Publications

  1. Use of Indomethacin in COVID-19 Patients — Experience from Two Medical Centres 
    Rajan Ravichandran, Prasanna Purna, Sivakumar Vijayaraghavalu, Ravi Teja Kalavakollu, Shilpa Gaidhane, Ramarathnam Krishna Kumar. – JIMA – Vol 119, No.7, July 2021
  2. Efficacy and Safety of Indomethacin in Covid-19 patients
    medRxiv 2020.12.14.20245266;
  3. Low Dose Indomethacin in the Outpatient Treatment of COVID-19 in Kidney Transplant Recipients—A Case Series
    Arumugam Kanakaraj, Rajan Ravichandran, Open Access Library Journal,  10 2020
    Abstract:
    The pandemic caused by the coronavirus SARS-CoV-2 has affected millions of people around the world. There are no definitive treatments available to date, which has led to the use of several repurposed drugs. Indomethacin is an effective non-steroidal anti-inflammatory drug, which has played an important role in the treatment of rheumatological conditions and cytokine storms, in the past. Coronavirus disease 2019 (COVID-19) causes cytokine storm and multiorgan dysfunction resulting in high mortality in those affected. Kidney transplant recipients are susceptible to COVID-19, which has caused a higher mortality than the general population, due to the immunosuppressed state. Twelve kidney transplant recipients under regular follow up at our hospital, consulted over the telephone, if they had features of COVID-19. Low dose indomethacin in this group of patients was given in those who were assessed to have mild disease and could be managed at home. Four of twelve patients were admitted to hospital due to their worsening symptoms. However, none of them died and all the 12 patients made good recovery at the end of 4 weeks. This has resulted in not only treating their symptoms, but probably also prevented more hospitalizations by avoiding or attenuating a cytokine storm in them. Indomethacin could prove to be a useful drug in the treatment of mild COVID-19, in view of its easy availability, low cost and minimal side effects.
    Key words: Indomethacin, COVID 19, Renal Transplantation
    For full text https://doi.org/10.4236/oalib.1106860
  4. LOW DOSE INDOMETHACIN FOR SYMPTOMATIC
    TREATMENT OF COVID-19
    Ravichandran Rajan et al./ International Journal of Medical Reviews and Case Reports (2020)ABSTRACT: At present paracetamol is widely used for symptomatic treatment in Covid-19 with poor results. Indomethacin is a powerful anti inflammatory drug and gives relief in low doses also.We describe our experience in using indomethacin in a small number of patients with Covid-19including those who would be classied as high risk. The
    response to indomethacin is rapid and would help reducing hospitalisation during the epidemic. KEYWORDS: Indomethacin, Covid-19, Symptoms
    For full article click here
  5. Experience with Bortezomib in ABO-incompatible renal transplantation – a case series.
    Int J Med Rev Case Rep. 2020; 4(Reports in Surgery, Urology and Orthopaedics)
  6. Use of Indomethacin in Covid-19 –  evidence to try in large scale
    It is very sad that a large number of patients are dying all over the world due to Covid-19 infections. Various drugs and other modalities are being tried to control the infection and reduce the mortality .The main cause of death seems to be the release of cytokines. Why some people are more prone to cytokine release is not clear.Indomethacin is a time honoured drug used as an anti-inflammatory drug specially in arthritis. It has also been used to prevent cytokine release while using an anti-rejection drug OKT3 very successfully (1,2).  It also has antiviral properties when tried in the lab. It has been effective in SARS infection in the lab to reduce the viral load and hasten recovery (3). The drug is effective against canine corona virus (4). Unlike other NSAIDS it does not affect the clotting system (5). On the contrary it prevents thrombosis in lungs in experiments with septicemia  (6).The medicine has low side effect profile when used for short periods .It would be best in to give indomethacin 25 to 50 mg twice a day or according to the body weight for at least 5 days to prevent the cytokine storm in symptomatic patients with Covid-19. The drug should be used early to save lives. It can reduce hospitalisations and spread of the virus by hastening recovery. Considering the scientific evidence and the low side effect profile a trial with Indomethacin is worthwhile to reduce deaths from Covid -19.
