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Kochar A, Taigen T, Courson J, Mayuga K, Nakhla S, Wazni O, Santangeli P. Cardioneuroablation for the Treatment of Hypervagotonic Sinus Node Dysfunction. JACC Case Rep 2024; 29:102185. [PMID: 38379643 PMCID: PMC10874895 DOI: 10.1016/j.jaccas.2023.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 02/22/2024]
Abstract
Hypervagotonic sinus node dysfunction (SND) is a form of SND with sinus bradycardia caused by enhanced vagal tone. Indirect proof of hypervagotonia as the mechanism can be inferred from resolution of bradycardia following atropine infusion. In symptomatic patients, pacemaker implantation is recommended. We describe cardioneuroablation as a treatment for hypervagotonic SND.
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Affiliation(s)
- Arshneel Kochar
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Taigen
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeffery Courson
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kenneth Mayuga
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama Wazni
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Department of Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Donnellan E, Wazni OM, Chung MK, Elshazly MB, Chung R, Taigen T, Niebauer M, Kochar A, Hussain M, Patel DR, Il'Giovine Z, Harb S, Cantillon DJ, Kanj M, Saliba W, Jaber W. Attenuated heart rate recovery is associated with higher arrhythmia recurrence and mortality following atrial fibrillation ablation. Europace 2021; 23:1063-1071. [PMID: 33463688 DOI: 10.1093/europace/euaa419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/24/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Heart rate recovery (HRR), the decrease in heart rate occurring immediately after exercise, is caused by the increase in vagal activity and sympathetic withdrawal occurring after exercise and is a powerful predictor of cardiovascular events and mortality. The extent to which it impacts outcomes of atrial fibrillation (AF) ablation has not previously been studied. The aim of this study is to investigate the association between attenuated HRR and outcomes following AF ablation. METHODS AND RESULTS We studied 475 patients who underwent EST within 12 months of AF ablation. Patients were categorized into normal (>12 b.p.m.) and attenuated (≤12 b.p.m.) HRR groups. Our main outcomes of interest included arrhythmia recurrence and all-cause mortality. During a mean follow-up of 33 months, 43% of our study population experienced arrhythmia recurrence, 74% of those with an attenuated HRR, and 30% of those with a normal HRR (P < 0.0001). Death occurred in 9% of patients in the attenuated HRR group compared to 4% in the normal HRR cohort (P = 0.001). On multivariable models adjusting for cardiorespiratory fitness (CRF), medication use, left atrial size, ejection fraction, and renal function, attenuated HRR was predictive of increased arrhythmia recurrence (hazard ratio 2.54, 95% confidence interval 1.86-3.47, P < 0.0001). CONCLUSION Heart rate recovery provides additional valuable prognostic information beyond CRF. An impaired HRR is associated with significantly higher rates of arrhythmia recurrence and death following AF ablation.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Mina K Chung
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Roy Chung
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Mark Niebauer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Arshneel Kochar
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Muzna Hussain
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Divyang R Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Zachary Il'Giovine
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Daniel J Cantillon
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
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3
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Donnellan E, Wazni O, Chung M, Elshazly M, Chung R, Taigen T, Niebauer M, Kochar A, Hussain M, Patel D, Il'Giovine Z, Martyn T, Harb S, Cantillon D, Kanj M, Saliba W, Jaber W. ATTENUATED HEART RATE RECOVERY IS ASSOCIATED WITH HIGHER ARRHYTHMIA RECURRENCE AND MORTALITY FOLLOWING ATRIAL FIBRILLATION ABLATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01591-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Randhawa V, Kochar A, Mentias A, Soltesz E, Tong M, Starling R, Estep J. Greater Left Ventricular Remodeling in Patients with Heartmate 3 Support is Associated with Fewer Heart Failure Readmissions, Gastrointestinal Bleeding and Renal Failure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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5
