A recent large-scale, randomized trial demonstrated the noninferiority of a strategy of bivalirud... more A recent large-scale, randomized trial demonstrated the noninferiority of a strategy of bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition compared with routine GP IIb/IIIa inhibition. There is a paucity of outcome data with bivalirudin use in the setting of real-world experience. We evaluated 6,996 patients who underwent percutaneous coronary intervention between January 2001 and December 2004 to compare early and late outcomes with a bivalirudin-based antithrombotic regimen with those with a heparin-based regimen. Propensity adjustment was performed to correct for baseline differences in patient characteristics. Bivalirudin-based therapy was used in 1,070 patients, heparin only in 801 patients, and heparin plus GP IIb/IIIa inhibitors in 5,125 patients. Compared with patients who received heparin or those who received heparin plus GP IIb/IIIa inhibitors, patients who received bivalirudin had lower incidences of bleeding (blood transfusion rate 1.7% vs 4.0%, p <0.001) and periprocedural myonecrosis (creatine kinase-MB >5 times the upper limit of normal 2.7% vs 4.3%, p ؍ 0.016). Differences in bleeding end points remained significant after adjusting for the propensity to receive bivalirudin, but there was no difference in ischemic events. There was no difference in unadjusted long-term survival rate (log-rank test p ؍ 0.46, total number of deaths 412, mean follow-up 17 months) or in propensity-adjusted long-term survival rate (hazard ratio 1.37, 95% confidence interval 0.90 to 2.08, p ؍ 0.14). Compared with heparin with or without GP IIb/IIIa inhibition, the use of bivalirudin in a large consecutive patient registry at a tertiary care center was associated with fewer bleeding events and no evident increase in the incidence of ischemic complications. ᮊ2005 by Excerpta Medica Inc.
Objective. To evaluate the feasibility, safety and utility of the ultrasonic shears for laparosco... more Objective. To evaluate the feasibility, safety and utility of the ultrasonic shears for laparoscopic pelvic and para-aortic lymph node retrieval in the treatment of gynecologic cancers.
Journal of The American Association of Gynecologic Laparoscopists, 2004
Patients. Forty-two sterile women (ages 24-41 years) with tubal occlusion. Intervention. Fallopos... more Patients. Forty-two sterile women (ages 24-41 years) with tubal occlusion. Intervention. Falloposcopic tuboplasty with laparoscopy or laparotomy. Measurements and Main Results. We examined the relationship between efficacy of FF and Chlamydia trachomatis (CT) infection. Of the 42 patients (44 cases) who had surgery and were followed-up, 21 had preoperative CT infection, 17 were not infected, and 6 were not tested. In the CT infected group (CT+), 38 tubes were performed to FT, and in the no-infection group (CT-), 29 tubes were performed to FT. Recanalization rate per tubes were 60% in CT+ group and 79% in CT-group. During follow-up of tubes by hysterosalpingography or second-look laparoscopy, postoperative patency rate were 38% in the CT+ group and 62% in the CT-group. In patients who were followed-up for six months or more, five patients (35%) became pregnant except IVF/ET in the CT+ group, and eight patients (53%) became pregnant except IVF/ET in the CT-group. These data show better tendency in the CT-group, but there were no significant differences between two groups. Conclusion. CT infection is negative factor of FT. However, in CT+ group, postoperative pregnancy rate was 35% and was by no means inferior to those of IVF-ET. This research shows that a CT infection is a negative factor of FT, but FT is recommended to patients who have tubal occlusion before IVF/ET even if the patients were infected by CT.