    The proposal to try indomethacin was submitted to the ICMR ,health minister India, UK govt and US gov on 29th April 2020.  The chief medical officer of UK Dr Chris Witty has forwarded the proposal to the Therapeutic Task Force where it is under triage .Although there has been no reply from US govt 60 patients have been started on indomethacin in New York with promising results and Dr Jonathan Leibowitz has expressed interest in conducting a multinational case studies. It is essential that we waste no further time in using indomethacin which is possibly superior to hydroxychloroquine according to Dr Jonathan Leibowitz.          

     

    Dr. Rajan  Ravichandran M.D. Director Nephrology, MIOT Hospitals, Chennai ,India

    References:
    1. First, M. R., Schroeder, T. J., Hariharan, S., Alexander, J. W., & Weiskittel, P. (1992). The Effect Of Indomethacin On The Febrile Response Following Okt3 Therapy1. Transplantation, 53(1), 91–93. doi: 10.1097/00007890-199201000-00017
    2. Gaughan, W. J., Francos, B. B., Dunn, S. R., Francos, G. C., & Burke, J. F. (1994). A Retrospective Analysis of the Effect of Indomethacin on Adverse Reactions to Orthoclone OKT3 in the Therapy of Acute Renal Allograft Rejection. American Journal of Kidney Diseases, 24(3), 486–490. doi: 10.1016/s0272-6386(12)80906-1
    3. Amici C, Di Caro A, Ciucci A, et al. Indomethacin has a potent antiviral activity against SARS coronavirus. Antivir Ther. 2006;11(8):1021‐1030.
    4. Xu, T., Gao, X., Wu, Z., Selinger, D. W., & Zhou, Z. (2020). Indomethacin has a potent antiviral activity against SARS CoV-2 in vitro and canine coronavirus in vivo. doi: 10.1101/2020.04.01.017624
    5. Phadnaik BS,Parashar GC. Coagulation profile of indomethacin. (1982). Indian Journal of Pharmacology, 14(4), 355–356. Retrieved from http://www.ijp-online.com/
    6. Short, B. L., Gardiner, M., & Fletcher, J. R. (1981). 1071 INDOMETHACIN IMPROVES HEMODYNAMIC AND CLOTTING STUDIES IN E.coli SEPSIS. Pediatric Research, 15, 621–621. doi: 10.1203/00006450-198104001-01097
    7. Christine Clark, Indomethacin in Covid-19, May 2020, https://medicalupdateonline.com/2020/05/indomethacincovid19/

  7. Tuberculous granulomatous interstitial nephritis of solitary kidney in a renal donor.
    Int J Med Rev Case Rep. 2018; 2(3):73-75
  8. Sofosbuvir-based treatment is safe and effective in indian hepatitis C patients on maintenance hemodialysis: A retrospective study.
    Nephrology. 2018;23(5);446-452
  9. Microbiology, Clinical Spectrum and Outcome of Peritonitis in Patients Undergoing Peritoneal Dialysis in India: Results from a Multicentric, Observational Study
    Indian J Med Microbiol 2017;35:491-8
  10. Education and screening for chronic kidney disease in Indian youth: pilot program results
    Int J Nephrol Renovasc Dis. 2017; 10: 85–90. Published online 2017 Apr 24. doi:  10.2147/IJNRD.S128417
  11. Complications of ABO incompatible Kidney Transplantation
    ECAB Clinical Update: Nephrology. ELSEVIER India. Page 131-142. 2016
    Abstract:
     
    ABO incompatible kidney transplantation (ABOi KT) is getting increasingly popular all over the world in order to increase the living donor pool. Since the process involves desensitization one to four weeks prior to transplantation and increased immunosuppression at least for the first two weeks, the complications are higher than the regular kidney transplantation. The major complications include increased incidence of Antibody Mediated Rejection (ABMR), bleeding and infections. These complications are seen more in the early post operative period rather than in the long term. The complications can start even before transplantation since the protocol of desensitization includes plasmapheresis (PE) and immunosuppression well before the transplantation. A national database study from the US reported in 2013 the early complications of ABOi KT between the years 2000 to 2007 [1]. Unadjusted complication frequencies at 90 days after transplantation in the ABO incompatible (ABOi) recipients were significantly high for hemmorrage (13%), wound infections (12.1%), pneumonia (7.3%) and urinary tract infection (UTI) (34.1%). The corresponding figures for ABO compatible (ABOc) recipients were 6.7%, 7.3%, 3.8% and 22.2% respectively (Table 1). The complications were not significantly different between 91 to 365 days.
