Browsing by Author "Jeyaseelan, Lakshmanan"

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Ankle dorsiflexion assist using a single sensor-based FES: Results from clinical study on patients with stroke
(2023) Jeyaseelan, Lakshmanan
Objective: Ankle foot orthosis (AFO) commonly prescribed to manage foot-drop following stroke restricts ankle mobility. Commercially available functional electrical stimulation (FES) is an expensive alternative to achieve desired dorsiflexion during swing phase of the gait cycle. An in-house cost effective innovative solution was designed and developed to address this problem. The aim of the study was to compare spatiotemporal gait characteristics of patients with foot-drop following stroke using commercially available FES against in-house developed versatile single sensor-based FES. Material and Methods: Ten patients with cerebrovascular accident of at least 3 months duration and ambulant with/without AFO were recruited prospectively. They were trained with Device-1 (Commercial Device) and Device-2 (In-house developed, Re-Lift) for 7 h over 3 consecutive days with each device. Outcome measures included timed-up-and-go-test (TUG), six-minute-walk-test (6MWT), ten-meter-walk-test (10MWT), physiological cost index (PCI), instrumented gait analysis derived spatiotemporal parameters, and patient satisfaction feedback questionnaire. We calculated intra class correlation between devices and median interquartile range. Statistical analysis included Wilcoxon-signed-rank-test and F-test (P < 0.05 was considered statistically significant). Bland Altman and scatter plots were plotted for both devices. Results: Intra class correlation coefficient for 6MWT (0.96), 10MWT (0.97), TUG test (0.99), and PCI (0.88) reflected high agreement between the two devices. Scatter plot and Bland Altman plots for the outcome parameters showed good correlation between two FES devices. Patient satisfaction scores were equal for both Device-1 and Device-2. There was statistically significant change in swing phase ankle dorsiflexion. Conclusions: The study demonstrated good correlation between commercial FES and Re-Lift suggestive of the utility of low-cost FES device in clinical setting.
Can Generalized Poisson model replace any other count data models? An evaluation
(2021) Jeyaseelan, Lakshmanan
Background: Count data represents the number of occurrences of an event within a fixed period of time. In count data modelling, overdispersion is inevitable. Sometimes, this overdispersion may not be just due to the excess zeros but may be due to the presence of two or more mixtures. Hence the main objective is to examine for the presence of mixtures if any, with excess zeros and compare Generalized Poisson model, Mixture models with other count data models using real time and simulated data. Methods: Three real time over-dispersed datasets were used for the comparison of the models. The real time data models were compared using information criteria like AIC and BIC and regression coefficients. Data was also simulated using mixture Poisson with excess zeros. The simulation was repeated for different sample sizes were used to identify the better model. Results: Generalized Poisson showed consistently lower bias and MSE when compared to the other models for varying sample of sizes. AIC and BIC values were almost similar for Generalized Poisson, ZIP and Mixture Poisson model. Similar findings were also obtained from real time data. Conclusion: Generalized Poisson models provides a better fit for overdispersed data due to excess zeros, consistently in real time and simulated with varying sample sizes. Negative Binomial models can be redistricted or reevaluated against Generalized Poisson model.
Exact correction factor for estimating the OR in the presence of sparse data with a zero cell in 2 × 2 tables
(2023) Jeyaseelan, Lakshmanan
Abstract: In case-control studies, odds ratios (OR) are calculated from 2 × 2 tables and in some instances, we observe small cell counts or zero counts in one of the cells. The corrections to calculate the ORs in the presence of empty cells are available in literature. Some of these include Yates continuity correction and Agresti and Coull correction. However, the available methods provided different corrections and the situations where each could be applied are not very apparent. Therefore, the current research proposes an iterative algorithm of estimating an exact (optimum) correction factor for the respective sample size. This was evaluated by simulating data with varying proportions and sample sizes. The estimated correction factor was considered after obtaining the bias, standard error of odds ratio, root mean square error and the coverage probability. Also, we have presented a linear function to identify the exact correction factor using sample size and proportion.
