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E Krishnan

Publications and source records attributed to E Krishnan.

13 recordsLinked to original sources
PubMed2006

Ethnicity and mortality from systemic lupus erythematosus in the US.

OBJECTIVE: To study ethnic differences in mortality from systemic lupus erythematosus (lupus) in two large, population-based datasets. METHODS: We analysed the national death data (1979-98) from the National Center for Health Statistics (Hyattsville, Maryland, USA) and hospitalisation data (1993-2002) from the Nationwide Inpatient Sample (NIS), the largest hospitalisation database in the US. RESULTS: The overall, unadjusted, lupus mortality in the National Center for Health Statistics data was 4.6 per million, whereas the proportion of in-hospital mortality from the NIS was 2.9%. African-Americans had disproportionately higher mortality risk than Caucasians (all-cause mortality relative risk adjusted for age = 1.24 (women), 1.36 (men); lupus mortality relative risk = 3.91 (women), 2.40 (men)). Excess risk was found among in-hospital deaths (odds ratio adjusted for age = 1.4 (women), 1.3 (men)). Lupus death rates increased overall from 1979 to 98 (p<0.001). The proportional increase was greatest among African-Americans. Among Caucasian men, death rates declined significantly (p<0.001), but rates did not change substantially for African-American men. The African-American:Caucasian mortality ratio rose with time among men, but there was little change among women. In analyses of the NIS data adjusted for age, the in-hospital mortality risk decreased with time among Caucasian women (p<0.001). CONCLUSIONS: African-Americans with lupus have 2-3-fold higher lupus mortality risk than Caucasians. The magnitude of the risk disparity is disproportionately higher than the disparity in all-cause mortality. A lupus-specific biological factor, as opposed to socioeconomic and access-to-care factors, may be responsible for this phenomenon.

Adolescent↗
PubMed2005

Impact of age and comorbidities on the criteria for remission and response in rheumatoid arthritis.

OBJECTIVE: To determine to what extent health status impairment in rheumatoid arthritis (RA) measured by self report of pain, global assessment, and functional disability is attributable to age and other comorbid conditions as opposed to the disease itself. METHODS: Pain, global assessment, and Health Assessment Questionnaire Disability Index (HAQ-DI) were measured in a random sample of 1530 adults in the Central Finland District, Finland. Median regressions were used for multivariable analyses. RESULTS: The mean age was 55.4 years and 72% were women. A large majority of the population reported some pain (76%) and less than perfect general health (83%). The overall mean values of pain, HAQ-DI, and general health were 20 mm, 0.25 units, and 21 mm, respectively. The most common self reported musculoskeletal comorbidities were osteoarthritis (24%) and chronic back pain (25%). Age and number of comorbidities were the only statistically significant correlates of pain and general health in multivariable analyses. CONCLUSIONS: Self reported disability, pain, and poor health were widely prevalent in the general population and are related to age and comorbid conditions. This needs to be taken into account when interpreting remission and response rates using current criteria and for future development of definitions for these end points in RA and other rheumatic diseases.

Adult↗
PubMed2004

Similar prediction of mortality by the health assessment questionnaire in patients with rheumatoid arthritis and the general population.

BACKGROUND: The self report health assessment questionnaire (HAQ) quantifies disability in activities of daily living (ADL). In patients with rheumatoid arthritis, the HAQ predicts mortality, work disability, and hip replacement surgery. It has been widely used in rheumatology, but population based data are rare. OBJECTIVE: To determine whether the HAQ predicts mortality in patients with rheumatoid arthritis (n = 1095) and community controls (n = 1490). METHODS: A mailed questionnaire including the HAQ, visual analogue scales for pain and global health, comorbidities, education level, height, weight, and smoking status was administered in June 2000. Two years later, the vital status of the subjects was ascertained from the Finnish Population Register database. RESULTS: There were 41 deaths (10.1%) among the 404 patients with rheumatoid arthritis who had a baseline HAQ > or =1 (indicating at least some difficulty in most ADL), and 16 (2.3%) among 691 patients with HAQ <1 (p<0.001); in the community controls the values were 20 (13.6%) among 147 with HAQ > or =1, and 14 (1.0%) among 1343 with HAQ <1 (p<0.001). A higher HAQ score was an independent predictor of mortality in patients with rheumatoid arthritis (hazard ratio 2.73 (95% confidence interval, 1.86 to 4.02); p<0.001) and in community controls (2.75 (1.61 to 4.70); p<0.001). CONCLUSIONS: The HAQ predicts mortality in the community population as well as in patients with rheumatoid arthritis. People with similar levels of disability appear to have a similar likelihood of mortality over two years.