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Donnellan E, Cotter TG, Wazni OM, Elshazly MB, Kochar A, Wilner B, Patel D, Kanj M, Hussein A, Baranowski B, Cantillon D, Griffin B, Jaber W, Saliba WI. Impact of Nonalcoholic Fatty Liver Disease on Arrhythmia Recurrence Following Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2020; 6:1278-1287. [PMID: 33092755 DOI: 10.1016/j.jacep.2020.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study sought to investigate the association between nonalcoholic fatty liver disease (NAFLD) and arrhythmia recurrence following atrial fibrillation ablation; and to examine the impact of NAFLD stage on outcomes. BACKGROUND Metabolic derangements, including obesity and diabetes, are associated with incident and recurrent atrial fibrillation (AF), in addition to the development of NAFLD. METHODS This was a retrospective study of 267 consecutive patients undergoing AF ablation, 89 of whom were diagnosed with NAFLD prior to ablation and matched in a 2:1 manner based on age, sex, body mass index, ejection fraction, and AF type with 178 patients without NAFLD. Patients were monitored for arrhythmia recurrence during a mean follow-up of 29 months. RESULTS Recurrent arrhythmia was observed in 50 (56%) patients with NAFLD compared with 37 (21%) without NAFLD. Epicardial fat volume was measured on computed tomography and was significantly higher among those with NAFLD (248 ± 125 ml vs. 223 ± 97 ml; p = 0.01). On multivariable models adjusting for sleep apnea, body mass index, heart failure, AF type, and left atrial size, NAFLD was independently associated with increased rates of arrhythmia recurrence (hazard ratio: 3.010; 95% confidence interval: 1.980 to 4.680; p < 0.0001). CONCLUSIONS NAFLD is associated with significantly increased arrhythmia recurrence rates following AF ablation. Identification and reversal, where possible, may result in improved arrhythmia-free survival.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas G Cotter
- Department of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arshneel Kochar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Wilner
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Divyang Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Cantillon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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Donnellan E, Wazni OM, Saliba WI, Hanna M, Kanj M, Patel DR, Wilner B, Kochar A, Jaber WA. Prevalence, Incidence, and Impact on Mortality of Conduction System Disease in Transthyretin Cardiac Amyloidosis. Am J Cardiol 2020; 128:140-146. [PMID: 32650908 DOI: 10.1016/j.amjcard.2020.05.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized infiltrative cardiomyopathy in which conduction system disease is common. The aim of our study was to define the incidence and prevalence of high-grade atrioventricular (AV) block requiring pacemaker implantation in our quaternary referral center. This was a single-center retrospective cohort study of 369 consecutive patients with ATTR-CA who underwent 12-lead electrocardiogram at the time of ATTR-CA diagnosis. During a mean follow-up of 28 months, serial ECGs and the electronic medical record were examined for the development of high-grade AV block and pacemaker implantation. Wild-type ATTR-CA (wtATTR-CA) was diagnosed in 261 patients and 108 had hereditary ATTR-CA (hATTR-CA). A total of 35 (9.5%) had high-grade AV block requiring pacemaker implantation at the time of diagnosis of ATTR-CA. The most common conduction abnormalities evident on the baseline ECG were a wide QRS complex, present in 51% with wtATTR-CA and 48% with hATTR-CA (p = 0.62), followed by first-degree AV block, which was present in 49% with wtATTR-CA and 43% with hATTR-CA (p = 0.31). During follow-up, high-grade AV block developed in 10% of those with hATTR-CA and 12% of patients with wtATTR-CA (p = 0.64). On multivariable models, high-grade AV block was not significantly associated with increased mortality. More advanced ATTR-CA stage and a history of obstructive coronary artery disease were associated with increased mortality on multivariable models. In conclusion, the incidence and prevalence of high-grade AV block is high in patients with ATTR-CA. Patients with ATTR-CA require close monitoring during follow-up for the development of conduction system disease.
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Donnellan E, Wazni O, Kanj M, Cantillon D, Patel D, Trulock K, Elshazly M, Kochar A, Cohen J, Hussein A, Baranowski B, Griffin BP, Jaber WA, Saliba WI. IMPACT OF NONALCOHOLIC FATTY LIVER DISEASE ON ARRHYTHMIA RECURRENCE FOLLOWING ATRIAL FIBRILLATION ABLATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Donnellan E, Wazni OM, Elshazly M, Kanj M, Hussein AA, Baranowski B, Kochar A, Trulock K, Aminian A, Schauer P, Jaber W, Saliba WI. Impact of Bariatric Surgery on Atrial Fibrillation Type. Circ Arrhythm Electrophysiol 2020; 13:e007626. [DOI: 10.1161/circep.119.007626] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Obesity is an independent risk factor for atrial fibrillation (AF) and is associated with a higher AF burden. Recently, weight loss has been found to be associated with a significant reversal in AF type. Bariatric surgery (BS) is associated with reductions in inflammation, left atrial and ventricular remodeling, sleep apnea, blood pressure, and improved glycemic control, all of which may reduce AF burden. In this study, we sought to determine the impact of BS on AF type.
Methods:
We studied AF type before and after BS in 220 morbidly obese patients (body mass index, ≥40 kg/m
2
). All patients underwent extended outpatient cardiac rhythm monitoring within 12 months of BS and at least 1 year after BS.
