ORCID Profile
0000-0002-1015-9280
Current Organisations
University of Melbourne Melbourne Medical School
,
Melbourne Institute, University of Melbourne
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Publications
Systemic sclerosis and COVID-19 vaccine safety: short-term insights from the global COVID-19 vaccination in autoimmune disease (COVAD) survey
Publisher: Springer Science and Business Media LLC
Date: 31-03-2023
Prevalence and Impact of Iron Deficiency in Patients Undergoing Cardiac Surgery: An Indian Perspective
Publisher: Elsevier BV
Date: 2018
Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients
Publisher: MDPI AG
Date: 30-03-2023
DOI: 10.3390/JCM12072594
Abstract: Multiple arterial grafting (MAG) utilizes more than one arterial graft with any additional grafts being saphenous vein grafts (SVG). It remains an infrequently used coronary surgical revascularization technique, especially in elderly patients. Our study aims to evaluate the age-related association with the relative outcomes of multiple versus single arterial grafting (SAG). The Australian and New Zealand national registry was used to identify adult patients undergoing primary isolated CABG with at least two grafts. Exclusion criteria included reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Propensity score matching was used to match patient groups. The primary outcome was all-cause late mortality and the secondary outcomes were 30-day mortality and 30-day hospital readmission. We selected 69,624 eligible patients with a mean (standard deviation) age of 65.0 (10.2) years old. Matching between MAG and SAG generated 16,882 pairs of patients 70 years old and 10,921 pairs of patients ≥ 70 years old. At a median [interquartile range] follow-up duration of 5.9 [3.2–9.6] years, MAG was associated with significantly reduced mortality compared to SAG (hazard ratio [HR], 0.73 95% confidence interval [CI], 0.68–0.78 p 0.001) in the younger subgroup as well as the elderly subgroup (HR, 0.84 95% CI, 0.79–0.88 p 0.001). In conclusion, MAG offers a survival benefit over SAG, in both younger and elderly patients.
Coronary Artery Bypass Surgery Without Saphenous Vein Grafting
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JACC.2022.08.795
Abstract: Approximately 95% of patients of any age undergoing contemporary, coronary bypass surgery will receive at least 1 saphenous vein graft (SVG). It is recognized that SVG will develop progressive and accelerated atherosclerosis, resulting in a stenosis, and in occlusion that occurs in 50% by 10 years postoperatively. For arterial conduits, there is little evidence of progressive failure as for SVG. Could avoidance of SVG (total arterial revascularization [TAR]) lead to a different late (>5 year) survival? A literature review of 23 studies (N = 100,314 matched patients) at a mean 8.8 years postoperative found reduced all-cause mortality for TAR (HR: 0.77 95% CI: 0.71-0.84 P < 0.001). An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565). It found reduced all-cause mortality for TAR (HR: 0.78 95% CI: 0.72-0.85 P < 0.001). Additional Bayesian analysis found a very high probability of a TAR-associated reduction all-cause mortality.
Malignant melanoma of the heart: ambiguity and surprise
Publisher: Wiley
Date: 25-10-2021
DOI: 10.1111/ANS.17315
COVAD survey 2 long-term outcomes: unmet need and protocol
Publisher: Springer Science and Business Media LLC
Date: 14-08-2022
DOI: 10.1007/S00296-022-05157-6
Abstract: Vaccine hesitancy is considered a major barrier to achieving herd immunity against COVID-19. While multiple alternative and synergistic approaches including heterologous vaccination, booster doses, and antiviral drugs have been developed, equitable vaccine uptake remains the foremost strategy to manage pandemic. Although none of the currently approved vaccines are live-attenuated, several reports of disease flares, waning protection, and acute-onset syndromes have emerged as short-term adverse events after vaccination. Hence, scientific literature falls short when discussing potential long-term effects in vulnerable cohorts. The COVAD-2 survey follows on from the baseline COVAD-1 survey with the aim to collect patient-reported data on the long-term safety and tolerability of COVID-19 vaccines in immune modulation. The e-survey has been extensively pilot-tested and validated with translations into multiple languages. Anticipated results will help improve vaccination efforts and reduce the imminent risks of COVID-19 infection, especially in understudied vulnerable groups.
Do practice gaps exist in evidence-based medication prescription at hospital discharge in patients undergoing coronary artery bypass surgery & coronary angioplasty?
