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Gilani S, Batra M, Tandon M, Khan M, Jegannathen A, Gahir D, Karanam S, Sivaramalingam M. P093 Impact of breast size on partial breast radiotherapy planning and short term outcome: a single institution experience at University Hospital of North Midlands (UHNM) UK. Breast 2023. [DOI: 10.1016/s0960-9776(23)00210-2] [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: 03/17/2023] Open
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Tandon M, Ranjan R, Muralidharan U, Kannan A. Influence of Anaemia on Multifactorial Disease Retinopathy of Prematurity: A Prospective Observational Study. Cureus 2022; 14:e27877. [PMID: 36110483 PMCID: PMC9462659 DOI: 10.7759/cureus.27877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Retinopathy of prematurity (ROP), a preventable cause of childhood blindness, is a severe complication of preterm (PT) birth treatment. Purpose: The purpose of this study is to analyse the risk factors (RF) associated with the development and progression of ROP. Particular focus is on the contribution of anaemia towards the development and progression of ROP. Methods: This study is a prospective observational study done in the Department of Paediatrics at Meenakshi Mission Hospital & Research Centre, Madurai, over 12 months from May 2013 to April 2014. The study included all consecutively admitted neonates born in and out of the hospital with gestational age (GA) less than or equal to 35 weeks or birth weight (BW) less than or equal to 2 kg and assessed for the gestational, perinatal, and postnatal RF. In addition, at the time of ROP screening, haemoglobin (Hb) and haematocrit (Hct) were checked. The statistical analysis was performed by Stata 11.1 (StataCorp LLC, College Station, TX). Result: The incidence of ROP in our study (46.7%) is higher than previously reported in India. In our study, GA and weight of the neonate at birth have a significant association with ROP incidence. Anaemia in our study is significantly associated with ROP incidence but not as an independent RF. The outcome of various stages of ROP is statistically significant, showing early stages 1 and 2 have more chances of spontaneous regression, and stages 3 and 4 are more likely to need treatment. Two cases in our study with stage 4 ROP had no complications, and none had stage 5 disease. Conclusion: Anaemia should be avoided or corrected in PT newborns as it is a potential and avoidable RF for ROP development. The limitation of our study is the small sample size, and probably more extensive randomized trials will help make this association clear. We recommend ROP screening for PT babies with GA less than 35 weeks and BW less than 2 kg who have the RF amounting to screening and done as per protocol.
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Escobar N, DiMaggio C, Frangos SG, Winchell RJ, Bukur M, Klein MJ, Krowsoski L, Tandon M, Berry C. Disparity in Transport of Critically Injured Patients to Trauma Centers: Analysis of the National Emergency Medical Services Information System (NEMSIS). J Am Coll Surg 2022; 235:78-85. [PMID: 35703965 DOI: 10.1097/xcs.0000000000000230] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient morbidity and mortality decrease when injured patients meeting CDC Field Triage Criteria (FTC) are transported by emergency medical services (EMS) directly to designated trauma centers (TCs). This study aimed to identify potential disparities in the transport of critically injured patients to TCs by EMS. STUDY DESIGN We identified all patients in the National EMS Information System (NEMSIS) database in the National Association of EMS State Officials East region from January 1, 2018, to December 31, 2019, with a final prehospital acuity of critical or emergent by EMS. The cohort was stratified into patients transported to TCs or non-TCs. Analyses consisted of descriptive epidemiology, comparisons, and multivariable logistic regression analysis to measure the association of demographic features, vital signs, and CDC FTC designation by EMS with transport to a TC. RESULTS A total of 670,264 patients were identified as sustaining an injury, of which 94,250 (14%) were critically injured. Of those 94,250 critically injured, 56.0% (52,747) were transported to TCs. Among all critically injured women (n = 41,522), 50.4% were transported to TCs compared with 60.4% of critically injured men (n = 52,728, p < 0.001). In a multivariable logistic regression model, critically injured women were 19% less likely to be taken to a TC compared with critically injured men (OR 0.81, 95% CI 0.71-0.93, p = 0.003). CONCLUSIONS Critically injured female patients are less likely to be transported to TCs when compared with their male counterparts. Performance improvement processes that assess EMS compliance with field triage guidelines should explicitly evaluate for sex-based disparities. Further studies are warranted.