Activities of Daily Living↗
PubMed2000

Repair of iliac artery aneurysms by endoluminal grafting: the systematic approach of one institution.

Isolated iliac artery aneurysms are rare lesions that are difficult to detect and treat. Prompt diagnosis and timely intervention are essential, because the incidence of rupture is as high as 50%. The reported mortality rate for patients who undergo surgery for ruptured iliac artery aneurysm ranges from 50% to 70%. The recommended therapy remains surgical excision, although percutaneous techniques are effective alternatives in selected cases. Early intervention, carried out in a systematic fashion, can reduce the high morbidity and mortality. We report 4 cases of isolated iliac artery aneurysms managed over a period of 8 years by means of endoluminal grafting, with only 1 death. In our experience, prompt diagnosis by use of less invasive methods, such as duplex Doppler imaging, and timely intervention led to a reduction in the overall mortality.

Aged↗
PubMed1998

Malignant mixed mullerian tumours of gynaecological origin: chemosensitive but aggressive tumours.

We report the clinical management and outcome of 11 patients with a histological diagnosis of mixed mullerian tumour of gynaecological origin who were treated at Weston Park Hospital, Sheffield during the period 1991 to 1996. Case note review provided the data on the patients, their disease and the treatment given. In six patients, the primary site was the ovary and in four it was the uterus; in the remaining patient, the tissue of primary origin was uncertain. The median age at diagnosis was 53 years (range 48-84). Seven patients had heterologous tumour histology. All but one underwent surgical removal or debulking of disease. Seven patients were treated with platinum-based chemotherapy. There were four complete responders and three partial responders. The median survival was 18 months. Three patients remain alive, two of them disease-free. Mixed mullerian tumours are initially chemosensitive but have an aggressive clinical course, typically with early relapse after treatment and a poor long-term prognosis. Collaborative Phase III studies are required to improve the management of this uncommon cancer.

Aged↗
PubMed1994

Plague in India.

Explore the source record for details and available documents.

Disease Outbreaks↗
PubMed1992

Independent predictors of response and disease-free survival in oral cancer treated with radical radiation therapy.

There have been no reports concerning the independent predictors of response and disease-free survival (DFS) in oral cancer in India, where the highest incidence is reported. The authors analyzed the outcome of radical radiation therapy of 378 patients with oral cancer and found that the complete response rate within 6 months of completion of treatment was 45% and the 5-year DFS was 34% (95% confidence interval 29% to 39%). Regional lymph node involvement (P less than 0.001), histologic type (P less than 0.01), and the intraoral site of lesion (P less than 0.025) were identified as independent predictors of response when adjusted in a forward stepwise logistic regression analysis. The Cox proportional hazards regression analysis revealed that regional lymph node involvement (P less than 0.001) and histologic type (P less than 0.05) were independent prognostic factors for DFS. Patients with fixed regional lymph node involvement demonstrated a relative risk (RR) of 2.4 compared with those with N0 disease. Patients with well-differentiated squamous carcinoma had an RR of 2, and those with other histologic types (other than verrucous carcinoma) had an RR of 1.5.

Adult↗
PubMedDate not supplied

Survival in multiple myeloma in Kerala.

BACKGROUND: The reported incidence of multiple myeloma in India ranges from 0.5 to 1.2 per 100,000 but there have been few studies on the effect of treatment of this condition. We, therefore, analysed the clinical profile of patients in Kerala with myeloma, the treatment given and the factors affecting survival. METHODS: Case records of 142 patients with multiple myeloma treated at the Regional Cancer Centre, Trivandrum, between 1984 and 1989 were reviewed and abstracted. Chemotherapy (using melphalan and prednisolone) and radiotherapy were the treatment modalities. Survival analysis was done using the Kaplan-Meier estimates and multivariate analysis of factors affecting survival was performed using Cox's proportional hazards regression model. RESULTS: The mean age of the patients was 61 years and 90 were males. Bone pain and pallor were the most common presenting symptoms and the median survival was 30 months. A combination of melphalan and prednisolone was found to be well tolerated and achieved a survival rate of 62% at 5 years. Hemibody irradiation was beneficial in a small group of patients. On a multivariate analysis, Bence-Jones proteinuria, melphalan and prednisolone combination chemotherapy and response to treatment at 6 months were the most significant factors affecting survival. Socioeconomic status did not seem to influence survival. CONCLUSIONS: Melphalan and prednisolone chemotherapy achieves prolonged survival in myeloma. Radiotherapy can relieve symptoms and in a small group of patients hemibody irradiation can achieve prolonged remission. Further studies are required to identify the subgroups in which certain treatments are most effective in improving survival.

Adult↗