the primary outcome studied. After trigger and oocyte retrieval followed by ICSI the rest of the dependent parameters of COH were assessed including the pregnancy rate. Based on the AMH and AFC subgroups (low / normal/ high), the various parameters were compared. Results were analyzed using SPSS version 20.

Results: Eighty women who underwent COH and ICSI were followed up till 12 weeks of pregnancy. Patients divided into AMH and AFC low, normal and high groups. With respect to the follicle number, on comparing between the AMH and AFC groups there was no difference between the low, normal and high sub groups (p = 0.76).

Conclusion: AMH and AFC are having same ability and clinical value in prediction of ovarian response. So AFC may be considered as a substitute for the expensive AMH estimation in predicting the ovarian response to stimulation.

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2019

Renjitha Bhaskaran, Viral, P., Rajanbabu, A., Pavithran, K., K, C., R.Nair, I., Gangadharan, P., and DK, V., “Long-term survival outcome of advanced epithelial ovariancancer: A single institutional study”, Indian Journal of Cancer, 2019.[Abstract]


Background: A number of patients with advanced-stage epithelial ovarian cancer do survive beyond 5 years. The long-term follow-up data are limited, especially for the Indian setting. We evaluated the 10-year survival outcome and influencing clinicopathological factors.

Methods: A retrospective analysis of advanced-stage epithelial ovarian cancer patients who underwent primary cytoreductive surgery (PCS) or interval cytoreductive surgery (ICS) from 2005 to 2008 was conducted. Survival analysis was performed with the Kaplan-Meier method, and the Cox proportional hazards model was used for prognostic clinicopathological factors analysis.

Results: Ninety-four patients with a median age of 54.5 (18-79) years were evaluated. The median follow-up period was 11.2 years. The overall survival (OS) rates at 5, 7, and 10 years were 37%, 23%, and 18%, respectively. The median OS (MOS) was 46 (95% confidence interval [CI], 36-55.8) months and progression-free survival (PFS) was 19.5 (15.3-23.6) months. Long-term survival was significantly predicted by R0 resection (complete cytoreduction with no macroscopic residual disease) and PFS >20 months while prolonged PFS was influenced by age ≤55 years and R0 resection. For the R0 resection group, patients who underwent PCS had better overall survival in comparison with ICS [72.1(25.2-119) months vs 47.4 (34.9-59.9)months] on 10 years follow-up but was not significant statistically.

Conclusion: Patients with age ≤55 years, R0 resection, PFS >20 months have a better 10-year survival outcome. Among R0 resection, patients undergoing PCS have clinically a better outcome on 10-year follow-up.

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2019

K. D. Salima, Dr Rajesh Gopalakrishna, Renjitha Bhaskaran, and R., R. P., “Physician Preference of Anti-diabetic Medications and Complications in Pancreatic Diabetes - An Experience from A Tertiary Care Teaching Hospital”, Research Journal of Pharmacy and Technology, Raipur, vol. 12, no. 3, 2019.[Abstract]


<p>Aim: There are no guidelines for use of diabetic medications in pancreatic diabetes. Hence we attempted to the<br />benefits of antidiabetic agents in pancreatic diabetes. Materials and methods: a total of 670 chronic pancreatitis<br />patients are selected. Out of that about 126 patients with pancreatic diabetic are selected for the study. The data<br />collected from 2010. Results: In this study mean age was found to be 53.86&plusmn;12.53. The male patients (73.8%)<br />were more predominant in this study than female patients (26.2%). The complications of chronic pancreatitis<br />among 126 patients, 126 (100) patient had diabetes mellitus (DM), 100 (79) patients had pain. Among 126<br />patients 52 (41.3%) patients had taken insulin only, 21 (16.7%) patients had taken insulin+ oral combination, 16<br />(12.7%) patients had taken Biguanides, 13 (10.3%) of patients had taken oral combinations, 13 (10.3%) patients<br />had taken alpha glucosidase inhibitors, 11 (8.7%) patients who are taken sulfonyl ureas. Most of the patients<br />took insulin monotherapy. Conclusion: Insulin was most preferred agent. Metformin was the most commonly<br />preferred oral antidiabetic agent.</p>

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2019

U. K. Menon, Raj, M., Antony, L., Soman, S., and Renjitha Bhaskaran, “Prevalence of Voice Disorders in School Teachers in a District in South India”, Journal of Voice, vol. 35, no. 1, 2019.[Abstract]