Journal of The American Association of Gynecologic Laparoscopists, 2004
Study Objective. To assess compatibility of NovaSure ablation procedure with an office setting un... more Study Objective. To assess compatibility of NovaSure ablation procedure with an office setting under local anesthesia. Design. Prospective, single-arm, pilot study. Setting. Private obstetrics and gynecology office. Patients. Sixty-three patients with refractory menorrhagia secondary to dysfunctional uterine bleeding. Intervention. Endometrial ablation using NovaSure system. Methods. Patient evaluation included vaginal sonography, endometrial biopsy, and Papanicolaou smear. One hour before the procedure, patients received Valium 5 mg and Vicodin 325 mg by mouth. At the time of the operative visit, a paracervical block was administered using 1% Xylocaine with epinephrine at 3, 6, 9 and 12 o'clock. NovaSure procedure was performed according to the instructions for use. Postoperatively, the patients were observed for 20 minutes with vital signs measured at 5 and 15 minutes. They were discharged with prescriptions for Vicodin/Vioxx for 48 hours. Measurements and Main Results. When intraoperative discomfort was assessed using the numeric response scale (NRS), 48% of the patients responded with the level of 3, and another 51% indicated a discomfort level of 5 to 6. One patient reported a level of discomfort of 8 on the NRS scale. During follow-up 50% of patients reported amenorrhea, 44% had their bleeding reduced to spotting and hypomenorrhea, and the remaining 6% had reported eumenorrhea. No intra or postoperative complications were reported. Conclusion. Clinical results indicate due to its short treatment time of 90 seconds, the NovaSure system demonstrated low intra and postoperative level of discomfort, no need for deep level of sedation, and short recovery time. NovaSure is a viable endometrial ablation procedure when performed in an office setting.
To assess the effect of laparoscopic surgery on the survival of women with early-stage endometria... more To assess the effect of laparoscopic surgery on the survival of women with early-stage endometrial cancer and to analyze the factors that affect survival. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary teaching hospital. Women with clinical stage I and II endometrial cancer (International Federation of Gynecology and Obstetrics staging, 1971) from January 1993 through June 2003. Demographic, surgical, perioperative, and pathologic characteristics of women treated with laparoscopy or laparotomy were compared by use of Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test or the Student t test. Recurrence-free and overall survival was calculated by use of the Kaplan-Meier method. Stratified analyses were performed with the log-rank test for factors affecting survival (surgical stage, histologic study, and grade). Sixty-seven and 127 women were treated with laparoscopy and laparotomy, respectively. Median follow-up was 36.3 months for the laparoscopy group and 29.6 months for the laparotomy group. The complication rates in the 2 groups were comparable. Women undergoing laparoscopy had shorter hospital stay and less morbidity related to infection. The 2- and 5-year estimated recurrence-free survival rates for the laparoscopy and laparotomy groups (93 % vs 91.7% and 88.5% vs 85%, respectively), as well as the overall 2- and 5-year survival rates (100% vs 99.2% and 100% vs 97%, respectively) were similar. Laparoscopic surgery in women with early-stage endometrial carcinoma resulted in survival rates similar to laparotomy, although a small sample size precludes definitive conclusions. A larger randomized comparison of the 2 techniques is needed to validate these findings.