Publisher: Medknow
Date: 2017
Effect of coronary artery bypass grafting on function of right ventricle in patients with severe left ventricular dysfunction
Publisher: Medknow
Date: 03-2016
COVID-19 vaccination in autoimmune diseases (COVAD) study: vaccine safety and tolerance in rheumatoid arthritis
Publisher: Oxford University Press (OUP)
Date: 31-10-2022
DOI: 10.1093/RHEUMATOLOGY/KEAC624
Abstract: The COVID-19 vaccination in autoimmune diseases (COVAD) study aimed to assess short-term COVID-19 vaccination-related adverse events (AEs) in RA patients. An online self-reported questionnaire (March–December 2021) was used to capture data related to COVID-19 vaccination-related AEs in RA, other autoimmune rheumatic diseases (AIRDs) (excluding RA and inflammatory myositis), non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs). Descriptive and multivariable regression analyses were performed. Of the 9462 complete respondents, 14.2% (n = 1347) had been diagnosed with RA they had a mean (s.d.) age of 50.7 (13.7) years, 74.2% were women and 49.3% were Caucasian. In total, 76.9% and 4.2% of patients with RA reported minor and major AEs, respectively. Patients with active and inactive RA had similar AE and hospitalization frequencies. Overall, AEs were reported more frequently by BNT162b2 and mRNA-1273 recipients and less frequently by BBV152 recipients compared with the rest. Major AE and hospitalization frequencies were similar across recipients of different vaccines. Patients receiving methotrexate and hydroxychloroquine reported fewer minor AEs than those patients not on them. Compared with HCs and patients with other AIRDs, patients with RA reported similar total AEs, overall minor AEs, and hospitalizations. Compared with nrAIDs, patients with RA reported lower frequencies of overall AEs, minor AEs (both odds ratio [OR] = 0.7 95% CI: 0.5, 0.9), and injection site pain (OR = 0.6 95% CI: 0.5, 0.8) with similar major AE and hospitalization frequencies. Despite the differences in AE frequency across different COVID-19 vaccines, all were well tolerated in patients with RA and were comparable to HCs, providing reassurance as to the safety of COVID-19 vaccination.
COVID-19 vaccination-related adverse events among autoimmune disease patients: results from the COVAD study
Publisher: Oxford University Press (OUP)
Date: 17-06-2022
DOI: 10.1093/RHEUMATOLOGY/KEAC305
Abstract: COVID-19 vaccines have been proven to be safe in the healthy population. However, gaps remain in the evidence of their safety in patients with systemic autoimmune and inflammatory disorders (SAIDs). COVID-19 vaccination-related adverse events (AEs) in patients with SAIDs and healthy controls (HC) seven days post-vaccination were assessed in the COVAD study, a patient self-reported cross-sectional survey. The survey was circulated in early 2021 by & collaborators (94 countries) to collect SAID details, COVID-19 vaccination details and 7-day vaccine AEs, irrespective of respondent vaccination status. Analysis was performed based on data distribution and variable type. Ten thousand nine hundred respondents [median (interquartile range) age 42 (30–55) years, 74% females and 45% Caucasians] were analysed 5867 patients (54%) with SAIDs were compared with 5033 HCs. Seventy-nine percent had minor and only 3% had major vaccine AEs requiring urgent medical attention (but not hospital admission) overall. Headache [SAIDs = 26%, HCs = 24% odds ratio (OR) = 1.1 (95% CI: 1.03, 1.3) P = 0.014], abdominal pain [SAIDs = 2.6%, HCs = 1.4% OR = 1.5 (95% CI: 1.1, 2.3) P = 0.011], and dizziness [SAIDs = 6%, HCs = 4% OR = 1.3 (95% CI: 1.07, 1.6) P = 0.011], were slightly more frequent in SAIDs. Overall, major AEs [SAIDs = 4%, HCs = 2% OR = 1.9 (95% CI: 1.6, 2.2) P & 0.001] and, specifically, throat closure [SAIDs = 0.5%, HCs = 0.3% OR = 5.7 (95% CI: 2.9, 11) P = 0.010] were more frequent in SAIDs though absolute risk was small (0–4%). Major AEs and hospitalizations (& %) were comparable across vaccine types in SAIDs. Vaccination against COVID-19 is safe in SAID patients. SAIDs were at a higher risk of major AEs than HCs, though absolute risk was small. There are small differences in minor AEs between vaccine types in SAID patients.