Background: Many professions tend to carry inherent risks for the practitioners. In such cases, it becomes mandatory for them to be aware of the risks and counselled about the preventive measures. The inevitable first step, however, is to ascertain the burden of risk. In the case of school teachers, it is known that they are prone to voice disorders of varying hues, at some point of their career. There should be an attempt to find the prevalence in the community. Presently, there is no such data documented from Kerala, a highly literate State in southern India. Aim and Objectives: The primary objective of this study was to document the prevalence of subjective dysphonia among the school teacher community. The secondary objective was to compare the prevalence and severity of dysphonia between primary and secondary school teachers. Materials and Methods: A cross-sectional study was conducted in 28 schools, using a screening questionnaire, based on similar ones used in other studies. All the schools were in the city of Kochi, the largest and most populous metropolitan area in Kerala. Teachers reporting a current voice complaint at the time of study were administered the validated vernacular version of the voice handicap index questionnaire (VHI 30). The completed questionnaires were collected and statistically analyzed. Results: The screening questionnaire was administered to 702 teachers; 165 were Primary school teachers (Class I–V), 242 Secondary (Class VI–XII), while 279 teachers had to take classes in both sections. The reported prevalence was 45.4% for present difficulty related to their voice, 52.8% for some voice problem in the last 1 year, and 70.1% for problems experienced during the duration of their teaching career. Possible risk factors like age, total years of teaching, hours of daily teaching and number of students taught did not show any significant association with voice problem. Conclusions: Nearly, half of all the screened school teachers reported a current voice problem, increasing to nearly three-fourths for symptoms during entire career. This is clearly a significant burden which must be addressed at various levels. The secondary school teachers seem to bear a bigger burden in this study. © 2019 The Voice Foundation

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2019

C. V. Lalithambika, Arun, C. S., Saraswathy, L. A., and Renjitha Bhaskaran, “Cognitive impairment and its association with glycemic control in type 2 diabetes mellitus patients”, Indian Journal of Endocrinology and Metabolism, vol. 23, pp. 353-356, 2019.[Abstract]


Introduction: Type 2 diabetes mellitus is one of the major causes of increasing morbidity worldwide. Effective screening is carried out routinely for diabetic retinopathy, neuropathy, and nephropathy. Of late, studies have reported that cognitive decline can occur in people with diabetes, which could go undetected for a long period, and hence routine screening could be warranted. Methodology: Our objective was to study the prevalence of previously unknown mild cognitive impairment (MCI) in type 2 diabetic patients visiting a tertiary care center with the Montreal Cognitive Assessment (MoCA) test and to study the correlations of HbA1c, fasting blood sugar (FBS), postprandial blood sugar (PPBS), age, and duration of diabetes with the MoCA scores. Seventy patients with type 2 diabetes mellitus were included in the study. Patients with MoCA scores ≥26 were considered to have normal cognition (NC) and those with <26 MCI. Results: MCI was noted in 38 (54.29%) type 2 diabetes mellitus patients and NC in 32 (45.71%). Those with MCI had higher HbA1c (8.79 ± 1.85 vs. 7.78 ± 1.60), higher FBS (177.05 ± 62.48 vs. 149.38 ± 54.38), and PPBS (282.03 ± 85.61 vs. 214.50 ± 82.43), which were statistically significant. The cognitive domains of executive function, naming, attention, language, and memory showed a statistically significant difference between those with MCI and NC. There were no differences in the mean age, duration of diabetes, and educational status between the groups. Conclusion: The high prevalence of MCI in type 2 diabetic patients highlights the importance of implementing routine cognitive testing. The correlation of cognitive impairment with poor glucose control needs further studies to find out whether improving glycemic control will help improve cognition. © 2019 Indian Journal of Endocrinology and Metabolism. Published by Wolters Kluwer - Medknow.