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Affiliation(s)
- Natalie Escobar
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Charles DiMaggio
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Spiros G Frangos
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Robert J Winchell
- Department of Surgery, Weill Cornell Medical College, New York, NY (Winchell)
| | - Marko Bukur
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Michael J Klein
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Leandra Krowsoski
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Manish Tandon
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
| | - Cherisse Berry
- From the NYC Health & Hospitals-Bellevue-Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, DiMaggio, Frangos, Bukur, Klein, Krowsoski, Tandon, Berry)
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Ponnappan KT, Parveez MQ, Pandey CK, Sharma A, Tandon M, Jain V, Pandey VK, Thomas S. Plasma neutrophil gelatinase-associated lipocalin and Interleukin-18 as predictors of acute kidney injury in renal transplant recipients: A pilot study. Saudi J Kidney Dis Transpl 2022; 32:355-363. [PMID: 35017329 DOI: 10.4103/1319-2442.335447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Urine neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL- 18) have shown promise for predicting renal graft recovery. However, urinary flow rate variations may cause variable biomarker dilution. Plasma NGAL and IL-18 may form a biomarker panel that may help predict delayed graft function and slow graft function (SGF) in renal transplant recipients within the first two postoperative days earlier than serum creatinine. There are only a few studies in the literature using plasma NGAL for predicting renal graft recovery. Hence, we planned this study. This observational single-center, prospective cohort study was conducted in renal transplant recipients above 18 years of age. In 22 consecutive renal transplant recipients, we collected ethylenediaminetetraacetic acid-plasma samples 1 h before surgery and subsequently at 6 h, 24 h, and 48 h after surgery for NGAL and IL-18 by sandwich enzyme-linked immuno-sorbent assay technique. Serum creatinine was measured as a part of routine transplant protocol. In renal transplant recipients, neither serum levels of NGAL and IL-18 nor their trends could reliably predict SGF. The only significant correlation existed between serum creatinine at day 2 and IL-18 at day 2 with P = 0.023. Serum NGAL did not correlate with serum creatinine in this setting of renal transplantation. Patients with immediate graft function had a greater percentage decrease of creatinine at day 1 and day 2 (P = 0.002 and 0.001) The percentage change in IL-18 at 24 h and 48 h after transplant from baseline could predict the occurrence of early graft loss (EGL) (P = 0.05, 0.04). The cutoffs were -4.12% at day 1 and +3.39% at day 2 with area under receiver operator characteristics of 0.82 and 0.83, respectively. The percentage change in IL-18 may be a useful marker of EGL in renal transplant recipients. Serum NGAL and creatinine were not able to predict EGL.
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Affiliation(s)
- Karthik T Ponnappan
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Mohd Qurram Parveez
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India; Department of Anesthesia and Intensive Care Medicine, London North West University NHS Trust, Harrow, United Kingdom
| | - Chandra Kant Pandey
- Department of Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Sharma
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi; Department of Trauma and Emergency (Anesthesia), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manish Tandon
- Department of Anesthesia, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - Vikas Jain
- Department of Urology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vijay Kant Pandey
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sherin Thomas
- Department of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India
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Tandon M, Jindal A, Gupta S, Goel N. Cardiac arrest during laparoscopic cholecystectomy in a patient with systemic sclerosis. Indian J Anaesth 2021; 65:S142-S143. [PMID: 34703061 PMCID: PMC8500196 DOI: 10.4103/ija.ija_402_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Manish Tandon
- Anaesthesia, Dharamshila Narayana Superspeciality Hospital, Delhi, India
| | - Aseem Jindal
- Surgical Gastroenterology, Dharamshila Narayana Superspeciality Hospital, Delhi, India
| | - Sajal Gupta
- Cardiology, Dharamshila Narayana Superspeciality Hospital, Delhi, India
| | - Neeraj Goel
- Surgical Gastroenterology, Dharamshila Narayana Superspeciality Hospital, Delhi, India
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Othman A, Winogradzki M, Lee L, Tandon M, Blank A, Pratap J. Bone Metastatic Breast Cancer: Advances in Cell Signaling and Autophagy Related Mechanisms. Cancers (Basel) 2021; 13:cancers13174310. [PMID: 34503118 PMCID: PMC8431094 DOI: 10.3390/cancers13174310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Bone metastasis is a frequent complication of breast cancer with nearly 70% of metastatic breast cancer patients developing bone metastasis during the course of their disease. The bone represents a dynamic microenvironment which provides a fertile soil for disseminated tumor cells, however, the mechanisms which regulate the interactions between a metastatic tumor and the bone microenvironment remain poorly understood. Recent studies indicate that during the metastatic process a bidirectional relationship between metastatic tumor cells and the bone microenvironment begins to develop. Metastatic cells display aberrant expression of genes typically reserved for skeletal development and alter the activity of resident cells within the bone microenvironment to promote tumor development, resulting in the severe bone loss. While transcriptional regulation of the metastatic process has been well established, recent findings from our and other research groups highlight the role of the autophagy and secretory pathways in interactions between resident and tumor cells during bone metastatic tumor growth. These reports show high levels of autophagy-related markers, regulatory factors of the autophagy pathway, and autophagy-mediated secretion of matrix metalloproteinases (MMP's), receptor activator of nuclear factor kappa B ligand (RANKL), parathyroid hormone related protein (PTHrP), as well as WNT5A in bone metastatic breast cancer cells. In this review, we discuss the recently elucidated mechanisms and their crosstalk with signaling pathways, and potential therapeutic targets for bone metastatic disease.