Serial Angiographic Follow-up of Coronary Artery Bypass Grafts: Do All Conduits Remain Susceptible to Failure Beyond Early Postoperative Angiography?
Publisher: Elsevier BV
Date: 2021
COVID-19 vaccine safety during the antenatal period in women with idiopathic inflammatory myopathies
Publisher: Oxford University Press (OUP)
Date: 12-11-2022
Unusual delayed presentation of a post traumatic giant left subclavian artery pseudoaneurysm with brachial neuropathy
Publisher: Medknow
Date: 06-2017
Incidence, Risk Factors and Effect on Short-Term Results of Postoperative Atrial Fibrillation in Indian Patients Undergoing Coronary Artery Bypass Grafting
Publisher: Elsevier BV
Date: 2018
Pivotal Role of Cardio Thoracic Surgeon in Surgical Management of Metastatic Renal Cell Carcinoma with Supradiaphragmatic Inferior Venecaval Invasion with Long-Term Survival
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Impaired physical function in patients with idiopathic inflammatory myopathies: results from the multicentre COVAD patient-reported e-survey
Publisher: Oxford University Press (OUP)
Date: 03-08-2022
DOI: 10.1093/RHEUMATOLOGY/KEAC441
Abstract: The assessment of physical function is fundamental in the management of patients with idiopathic inflammatory myopathies (IIMs). We aimed to investigate the physical function of patients with IIMs compared with those with non-IIM autoimmune rheumatic diseases (AIRDs) utilizing Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) data obtained in the COVAD study, an international self-reported e-survey assessing the safety of COVID-19 vaccines in AIRDs. Demographics, AIRD diagnosis, disease activity, and PROMIS PF short form-10a data were extracted from the COVAD database. PROMIS PF-10a scores were compared between disease categories and stratified by disease activity. Factors affecting PROMIS PF-10a scores other than disease activity were identified by multivariable regression analysis in patients with inactive disease. A total of 1057 IIM patients, 3635 non-IIM AIRD patients and 3981 healthy controls (HCs) responded to the COVAD e-survey from April to August 2021. Using a binomial regression model, the predicted mean of PROMIS PF-10a scores was significantly lower in IIM patients compared with non-IIM AIRD patients or HCs [36.3 (95% CI 35.5, 37.1) vs 41.3 (95% CI 40.2, 42.5) vs 46.2 (95% CI 45.8, 46.6), P & 0.001], irrespective of disease activity. The independent factors for lower PROMIS PF-10a scores in patients with inactive disease were older age, female, longer disease duration, and a diagnosis of inclusion body myositis or polymyositis. Physical function is significantly impaired in IIMs compared with non-IIM AIRDs or HCs, even in patients with inactive disease. Our study highlights a critical need for better strategies to minimize functional disability in patients with IIMs.
Safety and tolerance of vaccines against SARS-CoV-2 infection in systemic lupus erythematosus: results from the COVAD study
Publisher: Oxford University Press (OUP)
Date: 22-11-2022
DOI: 10.1093/RHEUMATOLOGY/KEAC661
Abstract: To determine COVID-19 vaccine-related adverse events (AEs) in the seven-day post-vaccination period in patients with SLE vs autoimmune rheumatic diseases (AIRDs), non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HC). Data were captured through the COVID-19 Vaccination in Autoimmune Diseases (COVAD) questionnaire (March–December 2021). Multivariable regression models accounted for age, gender, ethnicity, vaccine type and background treatment. Among 9462 complete respondents, 583 (6.2%) were SLE patients (mean age: 40.1 years 94.5% females 40.5% Asian 42.9% Pfizer-recipients). Minor AEs were reported by 83.0% of SLE patients, major by 2.6%, hospitalization by 0.2%. AE and hospitalization frequencies were similar between patients with active and inactive SLE. Rashes were more frequent in SLE patients vs HC (OR 95% CI: 1.2 1.0, 1.5), chills less frequent in SLE vs AIRDs (0.6 0.4, 0.8) and nrAIDs (0.5 0.3, 0.8), and fatigue less frequent in SLE vs nrAIDs (0.6 0.4, 0.9). Pfizer-recipients reported higher overall AE (2.2 1.1, 4.2) and injection site pain (2.9 1.6, 5.0) frequencies than recipients of other vaccines, Oxford/AstraZeneca-recipients more body ache, fever, chills (OR: 2.5, 3.0), Moderna-recipients more body ache, fever, chills, rashes (OR: 2.6, 4.3). Hospitalization frequencies were similar across vaccine types. AE frequencies were similar across treatment groups, although chills were less frequent in antimalarial users vs non-users (0.5 0.3, 0.9). While COVID-19 vaccination-related AEs were reported by four-fifths of SLE patients, those were mostly minor and comparable to AEs reported by healthy in iduals, providing reassurance regarding COVID-19 vaccination safety in SLE.