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2019

A. Ghurram, Krishna, N., Renjitha Bhaskaran, Kumaraswamy, N., Jayant, A., and Dr. Praveen Varma, “Patients who develop post-operative atrial fibrillation have reduced survival after off-pump coronary artery bypass grafting”, Indian Journal of Thoracic and Cardiovascular Surgery, vol. 36, no. 1, pp. 6–13, 2019.[Abstract]


Objective: Post-operative atrial fibrillation (POAF) increases hospital stay, resource utilization, morbidity, and mortality. However, there is paucity of data about its effect in Indian patients undergoing off-pump coronary artery bypass grafting (CABG). Methods: Seven hundred forty-eight patients underwent off-pump CABG from January 2015 to December 2016 (24 months). One hundred twenty-seven patients (16.7%) developed POAF. In an effort to mitigate the effects of wider risk factors on perioperative outcomes, a separate sub-analysis of patients based on risks quantified by EuroSCORE II (<> 3) was also performed. Results: Age > 60 years and development of sepsis were the independent predictors for the development of POAF. Thirty-day/mortality rate was higher in the POAF group (7.1% vs. 1.4%; p value < 0.001). POAF was associated with increased ICU and hospital stay and increased incidence of stroke and renal dysfunction. The survival was significantly lower in the POAF group compared with the normal sinus rhythm (NSR) (3-year survival in POAF was 81.3% vs. 94.4% in the NSR group; Hazard ratio (HR) 3.867 (1.989–7.516)). Intra-aortic balloon pump (IABP) usage, age ≥ 60 years and sepsis were independent predictors for the development of POAF in low-risk patients. For the NSR group, 1-year survival was 98% and 3-year survival was 95.7%. For the POAF group, 1-year survival was 94.4% and 3-year survival was 84.0% (HR. 3.794 (1.897–7.591)). Conclusion: The incidence of POAF was lower than reported in the wider global literature. Increasing age and development of post-operative sepsis were strong independent predictors of POAF. POAF increases the morbidity; length of hospital stay and these patients show decreased survival after off-pump CABG. © 2019, Indian Association of Cardiovascular-Thoracic Surgeons.

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2019

Rajesh Jose, Shetty, A., Krishna, N., Chathoth, V., Renjitha Bhaskaran, Jayant, A., and Dr. Praveen Varma, “Early and Mid-Term Outcomes of Patients Undergoing Coronary Artery Bypass Grafting in Ischemic Cardiomyopathy.”, J Am Heart Assoc, vol. 8, no. 10, p. e010225, 2019.[Abstract]


Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One-hundred and sixty-two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70&nbsp;years. Operative mortality was 11.62%. Thirty day/in-house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1&nbsp;year was 86.6%, and 5-year survival was 79.9%. Five-year event-free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18-35) to 39.9±8.3% (range 24-60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33-105.95). Even though there was a trend towards better early outcome in off-pump CABG , the 5-year survival rates were similar in off-pump and on-pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5-year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.

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2018

R. Rachel Paulose, Menon, P. Dileep, Renjitha Bhaskaran, and Sundaram, K. R., “Tumour Regression Grade - A Predictive Tool in Rectal Cancer: A 5-Year Experience from a Tertiary Centre in South India”, JMSCR (Journal of Medical Science And Clinical Research), vol. 6, no. 6, pp. 1005-1014, 2018.[Abstract]


Context: Multimodal therapy is the current recommended treatment of choice for rectal cancer. The downsizing effects of the neoadjuvant therapy/tumour regression can be assessed histologically in the resection specimen.

Aims: To assess the prognostic significance of pathological grade of tumour regression in rectal cancer treated with long course neoadjuvant therapy.

Settings and Design: This is a 5 year retrospective study conducted at a tertiary centre in South India.

Methods and Material: 137 patients with rectal adenocarcarcinoma pre-treated by long course neoadjuvant chemoradiation followed by surgery were analysed and categorised based on the Tumour Regression Grade(TRG) into 2 groups- Group 1(Good response, TRG 0,1) and Group 2 (Poor response, TRG 2,3). Other clinical and pathological features like lymphovascular/ perineural invasion, discontinuous extramural tumour deposits, resection margin status and pTNM stage of tumour were also evaluated and all variables along with TRG were correlated with disease progression and 5 year survival.

Statistical analysis used: IBM SPSS version 20.0 software. Categorical variables expressed using frequency and percentage and the continuous variables presented using mean and standard deviation. The chi-square test was used for finding prognostic factors. Univariate analyses of survival were carried out by Kaplan-Meier method and the evaluations of differences were performed with Log Rank test.

Results: Group 1 showed reduced risk for disease progression (p 0.01) and better mean disease free period and overall survival (p 0.017 and p <0.001 respectively). Poor tumour regression was associated with lymphovascular and perineural invasion, regional lymph node metastases (p<0.001), and advanced stage of disease, and predicted an unfavourable outcome with estimated shorter mean time until disease progression.