Results:
There was a significant reduction in body mass index following BS from 49.7±9 to 37.2±9 kg/m
2
. Weight loss was the greatest in the gastric bypass group with a mean percentage weight loss of 25% compared with 19% in patients who underwent sleeve gastrectomy and 16% following gastric banding (
P
<0.0001). Significant reductions in CRP (C-reactive protein), NT-proBNP (N-terminal pro-B-type natriuretic peptide), HbA1C (glycated hemoglobin), and systolic blood pressure were observed in all 3 groups. Reversal of AF type occurred in 71% of patients following gastric bypass, 56% of patients who underwent sleeve gastrectomy, and 50% of patients following gastric banding (
P
=0.004). On Cox proportional hazards analyses, percentage weight loss was significantly associated with AF reversal (
P
=0.0002).
Conclusions:
BS is associated with significant reductions in weight, inflammatory markers, blood pressure, and AF type, and the beneficial effects appear to be the greatest in those undergoing gastric bypass surgery. This study further exemplifies the importance of weight loss and risk factor modification in AF management.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | | | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | | | | | - Kevin Trulock
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ali Aminian
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Philip Schauer
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
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Spilias N, Kochar A, Patel J, Saliba W, Kapadia S. Percutaneous Retrieval of a Watchman Device from the Left Ventricle Using a Transarterial Approach. JACC Case Rep 2019; 1:876-883. [PMID: 34316950 PMCID: PMC8288985 DOI: 10.1016/j.jaccas.2019.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Nikolaos Spilias
- Address for correspondence: Dr. Nikolaos Spilias, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-3, Cleveland, Ohio 44195.
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10
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Minney MJ, Roberts RM, Mathias JL, Raftos J, Kochar A. Service and support needs following pediatric brain injury: perspectives of children with mild traumatic brain injury and their parents. Brain Inj 2018; 33:168-182. [PMID: 30396278 DOI: 10.1080/02699052.2018.1540794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. METHODS Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. RESULTS Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. CONCLUSIONS Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes.
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Affiliation(s)
- M J Minney
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J Raftos
- b Pediatric Emergency Department , Women's & Children's Hospital , North Adelaide , Australia
| | - A Kochar
- b Pediatric Emergency Department , Women's & Children's Hospital , North Adelaide , Australia
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Pathak R, Fahed J, Kochar A, Marchlinski F. Long-Term Clinical Outcome of Radiofrequency Catheter Ablation for Treatment of Bundle Branch Re-Entrant Ventricular Tachycardia. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Pathak R, Kochar A, Gordon J, Marchlinski F, Dixit S. Characteristics and Long-Term Outcomes of Patients with Left Ventricular Papillary Muscle Arrhythmias. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Cheek JA, Lyttle M, Oakley E, Babl F, Borland M, Dalziel K, Kanal GN, Phillips N, Gilhotra Y, Kochar A, Dalton S, McCaskill M, Furyk J, Neutze J, Dalziel SR. ANNUAL ACUTE HOSPITAL COST OF PAEDIATRIC HEAD INJURY IN AUSTRALIA – A PAEDIATRIC RESEARCH IN EMERGENCY DEPARTMENTS INTERNATIONAL COLLABORATIVE (PREDICT) STUDY. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Tanwar GS, Khatri PC, Sengar GS, Kochar A, Kochar SK, Middha S, Tanwar G, Khatri N, Pakalapati D, Garg S, Das A, Kochar DK. Clinical profiles of 13 children withPlasmodium vivaxcerebral malaria. ACTA ACUST UNITED AC 2013; 31:351-6. [DOI: 10.1179/1465328111y.0000000040] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pokharna RK, Joshi A, Raghuram AK, Kochar A, Sharma R. Celiac disease and postcricoid carcinoma. J Assoc Physicians India 2007; 55:866-867. [PMID: 18405136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Malignant disease of oropharynx, esophagus and small intestine occurs in patients of celiac disease frequently. The role of gluten-free diet in prevention of malignancy is unclear. We report a case of postcricoid carcinoma occurring in the patient of celiac disease.