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Tausch E, Schneider C, Yosifov D, Robrecht S, Zhang C, Al‐Sawaf O, Eichhorst B, Fink A, Bloehdorn J, Kreuzer K, Tandon M, Jiang Y, Kim SY, Porro Lura M, Döhner H, Fischer K, Hallek M, Stilgenbauer S. GENETIC MARKERS AND OUTCOME WITH FRONT LINE OBINUTUZUMAB PLUS EITHER CHLORAMBUCIL OR VENETOCLAX ‐ UPDATED ANALYSIS OF THE CLL14 TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.30_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- E Tausch
- Ulm University Department of internal medicine 3 Ulm Germany
| | - C Schneider
- Ulm University Department of internal medicine 3 Ulm Germany
| | - D Yosifov
- Ulm University Department of internal medicine 3 Ulm Germany
| | - S Robrecht
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - C Zhang
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - O Al‐Sawaf
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - B Eichhorst
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - A.‐M Fink
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - J Bloehdorn
- Ulm University Department of internal medicine 3 Ulm Germany
| | - K.‐A Kreuzer
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - M Tandon
- Roche Products Limited Clinical development Welwyn Garden City UK
| | - Y Jiang
- Genentech, Hematology South San Francisco USA
| | - S. Y Kim
- AbbVie, Medical, North Chicago United States of America
| | | | - H Döhner
- Ulm University Department of internal medicine 3 Ulm Germany
| | - K Fischer
- Ulm University Department of internal medicine 3 Ulm Germany
| | - M Hallek
- University Hospital Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany
| | - S Stilgenbauer
- Ulm University Department of internal medicine 3 Ulm Germany
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Al‐Sawaf O, Zhang C, Robrecht S, Tandon M, Panchal A, Fink A, Tausch E, Ritgen M, Kreuzer K, Kim S, Wendtner C, Eichhorst B, Stilgenbauer S, Jiang Y, Hallek M, Fischer K. VENETOCLAX‐OBINUTUZUMAB FOR PREVIOUSLY UNTREATED CHRONIC LYMPHOCYTIC LEUKEMIA: 4‐YEAR FOLLOW‐UP ANALYSIS OF THE RANDOMIZED CLL14 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.49_2880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- O. Al‐Sawaf
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | - C. Zhang
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | - S. Robrecht
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | - M. Tandon
- Roche Products Limited Welwyn Garden City UK
| | - A. Panchal
- Roche Products Limited Welwyn Garden City UK
| | - A.‐M. Fink
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | - E. Tausch
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - M. Ritgen
- University of Schleswig‐Holstein Department II of Internal Medicine Kiel Germany
| | - K.‐A. Kreuzer
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | | | - C. Wendtner
- Klinikum Schwabing Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine Munich Germany
| | - B. Eichhorst
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | - S. Stilgenbauer
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | | | - M. Hallek
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
| | - K. Fischer
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
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Al‐Sawaf O, Zhang C, Lu T, Liao MZ, Panchal A, Robrecht S, Ching T, Tandon M, Fink A, Tausch E, Ritgen M, Böttcher S, Kreuzer K, Kim S, Miles D, Wendtner C, Stilgenbauer S, Eichhorst B, Jiang Y, Hallek M, Fischer K. VENETOCLAX‐OBINUTUZUMAB MODULATES CLONAL GROWTH: RESULTS OF A POPULATION‐BASED MINIMAL RESIDUAL DISEASE MODEL FROM THE RANDOMIZED CLL14 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.31_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- O Al‐Sawaf
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | - C Zhang
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | - T Lu
- Genentec Inc San Francisco USA
| | | | - A Panchal
- Roche Products Limited Welwyn Garden City UK
| | - S Robrecht
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | - T Ching
- Adaptive Biotechnologies Corp Seattle USA
| | - M Tandon
- Roche Products Limited Welwyn Garden City UK
| | - A.‐M Fink
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | - E Tausch