Conclusions: Assessment of primary tumour regression is an independent prognostic predictor. The addition of lymph node status is recommended in the pathological tumour regression grading system.

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2017

P. Roopa, Preethi, M., Dinesh, M., Renjitha Bhaskaran, and Sundaram, K., “Prognostic significance of pathological grading of tumour regression in post neoadjuvant chemoradiotherapy rectal cancer- A 5 year experience from a tertiary centre in S. India”, Annals of OncologyAnnals of Oncology, vol. 28, p. iii131, 2017.[Abstract]


Introduction: Multimodal therapy is the current recommended treatment of choice for rectal cancer. The effects of the neoadjuvant therapy can be determined by histological assessment of the resected specimen.

The aim of this 5 year retrospective study was to assess the prognostic significance of the pathological grading of tumour regression in the surgical resected specimens of patients with rectal cancer who have received neoadjuvant chemoradiotherapy. Other established prognostic factors were also assessed to see if they independently or in concert contributed to the outcome of these patients.

Methods: Patients with histologically proven rectal carcinoma who had received neoadjuvant therapy followed by curative surgical resection from Jan 2010 to Dec 2015 were retrospectively analysed. Pathological assessment included plane of surgical excision, site of rectal tumour (above/at/below the anterior peritoneal reflection), Tumour Regression Grade(TRG), presence of lymphovascular emboli, perineural invasion, discontinuous extramural tumour deposits, resection margin status including circumferential resection margin(CRM) and UICC TNM stage of tumour. The primary outcome was assessed by disease progression in 5years. Kaplan-Meier survival functions were computed and hazard ratios (HRs) calculated, with the Cox proportional hazards model. Subgroup analyses were done to test for effect modification by other predicting factors

Results: A total of 166 patients were included and all patients were histologically categorised into 2 groups, Group 1(Good response, TRG 0&1) and Group 2 (Poor response, TRG 2&3). 25.3% showed no viable or a few residual tumor cells in the rectal wall (Group 1). Patients who had long course neoadjuvant therapy(CTRT) followed by delayed surgery had best chance for good tumour regression(30%). Poor tumour regression (Group 2) was associated with lymphovascular and perineural invasion and regional lymph node metastases (p = <0.001). Good tumour response was associated with reduced risk for disease progression(p = 0.01). There was also statistical significance in the mean disease free period between the two groups (p 0.017). Overall survival (OS) was better in the responder group (TRG 0,1) than in the nonresponder group (TRG 2, 3) (P < 0.001, log-rank test).

Conclusion: Multimodal treatment of rectal cancer warrants pathological assessment (TRG) of the effects of neoadjuvant therapy to predict disease outcome. It is recommended that TRG should be assessed in all neoadjuvant treated rectal resection specimens.

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2017

A. Narayanan, Venu, R. P., Renjitha Bhaskaran, and R, R. P., “Hepatic Encephalopathy Precipitated By Sepsis and Outcome of Its Management”, International Journal of Pharmaceutical Research (IJPR), 2017.[Abstract]


The aims of the present study 1)to determine the frequency of sepsis as precipitating factor for HE 2) evaluate the effectiveness of antibiotic therapy in SAE (Sepsis associated encephalopathy) and to determine the outcome of management.3) To study the effectiveness of secondary prophylactic antibiotic therapy. Prospective observational study of 150 patients who are diagnosed with cirrhosis complicated with hepatic encephalopathy. All the patients satisfying the inclusion and exclusion criteria were selected for the study and relevant data were collected. Antibiotics were assessed for appropriateness according to type, time, dose and frequency. The antibiotic prescribed was deemed to be appropriate if it was prescribed according to the microbial susceptibility data whereas it was inappropriate if it did not reflect the susceptibility data. If the antibiotic is not administered within 24hr after the culture and sensitivity report is considered as inappropriate. Outcome is measured with respect to the death or survival of patients. A total of 150 patients were enrolled in the study. Sepsis (55.3%) was the common precipitating factor for all patients with cirrhosis to develop hepatic encephalopathy. Antibiotic therapy was inappropriate (57.8%) in patients due to incorrect type, dose and frequency. There was a significant association between patient outcome (P=<0.001) and inappropriateness of antibiotics. Severity of sepsis was a strong prognostic factor of mortality. Mortality from HE is likely to decrease due to early diagnosis and appropriate use of antibiotics. These results emphasize the importance of providing appropriate antibiotics for treating infection.