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Affiliation(s)
- R K Pokharna
- Department of Gastroenterology, S.P. Medical College, Bikaner, Rajasthan
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16
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Kochar DK, Tanwar PD, Norris RL, Sabir M, Nayak KC, Agrawal TD, Purohit VP, Kochar A, Simpson ID. Rediscovery of severe saw-scaled viper (Echis sochureki) envenoming in the Thar desert region of Rajasthan, India. Wilderness Environ Med 2007; 18:75-85. [PMID: 17590073 DOI: 10.1580/06-weme-or-078r.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In India, venomous snakebite remains an enigma. Although ineffective first aid treatments that are centuries old continue to be used by people bitten by snakes, important factual information, such as the importance and uniqueness of bites by the northern saw-scaled viper (Echis sochureki), has been largely lost and forgotten. In this paper, we report the first systematically gathered data on the clinical course of envenoming by E sochureki in Rajasthan, India. Clinical information is reported on 12 victims bitten by definitively identified E sochureki, and 2 clinical cases are described in greater detail to illustrate the severity of envenoming by this snake. METHODS A data collection form was developed and used to prospectively gather clinical information regarding patients who were bitten by E sochureki and who brought the dead snake with them to hospital. All snakes were definitively identified by an experienced herpetologist. Information on symptoms and signs, management (both first aid and hospital), and outcomes was collected. RESULTS All 12 victims had evidence of systemic envenoming, including abnormal 20-minute whole blood clotting tests (with systemic bleeding in 7). All received polyvalent antivenom made, in part, with Echis carinatus venom from southern India. Antivenom was relatively ineffective in restoring coagulation to these patients. All patients survived, although 1 patient suffered an intracranial bleed with residual hemiparesis. CONCLUSIONS Echis sochureki causes severe bites in Rajasthan. Work needs to be done to alter the first aid practices used for snakebites in this area, to encourage more rapid presentation to hospital, and to develop antivenom that is more effective against E sochureki.
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Affiliation(s)
- D K Kochar
- S.P. Medical College Bikaner, Rajasthan, India
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17
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Kochar DK, Kaswan K, Kochar SK, Sirohi P, Pal M, Kochar A, Agrawal RP, Das A. A comparative study of regression of jaundice in patients of malaria and acute viral hepatitis. J Vector Borne Dis 2006; 43:123-9. [PMID: 17024861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND & OBJECTIVES Jaundice is one of the common manifestations of severe malaria in adults. The purpose of this study is to compare the pattern of clinical and biochemical parameters such as serum bilirubin and liver enzyme levels in patients of malaria with jaundice and acute viral hepatitis. METHODOLOGY The present study was conducted on 34 patients of malaria with jaundice and 15 patients of acute viral hepatitis. Estimation of serum bilirubin, aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase was done daily using standard procedures in malaria patients and weekly in acute viral hepatitis patients. RESULTS Mean level of serum bilirubin on first day in malaria and acute viral hepatitis patients was 7.07 +/- 3.94 and 10.38 +/- 7.87 mg%, whereas on Day 8 it was 1.19 +/- 1.43 and 7.88 +/- 7.02 mg% respectively. Mean level of AST on Day 1 in malaria and acute viral hepatitis patients was 158.47 +/- 120.35 and 1418.6 +/- 834.11 IU/L, whereas on Day 8 it was 41 +/- 28.33 and 775.3 +/- 399.01 IU/L respectively. Mean level of ALT on Day 1 in malaria and acute viral hepatitis patients was 220.14 +/- 145.61 and 1666.67 +/- 1112.77 IU/L, whereas on Day 8 it was 50.85 +/- 37.31 and 823.8 +/- 475.06 IU/L respectively. Mean level of serum alkaline phosphatase on Day 1 in malaria and acute viral hepatitis patients was 394.74 +/- 267.78 and 513.4 +/- 324.7 IU/L, whereas on Day 8 it was 84.76 +/- 68.50 and 369.27 +/- 207.75 IU/L respectively. INTERPRETATION & CONCLUSION We observed that resolution of jaundice in malaria took 1-2 weeks in contrast 6 to 8 weeks in viral hepatitis. This difference in duration was statistically significant. Thus, jaundice not resolving in 1-2 weeks time in a patient of malaria requires serious consideration for presence of other concomitant diseases including viral hepatitis.
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Affiliation(s)
- D K Kochar
- Department of Medicine, S.P Medical College, Bikaner, India.