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - M Ritgen
- University of Schleswig‐Holstein Department II of Internal Medicine Kiel Germany
| | - S Böttcher
- University Hospital Rostock Department III of Internal Medicine, Rostock Germany
| | - K.‐A Kreuzer
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | | | | | - C Wendtner
- Klinikum Schwabing Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine Munich Germany
| | - S Stilgenbauer
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - B Eichhorst
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | - Y Jiang
- Genentec Inc San Francisco USA
| | - M Hallek
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
| | - K Fischer
- University Hospital of Cologne Department I of Internal Medicine, Cologne Germany
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Tandon M, Othman AH, Winogradzki M, Pratap J. Bone metastatic breast cancer cells display downregulation of PKC-ζ with enhanced glutamine metabolism. Gene 2021; 775:145419. [PMID: 33444686 DOI: 10.1016/j.gene.2021.145419] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/28/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer among women and its metastases results in poor survival rates in patients. The ability to alter metabolism is a key attribute cancer cells use to survive within different metastatic microenvironments and cause organ failure. We hypothesized that evaluation of metabolic alterations within tumor cells could provide a better understanding of cancer metastasis. Therefore, to investigate underlying metabolic alterations during metastases, we utilized human MDA-MB-231 and mouse 4T1 models that closely mimic human breast cancer metastasis. METHODS The glycolysis and glutamine pathway-related changes were examined in bone metastatic cells by XF-24 extracellular flux analyzer and western blotting. The expression levels of genes related to metabolism were examined by PCR arrays. RESULTS The MDA-MB-231 cells isolated after bone metastases showed reduced glucose uptake and glycolysis compared to parental cells, suggesting that these cells could alter metabolic requirements for survival. To understand these metabolic changes, we investigated glutamine, a common and naturally occurring non-essential amino acid. Interestingly, in reduced glucose conditions both cell lines showed dependence on glutamine for cell survival, and with glutamine withdrawal significantly increasing apoptotic cell death. Glutamine was also critical for normal cell proliferation even in the presence of high glucose concentrations. To further understand this metabolic switch in metastatic cells, we examined the genes related to metabolism and identified a more than seven-fold downregulation of protein kinase C zeta (PKC-ζ) expression levels in bone-derived MDA-MB-231 cells compared to the parental population. The PKC-ζ levels were also significantly reduced in metastatic 4T1 cells compared to non-metastatic MT1A2 cells. Since PKC-ζ deficiency promotes glutamine utilization via the serine biosynthesis pathway, we examined glutamine metabolism. The ectopic expression of PKC-ζ inhibited glutamine conversion to glutamate, while mutant PKC-ζ reversed this effect. Furthermore, the gene expression levels of enzymes involved in serine biosynthesis, phosphoserine phosphatase (PSPH), phosphoserine aminotransferase (PSAT1), and phosphoglycerate dehydrogenase (PHGDH) showed upregulation following glucose deprivation with PKC-ζ deficiency. The PHGDH upregulation was inhibited by ectopically expressing wild type but not mutated PKC-ζ in glucose-deprived conditions. CONCLUSIONS Our results support the upregulation of serine biosynthesis pathway genes and downregulation of PKC-ζ as potential metabolic alterations for bone metastatic breast cancer cells.
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Affiliation(s)
- Manish Tandon
- Suite 507, Armour Academic Building, Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - Ahmad H Othman
- Suite 507, Armour Academic Building, Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - Marcus Winogradzki
- Suite 507, Armour Academic Building, Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - Jitesh Pratap
- Suite 507, Armour Academic Building, Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612, United States.