Impact of exclusive breast feeding until six months of age on common illnesses: A prospective observational study
(2022) Jeyaseelan, Lakshmanan
Objectives: The WHO recommends exclusive breast feeding (EBF) for all infants for the first six months of life. National Family Health Survey 4 (2015 16) shows EBF rates of only 54.9%. We conducted a prospective study to assess prevalence of EBF and incidences of illnesses in infants from birth till six months of age. Methods: Healthy term infants born in our hospital between December 2017 and November 2018 were recruited at birth. Structured diary cards were given to mothers to record feeding patterns, occurrence and severity of illnesses. Mothers were interviewed at 6, 10, 14 and 26 weeks or contacted by telephone at 18 and 22 weeks. Data were analyzed using SPSS IBM Statistics 22. Results: The prevalence of EBF among 450 infants (M:F = 1.3:1) who completed the study was 47% at 6 months. 185 (69 EBF + 116 non EBF) of 450 infants reported a total of 242 illnesses, most commonly respiratory (82.6%) followed by gastrointestinal (11.6%). Number of illnesses per infant was 0.45 and 0.6 in EBF group and non EBF group respectively (p = 0.015). Illness incidences in EBF infants were significantly lower during all successive time intervals after 10 weeks of age. Logistic regression analysis confirmed significantly lower illness incidences in EBF infants at 10 14 weeks [OR = 0.27 (CI 0.12 0.64)] and 18 22 weeks [OR = 0.50 (CI 0.27 0.90)]. Conclusions: The prevalence of EBF is suboptimal in our setting, with illness incidences significantly higher in non EBF children. Appropriate intervention strategies need to be tailored to reinforce early initiation and continuation of EBF throughout the first six months of life.
Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care
(2024) Jeyaseelan, Lakshmanan
Abstract Objectives: This study evaluated the incidence and risk factors for deep venous thrombosis (DVT) while on thromboprophylaxis, in patients admitted to the medical intensive care unit (MICU), and to assess its impact on outcomes. Methods: Consecutive patients admitted to the MICU underwent compression ultrasound of the jugular, axillary, femoral, and popliteal veins at admission, day 3 and 7 to screen for DVT. All patients were on pharmacological and/or mechanical thromboprophylaxis as per protocol. The primary outcome was the incidence of DVT (defined as occurrence on day 3 or 7). Secondary outcomes were death and duration of hospitalization. Risk factors for DVT were explored using bivariate and multivariable logistic regression analysis and expressed as risk ratio (RR) with 95% confidence intervals (CIs). Results: The incidence of DVT was 17.2% (95% CI 12.0, 22.3) (n = 35/203); two-thirds were catheter associated (23/35). There was no difference in mortality between those with and without incident DVT (9/35 vs 40/168, p = 0.81). The mean (SD) duration of hospitalization was longer in the DVT group (20.1 (17) vs 12.9 (8.5) days, p = 0.007). Although day 3 INR (RR 2.1, 95% CI 0.9–5.3), age >40 years (2.1, 0.8–5.3), vasopressor use (1.0, 0.4–2.9) and SOFA score (0.9, 0.85–1.1) were associated with the development of DVT on bivariate analysis, only central venous catheters (15.97, 1.9–135.8) was independently associated with DVT on multivariable analysis. Conclusions: Despite thromboprophylaxis, 17% of ICU patients develop DVT. The central venous catheter is the main risk factor. DVT is not associated with increased mortality in the setting of prophylaxis.
Insights into values and emotional wellbeing of medical students in the United Arab Emirates: a cross-sectional study
(2024-08) Alhashimi, Fatma Mustafa; Salim, Sara; Siddiqi, Warda; Jeyaseelan, Lakshmanan; Khan, Nusrat; Sultan, Meshal A
Abstract Objective: To describe the difference in values among medical students from a first-year student' and final year student' perspective. In addition, it is designed to report associations and trends between personal values and overall emotional states. Methods: This is an analytical cross-sectional study that involved disseminating an online survey via email to first and final year students at the College of Medicine in Mohammed Bin Rashid University (MBRU) in Dubai, United Arab Emirates in December of 2023. The survey encompassed queries on demographics, the Life Values Inventory (LVI) and the Positive and Negative Affect Schedule (PANAS). Results: The survey was completed by 84 students. About half of the participants were final year medical students (45/84; 53.6%) with the majority being females (70/84; 83.3%). Positive emotions were positively correlated to various life values, including belonging, scientific understanding, responsibility, and achievement (p < 0.05). When comparing academic years, the scores of the life value of Achievement showed a significant correlation (p = 0.04), with first-year students' mean (SD) of 12 (2) out of 15 compared to 11 (3) out of 15 for final-year students. Positive Emotions also exhibited a significant correlation (p = 0.006), with first-year students' mean (SD) 40 (5) out of 50 compared to 36 (7) out of 50 for final-year students. Conclusion: This study adds to medical education research by exploring values and emotions, shedding light on factors shaping students' professional identities. Understanding these dynamics can aid in supporting future healthcare providers and by extension the patients for whom they care.
