Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

Evaluation of 5-fluorouracil pharmacokinetic models and therapeutic drug monitoring in cancer patients

Abstract: 5-fluorouracil (5-FU) remains the cornerstone of all currently applied regimens for the treatment of patients with cancers of the gastrointestinal tract, breast, and head and neck. Unfortunately, a large variation in the clearance of 5-FU has been observed between patients, suggesting that some patients might receive nonoptimal 5-FU doses. However, therapeutic drug monitoring of 5-FU has been shown to result in reduced intra- and inter-individual variability in 5-FU plasma levels and pharmacokinetically guided dose adjustments of 5-FU-containing therapy results in a significantly improved efficacy and tolerability. To date, compartmental Michaelis-Menten elimination-based modeling has proven to be a sensitive and accurate tool for analyzing the pharmacokinetics of 5-FU and to identify patients with a dihydropyrimidine dehydrogenase deficiency. These Michaelis-Menten models also allow the use of a limited sampling strategy and offer the opportunity to predict a priori the 5-FU plasma concentrations in patients receiving adapted doses of 5-FU.

CO2 laser for otosclerosis: safe energy parameters.

Abstract: Safe energy parameters for each Sharplan CO2 laser model (734, 1040, 1100A) were established in the laboratory. Ultrasensitive pyroelectric detectors analyzed the precise energy package delivered to the operative field with each of these power setting. Subsequently, 0.6-mm stapedotomy and stapedectomy revisions were performed under simulated operating room conditions while measuring temperature changes in the vestibule with a thermocouple. Table I illustrates safe energy settings for each of the Sharplan CO2 models tested. These power settings produced no more than 0.3 degrees C temperature rise in the vestibule during stapedotomy, and no more than 0.5 degrees C during stapedectomy revision. Following these guidelines, the CO2 laser was then employed to perform stapedotomy and stapedectomy revisions in otosclerosis patients. In over 200 consecutive operations performed under local anesthesia with the CO2 laser, no patient became dizzy intraoperatively while the CO2 laser was applied to the stapes footplate or the oval window neomembrane, confirming the lack of significant caloric effect to the inner ear at these energy settings. More importantly, no patient has yet experienced significant sensorineural hearing loss in the speech range.

Off-pump versus on-pump coronary artery bypass surgery: does the pump influence outcome?

Abstract: Background This study assessed hospitalization outcome differences for patients undergoing off-pump coronary artery bypass (OPCAB) grafting compared with patients having coronary artery bypass grafting with cardiopulmonary bypass. Study design We conducted a nested case—control study from an 8-year, hospitalization cohort (n = 7,905) in which the data were collected prospectively. Inclusion criteria included a coronary artery bypass graft only and age greater than 18 years. Cases were patients undergoing OPCAB (n = 360) and controls were patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (n = 1,080). Cases were matched to controls 1:3 on five variables: age (± 3 years), gender, diabetes, New York Heart Association Functional Classification, and surgical year (± 3 years). The 13 outcomes of interest were mortality, length of hospitalization, ICU length of stay, return to ICU, ventilator time, intraoperative complications, pulmonary complications, neurologic complications, renal complications, gastrointestinal complications, sternal wound infections, highest postoperative creatine kinase level, and units of blood products given during the procedure. Using logistic regression we controlled for eight confounding variables. Results Patients undergoing OPCAB had a significantly shorter length of hospitalization (relative risk [RR] = 0.95; 95% CI, 0.91–0.99%), fewer pulmonary complications (RR = 0.45; 95% CI, 0.22–0.88%), fewer intraoperative complications (RR = 0.04; 95% CI, 0.0048–0.31%) fewer blood product units given (RR = 0.31; 95% CI, 0.14–0.42%) and lower postoperative creatine kinase (RR = 0.99; 95% CI, 0.98–0.99%). There were no considerable differences for the remaining nine outcomes, including mortality and neurologic complications. Conclusions Patients undergoing OPCAB had a considerably shorter length of hospitalization, had fewer pulmonary and intraoperative complications, and received a lower volume of blood products.