Journal of The American Association of Gynecologic Laparoscopists, 2004
Methods. From January 2001, a prospective study is ongoing of consecutive patients undergoing vag... more Methods. From January 2001, a prospective study is ongoing of consecutive patients undergoing vaginal hysterectomy surgery in our Ambulatory Care Unit with planned discharge within 24 hours. Richard Penketh's standard approach to hysterectomy for women without uterine prolapse is via the vaginal route. Method of surgery and anesthetic, ease of operation, uterine size and mobility were recorded. Pain scores following surgery prior to discharge, and verbal feedback from patients in the six weeks following surgery were collected by telephone and at the follow-up consultation. Intra-and post-operative complications, conversion to laparotomy, the need for prolonged admission to the main hospital, and readmission due to delayed complications were recorded. Results. Of the 50 patients to date, 48 (96%) were discharged
It is being realized that the traditional closed-door and market driven approaches for drug disco... more It is being realized that the traditional closed-door and market driven approaches for drug discovery may not be the best suited model for the diseases of the developing world such as tuberculosis and malaria, because most patients suffering from these diseases have poor paying capacity. To ensure that new drugs are created for patients suffering from these diseases, it is necessary to formulate an alternate paradigm of drug discovery process. The current model constrained by limitations for collaboration and for sharing of resources with confidentiality hampers the opportunities for bringing expertise from diverse fields. These limitations hinder the possibilities of lowering the cost of drug discovery. The Open Source Drug Discovery project initiated by Council of Scientific and Industrial Research, India has adopted an open source model to power wide participation across geographical borders. Open Source Drug Discovery emphasizes on integrative science through collaboration, open-sharing, taking up multi-faceted approaches and accruing benefits from advances on different fronts of new drug discovery. Because the open source model is based on community participation, it has the potential to self-sustain continuous development by generating storehouse of alternatives towards continued pursuit for new drug discovery. Since the inventions are community generated, the new chemical entities developed by Open Source Drug Discovery will be taken up for clinical trial in a non-exclusive manner by participation of multiple companies with majority funding from Open Source Drug Discovery. This will ensure availability of drugs through a lower cost community driven drug discovery process for diseases afflicting people with poor paying capacity. Hopefully what LINUX and World Wide Web have done for the information technology, Open Source Drug Discovery will do for drug discovery.
This review discusses the progress of India from being one of the largest producers of generics t... more This review discusses the progress of India from being one of the largest producers of generics to its coming of age and initiating novel drug development programs such as the Open Source Drug Discovery for tuberculosis. A few groups have also begun to emerge which focus their research on rational or structure based drug design. We discuss here some of the ongoing efforts in drug discovery in India primarily in national research institutions and academia.
Clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for pat... more Clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for patients with symptomatic carotid artery disease have produced conflicting results. We performed a meta-analysis to systematically evaluate currently available data by comparing CAS with CEA in patients with symptomatic carotid artery disease.
A recent large-scale, randomized trial demonstrated the noninferiority of a strategy of bivalirud... more A recent large-scale, randomized trial demonstrated the noninferiority of a strategy of bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition compared with routine GP IIb/IIIa inhibition. There is a paucity of outcome data with bivalirudin use in the setting of real-world experience. We evaluated 6,996 patients who underwent percutaneous coronary intervention between January 2001 and December 2004 to compare early and late outcomes with a bivalirudin-based antithrombotic regimen with those with a heparin-based regimen. Propensity adjustment was performed to correct for baseline differences in patient characteristics. Bivalirudin-based therapy was used in 1,070 patients, heparin only in 801 patients, and heparin plus GP IIb/IIIa inhibitors in 5,125 patients. Compared with patients who received heparin or those who received heparin plus GP IIb/IIIa inhibitors, patients who received bivalirudin had lower incidences of bleeding (blood transfusion rate 1.7% vs 4.0%, p <0.001) and periprocedural myonecrosis (creatine kinase-MB >5 times the upper limit of normal 2.7% vs 4.3%, p ؍ 0.016). Differences in bleeding end points remained significant after adjusting for the propensity to receive bivalirudin, but there was no difference in ischemic events. There was no difference in unadjusted long-term survival rate (log-rank test p ؍ 0.46, total number of deaths 412, mean follow-up 17 months) or in propensity-adjusted long-term survival rate (hazard ratio 1.37, 95% confidence interval 0.90 to 2.08, p ؍ 0.14). Compared with heparin with or without GP IIb/IIIa inhibition, the use of bivalirudin in a large consecutive patient registry at a tertiary care center was associated with fewer bleeding events and no evident increase in the incidence of ischemic complications. ᮊ2005 by Excerpta Medica Inc.
Objective. To evaluate the feasibility, safety and utility of the ultrasonic shears for laparosco... more Objective. To evaluate the feasibility, safety and utility of the ultrasonic shears for laparoscopic pelvic and para-aortic lymph node retrieval in the treatment of gynecologic cancers.