  12. Molecular Analysis of the CTNS Gene in Indians with Nephropathic Cystinosis
    The Indian Journal of Pediatrics. Nov 2016
  13. Cystinosis: a truly orphan disease. Report of the Cystinosis Foundation India.
    Rare diseases and orphan drugs, Vol. 3, No.1 (2016)
  14. Treatment efficacy and tolerability of Sofosbuvir and Ribavirin for chronic hepatitis C infection in post renal transplant patients – A retrospective single centre study
    Indian Journal of Transplantation, June 2016
  15. Long Term Follow-Up of ABO Incompatible Kidney Transplantation—A Study from India
    Open Access Library Journal, 3: e2544. March 2016
    Abstract:
    Background: There is a need to do ABO incompatible kidney transplantation in a country like India where deceased donor transplantation is not common. More than 90% transplantations are done with living donors. Although short term results have been reported from 4 centers, there is paucity of data on long term follow-up of such patients. Methods: The data of 18 patients who had undergone ABO incompatible transplantation exceeding a follow-up of 12 months up to 66 months were analyzed. It was compared with the data of compatible kidney transplantation during the same period. Results: In both the groups, there was a similar incidence of urinary tract infection and gastroenteritis with complete recovery. Tuberculosis was successfully treated in 2 patients who had undergone ABO incompatible transplantation. The graft function was excellent with an average follow-up period of 38.2 months. There was no patient mortality during the follow-up period. Conclusion: The long term outcome of ABO incompatible kidney transplantation is similar to compatible kidney transplantation despite the increased incidence of short term complications. 
  16. ABO Incompatible Kidney Transplantation- A review with a perspective from a center in India
    International Journal of Pharmaceutical and Medicinal Research, 2015; 3(6):288-291
    Abstract:
    ABO incompatible kidney transplantation is performed all over the world in order to increase the donor pool and reduce the waiting time for kidney transplantation. The success of such transplantation depends on the desensitization at the time of transplantation. Although in the immediate post operative period more antibody mediated rejections are seen the long term outcome is excellent comparable to the regular kidney transplantation. In a country like India, infections are a major problem related to excessive immunosupression. This article describes the present state of art in ABO incompatible kidney transplantations and the experience of a center from South India where 35 patients have undergone such transplantation. 
  17. Forearm Bone Mineral Density of Normal Indian Population
    Open Access Library Journal. Volume 1:e691; August 2014
  18. ABO incompatible kidney transplantation – A single center experience
    Indian Journal of Transplantation. 6(4):103-106; Oct-Dec 2012 
    Abstract: 
    Aim/Objective: ABO incompatible kidney transplantations are getting popular all over the world. It is essential that such transplantations are carried out in our country also.
    Material and methods: Thirteen patients who had undergone ABO incompatible transplantations in a single center since 2009 were studied. The transplantations have been across different blood group combinations. The preconditioning of the patient was done as per the Japanese protocol.
    Results: The patients were followed up between 4 weeks to 28 months. Two patients had immediate antibody mediated rejection with loss of graft. The rest 11 patients have normal graft function without any complication.