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2017

G. Deepak, Appu, T., Balagopal, N. T., Lalitha, B., and Renjitha Bhaskaran, “FGFR3 Mutation Analysis in Voided Urine Sample and Its Histopathological Correlation In Transitional Cell Carcinoma of Urinary Bladder”, International Journal Of Scientific Research, vol. 6, no. 2, 2017.[Abstract]


Introduction: Bladder cancer is the most expensive and time consuming malignancy because of it high recurrence rate and disease progression. FGFR3 mutation in bladder cancer is associated with non muscle invasive and low grade disease this making it a non invasive marker of for nonaggressive disease.

AIM: e aim of this study was to detect FGFR3 mutation in a single voided urine sample of bladder cancer patients in Indian population and its diagnostic and prognostic performance.

MATERIALS AND METHOD:A prospective observational study was carried out with one-year follow-up of primary bladder tumor patients . Urine samples were collected before TURP. Screening for the most prevalent FGFR3 mutations was done using urinary cells. e prognostic significance of an FGFR3 mutation at the time of the initial diagnosis was determined. e performance of the test in diagnosing and/or predicting recurrence during follow up was assessed .

RESULTS: Of 39 patients studied, 2 (5.62%) had a positive analysis before TUR (FGFR3 MT). ere was no statistical significance between MT and WT when compared with grade and stage of tumor. Neither there was any significant risk of tumor recurrence and progression in FGFR3 mutated as compared to wild type group.

Conclusion: Among patients with an FGFR3 mutation in the initial tumor, a noninvasive urine test from a single voided sample before primary resection cannot be valuable in diagnosing or predicting subsequent recurrence or progression.

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2016

A. V., Kumar, A., J., A. Kumar, P., S. T., B., S., Prasad, B., Mohan, N., Karunanidhi, K., Sundaram, K. R., Renjitha Bhaskaran, Menon, P. R., and Gireesh Kumar K. P., “Prevalence of hyponatremia in adult patients presenting with altered sensorium to the emergency department of a tertiary care centre”, Amrita Journal of Medicine, vol. 11, no. 1, 2016.

2016

R. Prabhu, Renjitha Bhaskaran, Shenoy, V., G, R., and Sidharthan, N., “Clinical characteristics and treatment outcomes of primary autoimmune hemolytic anemia: a single center study from South India.”, Blood Res, vol. 51, no. 2, pp. 88-94, 2016.[Abstract]


<p><b>BACKGROUND: </b>Autoimmune hemolytic anemia (AIHA) is a less recognized, potentially fatal condition. There is a scarcity of data on clinicoserological characteristics and response to therapy concerning this disease from South India.</p><p><b>METHODS: </b>Data for 33 patients with primary AIHA recorded from July 2009 to June 2015 were retrospectively analyzed for clinical presentation, response to frontline therapy, durability of response, time to next treatment (TTNT), and response to second-line agents.</p><p><b>RESULTS: </b>The median follow-up period was 50 months. Among 33 patients, 48% of the cases were warm autoimmune hemolytic anemia (WAIHA), 46% were cold agglutinin disease (CAD), and 6% were atypical. Three-fourth of patients had severe anemia (<8 g/dL hemoglobin [Hb]) at onset; younger patients (age <40 yr) had more severe anemia. All of the patients who required treatment received oral prednisolone at 1.5 mg/kg/d as a frontline therapy, and the response rate was 90% (62% complete response [CR] and 28% partial response [PR]). The overall response to corticosteroids in WAIHA and CAD was 87% and 92%, respectively. The median corticosteroid duration was 14 months, and 50% of the patients required second-line agents. Fourteen patients received azathioprine as a second-line agent, and 11 of these patients responded well, with half of them not requiring a third agent. Four patients developed severe infections (pneumonia, sepsis, and soft tissue abscess) and two had life-threatening venous thrombosis. One case of death was recorded.</p><p><b>CONCLUSION: </b>AIHA is a heterogeneous disease that requires care by physicians experienced in treating these patients.</p>

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2015

A. Venugopalan, Kumar, A., Sreekrishnan,, Balachandran, S., Medayil, R., Prasad, B., Mohan, N., Kumar, A., Karunanidhi, K., R., S. K., Renjitha Bhaskaran, Menon, P. R., Kumar, G., and Pillay, V. V., “A study to estimate the prevalence of advise reactions to anti-snake venom therapy in a tertiary care centre in South India”, Amrita Journal of Medicine, 2015.