Noninvasive Ventilation in the Management of Respiratory Failure Due to COVID-19 Infection: Experience From a Resource-Limited Setting
(2022) Jeyaseelan, Lakshmanan
Objective: To study the role of noninvasive ventilation (NIV) in Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2) related acute respiratory failure (C-ARF). Patients and Methods: Patients with C-ARF managed on NIV were categorized as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as odds ratio (OR) with 95% CI. Results: Between April 1, 2020, and September 15, 2020, a total of 286 patients with a mean SD age of 53.111.6 years and Acute Physiology and Chronic Health Evaluation II score of 11.15.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe acute respiratory distress syndrome. When compared with NIV success, NIV failure was associated with lower admission PaO2 to fraction of inspired oxygen ratio P<.001) and higher respiratory rate (P<.001). On penalized logistic regression analysis, NIV failure was associated with higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.01 to 1.24), severe acute respiratory distress syndrome (OR, 3.99; 95% CI, 1.24 to 12.9), D-dimer level of 1000 ng/mL DDU (to convert to mg/L, divide by 1000) or greater (OR, 2.60; 95% CI, 1.16 to 5.87), need for inotropes or dialysis (OR, 12.7; 95% CI, 4.3 to 37.7), and nosocomial infections (OR, 13.6; 95% CI, 4.06 to 45.9). Overall mortality was 30.1% (86/286). In patients requiring intubation, time to intubation was longer in nonsurvivors than survivors (median, 5; interquartile range, 3-8 vs 3; interquartile range, 2-3 days; ; P<.001). Conclusion: Noninvasive ventilation can be used successfully in C-ARF. Illness severity and need for nonerespiratory organ support predict NIV failure.
The prevalence, severity, and risk factors for dry eye disease in Dubai – a cross sectional study
(2021) Alkabbani, Sarah; Jeyaseelan, Lakshmanan; Rao, Anupama P.; Warhekar, Pramod T.
Background: The prevalence of dry eye disease is increasing globally and requires the attention of healthcare professionals as it worsens patients’ quality of life. No published studies on the epidemiology of dry eyes have been found in Dubai. Purpose: To describe the epidemiology, prevalence, severity, and associated factors of dry eyes in Dubai, United Arab Emirates, in 2019. Methods: This was an analytical, cross-sectional, survey-based study. An online survey was distributed by email to Mohammed Bin Rashid University students, staff, and faculty and to the staff at Mediclinic City and Parkview Hospitals in Dubai, United Arab Emirates, from April–June 2019. The survey included demographic questions and the Ocular Surface Disease Index (OSDI). Results: The survey was completed by 452 participants; the majority were females (288/452; 63.7 %). The prevalence of dry eyes in Dubai was estimated to be 62.6 % (283/452), with severely dry eyes being the most prevalent (119/283; 42 %). Females, high daily screen time (> 6 h), and the use of contact lenses were found to be associated with dry eyes (P-value < 0.05, 95 % confidence interval). Age was found to be negatively correlated with prevalence of dry eyes. Exposure to smoking/shisha, history of eye injury/surgery, and nationality were not associated with dry eyes. Conclusions: This is the first cross-sectional study to investigate the prevalence of dry eyes in Dubai (62.6 %). The majority of participants had severe dry eyes symptoms. Severely dry eyes were more common among females and users of contact lenses.
Sleep Quality and Emotional State of Medical Students in Dubai
(2022) Jeyaseelan, Lakshmanan
Abstract: Poor sleep quality has been reported to be common amongst medical students and healthcare professionals worldwide. Sleep disturbance has been associated with increased rates of burnout and depression. As a result, this has been negatively impacting performance and functioning. Research on this topic is limited in the United Arab Emirates (UAE). This study is aimed at exploring sleep pattern and the emotional state of medical and dental students in Dubai, UAE. This cross-sectional study was based on an electronic survey sent to 181 medical and dental students. Of the 181 invitations, 96 individuals agreed to participate and complete the rating scales. The Pittsburgh Sleep Quality Index was utilized to explore sleep duration, quality, and daytime functioning. The Positive and Negative Affect Scale was used to assess the emotional states of the participants. Overall, the findings revealed diminished sleep duration. The average duration of sleep amongst the study participants was 5 hours and 24 minutes, which is significantly below the recommended duration as per sleep guidelines. Results also showed a significant positive correlation between total sleep duration and overall sleep quality with enthusiasm during the day. Future research designed to explore factors contributing to sleep efficiency, in more depth, as well as strategies to enhance sleep quality is highly warranted.