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Rebollo Salazar D, Velez-Rosborough A, DiMaggio C, Krowsoski L, Klein M, Berry C, Tandon M, Frangos S, Bukur M. Race and Insurance Status are Associated With Different Management Strategies After Thoracic Trauma. J Surg Res 2021; 261:18-25. [PMID: 33401122 DOI: 10.1016/j.jss.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/17/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Health-care disparities based on race and socioeconomic status among trauma patients are well-documented. However, the influence of these factors on the management of rib fractures following thoracic trauma is unknown. The aim of this study is to describe the association of race and insurance status on management and outcomes in patients who sustain rib fractures. METHODS The Trauma Quality Improvement Program database was used to identify adult patients who presented with rib fractures between 2015 and 2016. Patient demographics, injury severity, procedures performed, and outcomes were evaluated. Multivariate logistic regression analysis was used to determine the effect of race and insurance status on mortality and the likelihood of rib fixation surgery and epidural analgesia for pain management. RESULTS A total of 95,227 patients were identified. Of these, 2923 (3.1%) underwent rib fixation. Compared to White patients, Asians (AOR: 0.57, P = 0.001), Blacks or African-Americans (AA) (AOR: 0.70, P < 0.001), and Hispanics/Latinos (HL) (AOR: 0.78, P < 0.001) were less likely to undergo rib fixation surgery. AA patients (AOR: 0.67, P = 0.004), other non-Whites (ONW) (AOR: 0.61, P = 0.001), and HL (AOR 0.65, P = 0.006) were less likely to receive epidural analgesia. Compared to privately insured patients, mortality was higher in uninsured patients (AOR: 1.72, P < 0.001), Medicare patients (AOR: 1.80, P < 0.001), and patients with other non-private insurance (AOR: 1.23, P < 0.001). CONCLUSIONS Non-White race is associated with a decreased likelihood of rib fixation and/or epidural placement, while underinsurance is associated with higher mortality in patients with thoracic trauma. Prospective efforts to examine the socioeconomic disparities within this population are warranted.
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Affiliation(s)
| | | | - Charles DiMaggio
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Leandra Krowsoski
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Michael Klein
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Cherisse Berry
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Manish Tandon
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Spiros Frangos
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Marko Bukur
- Department of Surgery, New York University School of Medicine, New York, New York
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Caplin NJ, Zhdanova O, Tandon M, Thompson N, Patel D, Soomro Q, Ranjeeta F, Joseph L, Scherer J, Joshi S, Dyal B, Chawla H, Iyer S, Bails D, Benstein J, Goldfarb DS, Gelb B, Amerling R, Charytan DM. Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City. Kidney360 2020; 1:1345-1352. [PMID: 35372895 DOI: 10.34067/kid.0005192020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI. Methods Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive-care unit, demonstrating efficacy with outcomes comparable to standard care. Results From April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position. Conclusions Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.
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Affiliation(s)
- Nina J Caplin
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Olga Zhdanova
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Manish Tandon
- Department of Surgery, NYU Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Surgery, New York City Health and Hospitals/Bellevue, New York, New York
| | - Nathan Thompson
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Dhwanil Patel
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Qandeel Soomro
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Fnu Ranjeeta
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Leian Joseph
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Jennifer Scherer
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Shivam Joshi
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Betty Dyal
- Lower Manhattan Dialysis Center, Inc., New York, New York
| | - Harminder Chawla
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Sitalakshmi Iyer
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Douglas Bails
- Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York.,Department of Medicine, NYU Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Judith Benstein
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - David S Goldfarb
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Bruce Gelb
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Richard Amerling
- St. George's University School of Medicine, True Blue Campus, St. Georges, Grenada
| | - David M Charytan
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
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Frangos SG, Bukur M, Berry C, Tandon M, Krowsoski L, Bernstein M, DiMaggio C, Gulati R, Klein MJ. A multiple casualty incident clinical tracking form for civilian hospitals. Am J Disaster Med 2020; 15:43-48. [PMID: 32804385 DOI: 10.5055/ajdm.2020.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. CONCLUSIONS During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.