Vaccine hesitancy decreases in rheumatic diseases, long-term concerns remain in myositis: a comparative analysis of the COVAD surveys
Publisher: Oxford University Press (OUP)
Date: 03-02-2023
DOI: 10.1093/RHEUMATOLOGY/KEAD057
Abstract: COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs) however, hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs), using data from the two international COVID-19 Vaccination in Autoimmune Diseases (COVAD) e-surveys. The first and second COVAD patient self-reported e-surveys were circulated from March to December 2021, and February to June 2022 (ongoing). We collected data on demographics, comorbidities, COVID-19 infection and vaccination history, reasons for hesitancy, and patient reported outcomes. Predictors of hesitancy were analysed using regression models in different groups. We analysed data from 18 882 (COVAD-1) and 7666 (COVAD-2) respondents. Reassuringly, hesitancy decreased from 2021 (16.5%) to 2022 (5.1%) (OR: 0.26 95% CI: 0.24, 0.30, P & 0.001). However, concerns/fear over long-term safety had increased (OR: 3.6 95% CI: 2.9, 4.6, P & 0.01). We noted with concern greater skepticism over vaccine science among patients with IIMs than AIRDs (OR: 1.8 95% CI: 1.08, 3.2, P = 0.023) and HCs (OR: 4 95% CI: 1.9, 8.1, P & 0.001), as well as more long-term safety concerns/fear (IIMs vs AIRDs – OR: 1.9 95% CI: 1.2, 2.9, P = 0.001 IIMs vs HCs – OR: 5.4 95% CI: 3, 9.6, P & 0.001). Caucasians [OR 4.2 (1.7–10.3)] were likely to be more hesitant, while those with better PROMIS physical health score were less hesitant [OR 0.9 (0.8–0.97)]. Vaccine hesitancy has decreased from 2021 to 2022, long-term safety concerns remain among patients with IIMs, particularly in Caucasians and those with poor physical function.
Long-term observational angiographic patency and perfect patency of radial artery compared with saphenous vein or internal mammary artery in coronary bypass surgery
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JTCVS.2022.08.047
Abstract: It is uncertain if the long-term biological behavior of the radial artery as a conduit for coronary bypass surgery has a similar resistance to the development of atherosclerosis as for the internal mammary artery. We aimed to examine long-term angiographic patency and disease-free patency (perfect patency) for internal mammary artery, radial artery, and saphenous vein grafts. A retrospective, single-center, in idual patient cohort study of angiographic observations from patients' latest postoperative angiogram from 1997 to 2020 was performed. Analysis was per anastomosis and assessed for patency and perfect patency. A generalized linear mixed model premised upon logistic regression was used to minimize confounding bias. A total of 983 patients with 3064 grafts were included, with a median follow-up of 8.6 (interquartile range, 4.4-12.6) years after the operation. Multivariable analysis revealed differences for radial (patency, 86.9% perfect patency, 86.4%) and internal mammary artery (patency, 93.9% perfect patency, 93.5%) versus saphenous vein graft (patency, 72.8% perfect patency, 46.2%). There were no differences between the 2 arterial conduits for patency (odds ratio, 1.40 95% CI, 0.85-2.33 P = .189) and perfect patency (odds ratio, 1.14 95% CI, 0.71-1.84 P = .578). If a conduit was patent, then 99.4% of radial artery, 99.6% of internal mammary artery, and 63.5% of saphenous vein graft were reported as perfectly patent. Radial artery and internal mammary artery had similar patency and perfect patency while both were superior to saphenous vein graft.
Right ventricular dysfunction in rheumatic heart valve disease: A clinicopathological evaluation.
Publisher: Scientific Scholar
Date: 2021
Related Organisations
Sanjay Gandhi Post Graduate Institute Of Medical Sciences
Location: India
Related Funding Activities
No related grants have been discovered for Nilesh Srivastav.