Stress and Coping Strategies among Medical Students in Dubai, United Arab Emirates, in 2020: A Cross-Sectional Study
(2024-01) Boushehri, Yas Kaveh; Jeyaseelan, Lakshmanan
Abstract: Studies across the world, have revealed elevated levels of stress among medical students. The rate of significant stress is 55% higher among healthcare professionals in comparison to the general population. This level of stress may lead to higher rates of burnout, depression, and functional impairment. This study aims to investigate the stress levels among medical students in Dubai and also to assess their coping strategies. The total number of participants in this study was 97. Rates of high stress levels as per the Perceived Stress Scale (PSS-10) was found to be higher among year 1 to year 3 medical students (43.6%), in comparison to year 4 and year 5 medical students (7.7%). The Brief-COPE inventory was used in this study and found that among medical students the mean score for a Problem Focused coping style was 22 out of 32 (medium to high range). Future research that evaluates a more comprehensive investigation into the psychological impact of stress and also exploration of effective strategies to enhance coping with stress is highly warranted.
Study protocol: 'a large cohort study of postnatal events in a not-for-profit referral centre in Vellore, South India'
(2022-12) Jeyaseelan, Lakshmanan
Abstract: Introduction: In a large developing country, with diverse population characteristics and differential access to healthcare, it is important to identify factors that influence postnatal health. This knowledge will help frame recommendations to enhance universal postnatal care. Methods and analysis: A prospective cohort study will be conducted by recruiting all participants who deliver in a referral centre in South India during a 1-year period after written consent is obtained from them. In addition to clinical information pertaining to their delivery and demographics, details of physical health, mental health socioeconomic status and emotional support will also be collected. Every participant will be followed up physically and/or by telephonic consultation at 3, 9 and 18 months of their postnatal period to reassess their status and that of their babies. As there are several independent and dependent variables requiring multivariate analysis, a sample size of 10 000 is considered adequate. Any unplanned visits to a health facility will be enquired into and documented for analysis.During data analysis, the effect of Caesarean section, high-risk characteristics and gestational age of the baby at delivery on various outcome measures and postnatal status will be evaluated. Interpretation of the large volume of collected data will help frame recommendations to improve postnatal care ETHICS AND DISSEMINATION: The study is approved by the Institutional Review Boards (Research and Ethics Committees) of Christian Medical College, Vellore, Tamil Nadu, India (IRB 12178 date 24 June 2020).Women are provided with a detailed information sheet and written consent is obtained. They are reassured that their care will not be compromised if they do not consent to the study. Data will be available on the clinical trial portal to assist in the dissemination of results after the project is published.
Trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age during the last 15 years in India
(2023) Jeyaseelan, Lakshmanan
Background: Anaemia is a serious global public health problem that disproportionally affects children, adolescent girls, and women of reproductive age, especially pregnant women. Women of reproductive age are more vulnerable to anaemia, particularly severe and moderate anaemia leads to adverse outcomes among pregnant women. Despite continuous Government efforts, anaemia burden still poses a serious challenge in India. The objective of this study is to assess the trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age between 15 and 49 years. Method: We used three rounds of the large-scale National Family Health Survey (NFHS) India, conducted on a representative sample of households using a cross-sectional design across the country in 2005–06, 2015–16 and 2019–2021. We included all the women aged 15 to 49 years in our analysis. We used the same haemoglobin (Hb) cut-off values for all the three rounds of surveys to ensure comparability. Generalized linear regression analyses with log link were done. Survey weights were incorporated in the analysis. Results: The prevalence of severe or moderate Anaemia (SMA) in non-pregnant women was 14.20%, 12.43% and 13.98%; it was 31.11%, 25.98% and 26.66% for pregnant women in 2006, 2016 and 2021 respectively. The decline in SMA prevalence was 1.54% in non-pregnant women, whereas it was 14.30% in pregnant women in 15 years. Women who were poor, and without any formal education had a higher risk for severe and moderate Anaemia. Conclusion: Despite the intensive anaemia control program in India, SMA has not declined appreciably in non-pregnant women during the last two decades. Despite the decline, the prevalence of SMA was about 26% in pregnant women which calls for a comprehensive review of the existing anaemia control programmes and there must be targeted programmes for the most vulnerable and high-risk women such as rural, poor and illiterate women of reproductive age to reduce the burden of anaemia among them.