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Affiliation(s)
- Spiros G Frangos
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Marko Bukur
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Cherisse Berry
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Manish Tandon
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Leandra Krowsoski
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Mark Bernstein
- Department of Radiology, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Charles DiMaggio
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Rajneesh Gulati
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Michael J Klein
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
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Othman A, Winogradzki M, Tandon M, Pratap J. Abstract 1240: Runx2 promotes microtubule stability for survival of breast cancer bone metastatic cells. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Bone metastasis of breast cancer causes significant patient mortality. During metastasis, breast cancer cells induce autophagy to survive metabolic stress. Although the core components of the autophagy pathway have been characterized, the regulatory mechanism of autophagy in bone metastatic cancer cells is still unknown. To examine autophagy during bone metastasis, we used a bone metastatic isogenic variant of breast cancer MDA-MB-231 cells isolated from a xenograft tumor mouse model of metastasis. Previously, we and others have shown that Runt-related transcription factor-2 (Runx2) promotes cell survival, cell invasion, and metastatic tumor growth associated osteolysis. Therefore, we examined the regulatory mechanisms of Runx2-mediated autophagy for increased cell survival in the bone microenvironment. Our results show that Runx2 promotes microtubule (MTs) stability to enhance autophagy flux. We show that Runx2 silencing significantly decreases acetylated α-Tubulin (Ac-α-Tub) levels. Ac-α-Tub is a marker of stable MTs, which promotes trafficking of autophagosomes. Ac-α-Tub also increases during cellular stress, such as glucose starvation. We found that Runx2 knockdown cells are able to induce Ac-α-Tub upon glucose starvation but are unable to maintain acetylated polymer mass of MTs upon removal of stress. Furthermore, expression of wild type or transcriptionally inactive Runx2 can restore Ac-polymer of MTs in Runx2 knockdown cells, while C-terminal deletion mutant failed to rescue MT polymer mass. Previous studies have shown that the C-terminal of Runx2 serves a scaffolding function by interacting with MTs and multiple proteins including HDAC6, the deacetylase of α-Tubulin. Interestingly, the expression levels of HDAC6 and αTAT1 (α-tubulin acetyltransferase-1) were not altered with Runx2 silencing, suggesting a transcriptionally independent function for Runx2 for maintaining the MTs stability. As MT targeting agents are often used as chemotherapeutics, we found that treatment with vinblastine, a MT disrupting agent, decreases Ac-polymer MTs with Runx2 silencing or expression of C-terminal mutant Runx2, while WT and transcriptionally inactive Runx2 expressing cells exhibit resistance to the treatment. Conversely, treatment with Docetaxel, a MT stabilizing agent, enhances Ac-α-Tub and polymer MTs. Recent reports have also linked high levels of Ac-α-Tub with aggressive breast cancer. We performed immunohistochemistry for Ac-α-Tub levels in bone metastatic patient samples and found significantly strong Ac-α-Tub positive cells in matched and unmatched bone metastatic tumors compared to the primary tumors. Our findings indicate that inhibition of Runx2 may sensitize metastatic tumors to MT targeting agents, and Runx2 and Ac-α-Tub levels may serve as markers for metastatic tumors to help stratify patients for optimal treatment for bone metastatic tumors.
Citation Format: Ahmad Othman, Marcus Winogradzki, Manish Tandon, Jitesh Pratap. Runx2 promotes microtubule stability for survival of breast cancer bone metastatic cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1240.
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15
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Tandon M, Singh H, Singla N, Jain P, Pandey CK. Tongue thickness in health vs cirrhosis of the liver: Prospective observational study. World J Gastrointest Pharmacol Ther 2020; 11:59-68. [PMID: 32844044 PMCID: PMC7416379 DOI: 10.4292/wjgpt.v11.i3.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition affects 40%-90% of patients with cirrhosis of the liver. L3 skeletal muscle index (L3SMI) is presently accepted as the most objective and quantitative measure available for sarcopenia, a surrogate marker of malnutrition. L3SMI application is, however, limited by non-availability of computed tomography scanning in remote areas, cost, need for extensive training, and the risk of exposure to radiation. Therefore, an alternative dependable measure with wider availability is needed. Malnutrition causes sarcopenia not only in skeletal muscles but also in other muscular structures such as the psoas muscle, diaphragm and tongue. We therefore hypothesised that the tongue, being easily accessible for inspection and for measurement of thickness using ultrasonography, may be used to document sarcopenia.
AIM To measure and compare tongue thickness in healthy individuals and in patients with cirrhosis of the liver and to study its correlation with conventional prognostic scores for patients with cirrhosis of the liver.
METHODS Tongue thickness was measured using ultrasonography. One hundred twenty subjects of either gender aged 18 to 65 years were studied, with 30 subjects in each group. The tongue thickness was compared between groups based on “Child Turcotte Pugh” (CTP) scores. The correlations between measured tongue thickness and “Model for end stage liver disease” (MELD) score and between age and measured tongue thickness were also assessed.
RESULTS Mean tongue thickness (mean ± SD) in patients with CTP class A, B and C was 4.39 ± 0.39 cm, 4.19 ± 0.53 cm, and 3.87 ± 0.42, respectively, and was 4.33 ± 0.49 cm in normal healthy individuals. Significant differences were seen in tongue thickness between patients with CTP class C and those with CTP class A and B (P < 0.05). Patients with CTP class C also had a significantly reduced tongue thickness than normal individuals (P < 0.05). However, no significant difference was seen in tongue thickness between patients with CTP class A and B and normal individuals. A statistically significant, negative correlation was found between MELD score and tongue thickness (r = -0.331) (P < 0.001). No correlation was observed between L3SMI and MELD score (r = 0.074, P = 0.424). L3SMI (mean ± SD) in healthy subjects was 39.66 ± 6.8 and was 38.26 ± 8.88 in patients with CTP class C, and the difference was not significant. No significant correlation was found between age of the patients and tongue thickness. Intra-class correlation coefficient was used to determine the reliability of the tongue thickness measurements. The intra-class correlation coefficient was 0.984 (95%CI: 0.979-0.989) and was indicative of good reliability.