Journal of The American Association of Gynecologic Laparoscopists, 2004
Patients. Forty-two sterile women (ages 24-41 years) with tubal occlusion. Intervention. Fallopos... more Patients. Forty-two sterile women (ages 24-41 years) with tubal occlusion. Intervention. Falloposcopic tuboplasty with laparoscopy or laparotomy. Measurements and Main Results. We examined the relationship between efficacy of FF and Chlamydia trachomatis (CT) infection. Of the 42 patients (44 cases) who had surgery and were followed-up, 21 had preoperative CT infection, 17 were not infected, and 6 were not tested. In the CT infected group (CT+), 38 tubes were performed to FT, and in the no-infection group (CT-), 29 tubes were performed to FT. Recanalization rate per tubes were 60% in CT+ group and 79% in CT-group. During follow-up of tubes by hysterosalpingography or second-look laparoscopy, postoperative patency rate were 38% in the CT+ group and 62% in the CT-group. In patients who were followed-up for six months or more, five patients (35%) became pregnant except IVF/ET in the CT+ group, and eight patients (53%) became pregnant except IVF/ET in the CT-group. These data show better tendency in the CT-group, but there were no significant differences between two groups. Conclusion. CT infection is negative factor of FT. However, in CT+ group, postoperative pregnancy rate was 35% and was by no means inferior to those of IVF-ET. This research shows that a CT infection is a negative factor of FT, but FT is recommended to patients who have tubal occlusion before IVF/ET even if the patients were infected by CT.
Journal of The American Association of Gynecologic Laparoscopists, 2004
Study Objective. To assess compatibility of NovaSure ablation procedure with an office setting un... more Study Objective. To assess compatibility of NovaSure ablation procedure with an office setting under local anesthesia. Design. Prospective, single-arm, pilot study. Setting. Private obstetrics and gynecology office. Patients. Sixty-three patients with refractory menorrhagia secondary to dysfunctional uterine bleeding. Intervention. Endometrial ablation using NovaSure system. Methods. Patient evaluation included vaginal sonography, endometrial biopsy, and Papanicolaou smear. One hour before the procedure, patients received Valium 5 mg and Vicodin 325 mg by mouth. At the time of the operative visit, a paracervical block was administered using 1% Xylocaine with epinephrine at 3, 6, 9 and 12 o'clock. NovaSure procedure was performed according to the instructions for use. Postoperatively, the patients were observed for 20 minutes with vital signs measured at 5 and 15 minutes. They were discharged with prescriptions for Vicodin/Vioxx for 48 hours. Measurements and Main Results. When intraoperative discomfort was assessed using the numeric response scale (NRS), 48% of the patients responded with the level of 3, and another 51% indicated a discomfort level of 5 to 6. One patient reported a level of discomfort of 8 on the NRS scale. During follow-up 50% of patients reported amenorrhea, 44% had their bleeding reduced to spotting and hypomenorrhea, and the remaining 6% had reported eumenorrhea. No intra or postoperative complications were reported. Conclusion. Clinical results indicate due to its short treatment time of 90 seconds, the NovaSure system demonstrated low intra and postoperative level of discomfort, no need for deep level of sedation, and short recovery time. NovaSure is a viable endometrial ablation procedure when performed in an office setting.