    Conclusion: Successful ABO incompatible transplantation is feasible in our country without endangering the life of recipient with reasonable cost control. Further studies are required to modify the protocol to prevent immediate antibody-mediated rejections (ABMR).
  19. Prevalence of masked hypertension among kidney donors
    Indian Journal of Nephrology. Vol 22 (5);398 ; Sep 2012
  20. Optimization and application of subtype specific polymerase chain reaction for detection and identification of mixed subtypes of hepatitis C virus in patients with renal disease Journal of Virological Method. 2012
  21. A correlative study on Hepatitis C Virus load determined by Real Time Polymerase Chain Reaction with Serum Biomakers in patients with Renal disease
    Journal of Molecular Biomarkers & Diagnosis. 3(2):123;2012
  22. An Indian model for cost-effective CAPD with minimal man power and economic resources
    Nephrol Dial Transplant. 26(10):3089-91;2011 Oct
  23. Predictors of long-term survival on peritoneal dialysis in South India: a multicenter study
    Perit Dial Int. 30(1):29-34; 2010 Jan-Feb
  24. Ribavirin therapy for Chikungunya arthritis
    The Journal of Infection in Developing Countries. 2(2):140-142; 2008
  25. Efficacy and tolerability of Sevelamer in the treatment of hyperphosphatemia in Indian patients on dialysis.
    Indian Journal of Nephrology. 15(4):198-204; 2005
  26. Prevalence of Renovascular Abnormality in Patients undergoing Cardiac Catheteization
    Journal of Association of Physician of India.51: 175-177; 2003 Feb
  27. Spontaneous Bilateral Perirenal Hematoma in a patient with Tetrology of Fallot.
    Nephron. 92(4):929-930;2002 Dec.
  28. Intra Peritoneal Amikacin for treatment of Tuberculous Peritonitis in addition to oral drugs in CAPD patients – A report on two cases
    Indian Journal of Peritoneal Dialysis. 4:36-38; 2002
  29. 24-hours Ambulatory Blood Pressure ( ABP ) monitoring in Renal Transplant recipients
    Indian Journal of Nephrology .12(2); 47-51;2002.
  30. Bone Densitometry in Post Renal Transplant Patients
    Indian Journal of Nephrology; 11:58-60; 2001
  31. Vegetarian diet in kidney failure .
    International Vegetarian Congress Journal – 2001
  32. Ulnar basilic Arteriovenous Fistulae for Haemodialysis
    Dialysis & Transplantation .28(6):314-316; 1999 Jun
  33. Effect of Granulocyte Macrophage Colony Stimulating Factor on Hepatitis – B Vaccination in Haemodialysis patients.
    Journal of Association of Physician of India. 47(6): 602-604; 1999 Jun
  34. Methyl Alcohol Poisoning – ( Experience of an out break in Bombay )
    Journal of Post Graduate Medicine. 30 ( 2 ); 69-74;1984 Apr
  35. ASO Titre and Serum Complement ( C3 ) in Post Streptococcal Glomerulonephritis
    Journal of Post Graduate Medicine. 30 (1); 27-32; 1984 Jan
  36. Hyperlipidemia in Patients with Chronic Renal Failure.
    Journal of Post graduate Medicine. 29 ( 4 ); 212-217;1983 Oct
  37. Oliguria and left upper limb weakness.
    Journal of Association of Physician of India. 31(8); 539-541;1983 Aug
  38. Fatal Air Embolism following Retroperitoneal Air Insufflations
    Journal of Post Graduate Medicine.29 (3);191-2;1983 Jul.
  39. Xanthogranulomatous  pyelonephritis (Report  of two cases)
    Indian Journal  of Surgery. 45 (4). 1983
  40. Lymphuria (A Case Report)
    Indian Journal of Surgery .Vol.44 (9);1982
  41. Reversible malignant hypertension due to inferior vena cava thrombosis
    Journal of Post Graduate Medicine. 28 (4); 223-224; 1982.