CONCLUSION Tongue thickness measured by ultrasonography, correlates significantly with the severity of liver disease, as assessed by CTP and MELD scores. The patients with a CTP score ≥ 10 have significantly reduced tongue thickness as compared to normal individuals and those with less severe liver disease and CTP scores of 5-9. No significant difference in tongue thickness was found between healthy individuals and CTP class A and B patients.
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Affiliation(s)
- Manish Tandon
- Formerly at Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Harshita Singh
- Formerly at Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Nishant Singla
- Formerly at Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Priyanka Jain
- Formerly at Department of Research, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Chandra Kant Pandey
- Formerly at Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi 110070, India
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16
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Rodier SG, Kim M, Moore S, Frangos SG, Tandon M, Klein MJ, Berry CD, Huang PP, Dimaggio CJ, Bukur M. Early Anti-Xa Assay-Guided Low Molecular Weight Heparin Chemoprophylaxis is Safe in Adult Patients with Acute Traumatic Brain Injury. Am Surg 2020. [DOI: 10.1177/000313482008600434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study evaluated the safety of early anti-factor Xa assay–guided enoxaparin dosing for chemoprophylaxis in patients with TBI. We hypothesized that assay-guided chemoprophylaxis would be comparable in the risk of intracranial hemorrhage (ICH) progression to fixed dosing. An observational analysis of adult patients with blunt traumatic brain injury (TBI) was performed at a Level I trauma center from August 2016 to September 2017. Patients in the assay-guided group were treated with an initial enoxaparin dose of 0.5 mg/kg, with peak anti-factor Xa activity measured four hours after the third dose. Prophylactic range was defined as 0.2 to 0.5 IU/mL with a dose adjustment of ± 10 mg based on the assay result. The assay-guided group was compared with historical fixed-dose controls and to a TBI cohort from the most recent Trauma Quality Improvement Project dataset. Of 179 patients included in the study, 85 were in the assay-guided group and 94 were in the fixed-dose group. Compared with the fixed-dose group, the assay-guided group had a lower Glasgow Coma Score and higher Injury Severity Score. The proportion of severe (Abbreviated Injury Score, head ≥3) TBI, ICH progression, and venous thromboembolism rates were similar between all groups. The assay-guided and fixed-dose groups had chemoprophylaxis initiated earlier than the Trauma Quality Improvement Project group. The assay-guided group had the highest percentage of low molecular weight heparin use. Early initiation of enoxaparin anti-factor Xa assay–guided venous thromboembolism chemoprophylaxis has a comparable risk of ICH progression to fixed dosing in patients with TBI. These findings should be validated prospectively in a multicenter study.
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Affiliation(s)
- Simon G. Rodier
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Mirhee Kim
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Samantha Moore
- Department of Surgery, New York University School of Medicine, New York, New York
- St. John's University College of Pharmacy and Health Sciences, Queens, New York; and
| | - Spiros G. Frangos
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Manish Tandon
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Michael J. Klein
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Cherisse D. Berry
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Paul P. Huang
- Department of Neurosurgery, NYC Health and Hospitals/Bellevue, New York, New York
| | - Charles J. Dimaggio
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Marko Bukur
- Department of Surgery, New York University School of Medicine, New York, New York
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17
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Frangos SG, Bukur M, Berry C, Tandon M, Krowsoski L, Bernstein M, DiMaggio C, Gulati R, Klein MJ. A multiple casualty incident clinical tracking form for civilian hospitals. J Emerg Manag 2020; 18:261-266. [PMID: 32441042 DOI: 10.5055/jem.2020.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally ac-cepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formal-ized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for multiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in orga-nizing diagnostic and therapeutic triage. CONCLUSIONS During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.