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18
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Agrawal RP, Sharma P, Pal M, Kochar A, Kochar DK. Magnitude of dyslipedemia and its association with micro and macro vascular complications in type 2 diabetes: a hospital based study from Bikaner (Northwest India). Diabetes Res Clin Pract 2006; 73:211-4. [PMID: 16580758 DOI: 10.1016/j.diabres.2006.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 01/25/2006] [Indexed: 10/24/2022]
Abstract
AIM Type 2 diabetes is not only associated with hyperglycemia but also with disorders of lipid metabolism. The aim of this study was to investigate the association of dyslipedemia with micro and macro vascular complications of diabetes. METHODS Population based cross sectional study included 4067 diabetic patients who visited hospital during January 2000 to December 2002. Lipid profile was estimated by semi autoanalyser, Retinopathy was assessed by fundoscopy, Nephropathy by microalbuminurea, coronary artery disease (CAD) by electro cardiogram (ECG) changes, peripheral vascular disease (PVD) by doppler study and neuropathy by clinical examinations. The association of dyslipedemia with micro and macro vascular complications was assessed by regression analysis. RESULTS The prevalence of dyslipedemia is high in diabetic population with high serum cholesterol >240mg/dl was seen in 15%, serum triglycerides >160mg/dl was seen in 42.41%, raised LDL >130mg/dl in 45.26%, VLDL >40mg/dl in 24.09% and low levels of HDL-C <40mg/dl were seen in 52.27%. On regression analysis, CAD had strong correlation with high levels of VLDL (0.76), triglycerides (0.82), LDL (0.23) and low HDL (-0.81). Similar association was seen with PVD. Diabetic retinopathy and nephropathy were found to have significant correlation with low HDL (-0.43) and raised LDL (0.37), respectively. Neuropathy was not found to have any significant correlation with lipid profile abnormalities. CONCLUSION Lipid profile abnormalities are very common in type 2 diabetes and it has great influence on CAD and PVD. Hence, appropriate preventive and treatment strategies should be considered timely.
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Affiliation(s)
- R P Agrawal
- Department of Medicine, S.P. Medical College, Bikaner 334003, India.
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Samaha FF, Szapary PO, Iqbal N, Williams MM, Bloedon LT, Kochar A, Wolfe ML, Rader DJ. Effects of rosiglitazone on lipids, adipokines, and inflammatory markers in nondiabetic patients with low high-density lipoprotein cholesterol and metabolic syndrome. Arterioscler Thromb Vasc Biol 2005; 26:624-30. [PMID: 16357312 DOI: 10.1161/01.atv.0000200136.56716.30] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND PPAR-gamma agonists improve insulin sensitivity and glycemic control in type 2 diabetes and may reduce atherosclerosis progression. Thus, PPAR-gamma agonists may be an effective therapy for metabolic syndrome. However, the full spectrum of potentially antiatherogenic mechanisms of PPAR-gamma agonists have not been fully tested in nondiabetic patients with metabolic syndrome. METHODS AND RESULTS We performed a prospective, double-blinded, placebo-controlled study of 60 nondiabetic subjects with low high-density lipoprotein cholesterol (HDL-C) level and metabolic syndrome to rosiglitazone 8 mg daily or placebo for 12 weeks. We found no significant effect of rosiglitazone on HDL-C (+5.5% versus +5.8%, P=0.89), and an increase in total cholesterol (+8% versus -1%; P=0.03). Nevertheless, rosiglitazone significantly increased adiponectin (+168% versus +25%; P<0.001), and lowered resistin (-6% versus +4%; P=0.009), C-reactive protein (-32% versus +36%, P=0.002), interleukin (IL)-6 (-22% versus +4%, P<0.001), and soluble tumor-necrosis factor-alpha receptor-2 (-5% versus +7%, P<0.001). CONCLUSIONS These findings suggest that rosiglitazone, presumably through its PPAR-gamma agonist properties, has direct effects on inflammatory markers and adipokines in the absence of favorable lipid effects. These findings may help explain the mechanism underlying the possible antiatherosclerotic effects of rosiglitazone.
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Affiliation(s)
- Frederick F Samaha
- Cardiovascular Division, Department of Medicine, Cardiovascular Institute, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
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Agrawal RP, Kochar A, Kaswan K, Sharma S, Kochar DK. Need a Better Recognition - MMDM. Int J Diabetes Dev Ctries 2005. [DOI: 10.4103/0973-3930.26752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Narain VS, Kochar A, Gupta R, Puri VK. The Bermuda Triangle: hypertension, diabetes mellitus and nephropathy. Indian Heart J 2000; 52:346-50. [PMID: 10976162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- V S Narain
- Department of Cardiology, King George's Medical College, Lucknow
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22
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Narain VS, Kochar A. Renoprotection with angiotensin type-1 receptor blockers in hypertension. Indian Heart J 2000; 52:89-92. [PMID: 10820943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- V S Narain
- Department of Cardiology, King George's Medical College, Lucknow
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Mehta MC, Deshmukh VV, Kochar A. Hypoglycemia with primary liver cell carcinoma. J Assoc Physicians India 1973; 21:327-30. [PMID: 4366037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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