To assess the effect of laparoscopic surgery on the survival of women with early-stage endometria... more To assess the effect of laparoscopic surgery on the survival of women with early-stage endometrial cancer and to analyze the factors that affect survival. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary teaching hospital. Women with clinical stage I and II endometrial cancer (International Federation of Gynecology and Obstetrics staging, 1971) from January 1993 through June 2003. Demographic, surgical, perioperative, and pathologic characteristics of women treated with laparoscopy or laparotomy were compared by use of Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test or the Student t test. Recurrence-free and overall survival was calculated by use of the Kaplan-Meier method. Stratified analyses were performed with the log-rank test for factors affecting survival (surgical stage, histologic study, and grade). Sixty-seven and 127 women were treated with laparoscopy and laparotomy, respectively. Median follow-up was 36.3 months for the laparoscopy group and 29.6 months for the laparotomy group. The complication rates in the 2 groups were comparable. Women undergoing laparoscopy had shorter hospital stay and less morbidity related to infection. The 2- and 5-year estimated recurrence-free survival rates for the laparoscopy and laparotomy groups (93 % vs 91.7% and 88.5% vs 85%, respectively), as well as the overall 2- and 5-year survival rates (100% vs 99.2% and 100% vs 97%, respectively) were similar. Laparoscopic surgery in women with early-stage endometrial carcinoma resulted in survival rates similar to laparotomy, although a small sample size precludes definitive conclusions. A larger randomized comparison of the 2 techniques is needed to validate these findings.
Journal of The American Association of Gynecologic Laparoscopists, 2004
Methods. From January 2001, a prospective study is ongoing of consecutive patients undergoing vag... more Methods. From January 2001, a prospective study is ongoing of consecutive patients undergoing vaginal hysterectomy surgery in our Ambulatory Care Unit with planned discharge within 24 hours. Richard Penketh's standard approach to hysterectomy for women without uterine prolapse is via the vaginal route. Method of surgery and anesthetic, ease of operation, uterine size and mobility were recorded. Pain scores following surgery prior to discharge, and verbal feedback from patients in the six weeks following surgery were collected by telephone and at the follow-up consultation. Intra-and post-operative complications, conversion to laparotomy, the need for prolonged admission to the main hospital, and readmission due to delayed complications were recorded. Results. Of the 50 patients to date, 48 (96%) were discharged
It is being realized that the traditional closed-door and market driven approaches for drug disco... more It is being realized that the traditional closed-door and market driven approaches for drug discovery may not be the best suited model for the diseases of the developing world such as tuberculosis and malaria, because most patients suffering from these diseases have poor paying capacity. To ensure that new drugs are created for patients suffering from these diseases, it is necessary to formulate an alternate paradigm of drug discovery process. The current model constrained by limitations for collaboration and for sharing of resources with confidentiality hampers the opportunities for bringing expertise from diverse fields. These limitations hinder the possibilities of lowering the cost of drug discovery. The Open Source Drug Discovery project initiated by Council of Scientific and Industrial Research, India has adopted an open source model to power wide participation across geographical borders. Open Source Drug Discovery emphasizes on integrative science through collaboration, open-sharing, taking up multi-faceted approaches and accruing benefits from advances on different fronts of new drug discovery. Because the open source model is based on community participation, it has the potential to self-sustain continuous development by generating storehouse of alternatives towards continued pursuit for new drug discovery. Since the inventions are community generated, the new chemical entities developed by Open Source Drug Discovery will be taken up for clinical trial in a non-exclusive manner by participation of multiple companies with majority funding from Open Source Drug Discovery. This will ensure availability of drugs through a lower cost community driven drug discovery process for diseases afflicting people with poor paying capacity. Hopefully what LINUX and World Wide Web have done for the information technology, Open Source Drug Discovery will do for drug discovery.
This review discusses the progress of India from being one of the largest producers of generics t... more This review discusses the progress of India from being one of the largest producers of generics to its coming of age and initiating novel drug development programs such as the Open Source Drug Discovery for tuberculosis. A few groups have also begun to emerge which focus their research on rational or structure based drug design. We discuss here some of the ongoing efforts in drug discovery in India primarily in national research institutions and academia.
Clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for pat... more Clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for patients with symptomatic carotid artery disease have produced conflicting results. We performed a meta-analysis to systematically evaluate currently available data by comparing CAS with CEA in patients with symptomatic carotid artery disease.
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Papers by jyoti Yadav