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Affiliation(s)
- Spiros G Frangos
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Marko Bukur
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Cherisse Berry
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Manish Tandon
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Leandra Krowsoski
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Mark Bernstein
- Department of Radiology, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Charles DiMaggio
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Rajneesh Gulati
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
| | - Michael J Klein
- Department of Surgery, NYU School of Medicine, New York City Health and Hospitals/Bellevue, New York City, New York
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18
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Rajan RP, Kohli P, Babu N, Dakshayini C, Tandon M, Ramasamy K. Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines. Graefes Arch Clin Exp Ophthalmol 2020; 258:1205-1210. [PMID: 32322963 DOI: 10.1007/s00417-020-04706-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022] Open
Abstract
AIM To evaluate the incidence and clinical indications for which eyes were treated for retinopathy of prematurity (ROP) outside the guidelines set by International Classification of ROP (ICROP). METHODS Medical records of the patients treated at a single tertiary care ophthalmology hospital for ROP from January 2016 to December 2019 were retrospectively analysed to evaluate the indications for which they were treated. RESULTS Out of 241 eyes, 33 eyes (13.7%) were treated outside the guidelines. The reasons for the treatment outside the guidelines were structural changes (n = 24, 72.7%), persistent stage 3 ROP that did not show any sign of regression for 6 weeks (n = 7, 21.2%) and active ROP with fellow eye being treated (n = 2, 6.1%). The recorded specific structural changes were tangential traction with temporal vessel straightening concerning for macular distortion and ectopia (n = 5, 15.2%), and stage 3 neovascularisation or ridge with anteroposterior traction with risk of progression to stage 4 disease (n = 19, 57.6%). Pre-plus disease was present in 11 eyes (33.3%).After the treatment, ROP stages regressed and retinal vessels grew either until the ora or at least into zone III in all the treated eyes. None of the eyes showed worsening of structural changes after treatment. The mean follow-up of the patients was 12.4 ± 11.7 months. CONCLUSION Experts occasionally recommend treatment in eyes with disease milder than type 1 ROP. This study may help paediatric retinal practitioners in decision-making in borderline cases.
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Affiliation(s)
- Renu P Rajan
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
| | - Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - C Dakshayini
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Manish Tandon
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Rodier SG, Kim M, Moore S, Frangos SG, Tandon M, Klein MJ, Berry CD, Huang PP, DiMaggio CJ, Bukur M. Early Anti-Xa Assay-Guided Low Molecular Weight Heparin Chemoprophylaxis Is Safe in Adult Patients with Acute Traumatic Brain Injury. Am Surg 2020; 86:369-376. [PMID: 32391762] [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: 06/11/2023]
Abstract
This study evaluated the safety of early anti-factor Xa assay-guided enoxaparin dosing for chemoprophylaxis in patients with TBI. We hypothesized that assay-guided chemoprophylaxis would be comparable in the risk of intracranial hemorrhage (ICH) progression to fixed dosing. An observational analysis of adult patients with blunt traumatic brain injury (TBI) was performed at a Level I trauma center from August 2016 to September 2017. Patients in the assay-guided group were treated with an initial enoxaparin dose of 0.5 mg/kg, with peak anti-factor Xa activity measured four hours after the third dose. Prophylactic range was defined as 0.2 to 0.5 IU/mL with a dose adjustment of ± 10 mg based on the assay result. The assay-guided group was compared with historical fixed-dose controls and to a TBI cohort from the most recent Trauma Quality Improvement Project dataset. Of 179 patients included in the study, 85 were in the assay-guided group and 94 were in the fixed-dose group. Compared with the fixed-dose group, the assay-guided group had a lower Glasgow Coma Score and higher Injury Severity Score. The proportion of severe (Abbreviated Injury Score, head ≥3) TBI, ICH progression, and venous thromboembolism rates were similar between all groups. The assay-guided and fixed-dose groups had chemoprophylaxis initiated earlier than the Trauma Quality Improvement Project group. The assay-guided group had the highest percentage of low molecular weight heparin use. Early initiation of enoxaparin anti-factor Xa assay-guided venous thromboembolism chemoprophylaxis has a comparable risk of ICH progression to fixed dosing in patients with TBI. These findings should be validated prospectively in a multicenter study.
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Affiliation(s)
- Simon G Rodier
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Mirhee Kim
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Samantha Moore
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Spiros G Frangos
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Manish Tandon
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Michael J Klein
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Cherisse D Berry
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Paul P Huang
- ‡Department of Neurosurgery, NYC Health and Hospitals/Bellevue, New York, New York
| | - Charles J DiMaggio
- From the *Department of Surgery, New York University School of Medicine, New York, New York
| | - Marko Bukur
- From the *Department of Surgery, New York University School of Medicine, New York, New York
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Katare S, Suryawanshi S, Barkate H, Kodgule R, Tandon M. Effect of Remogliflozin Etabonate on Cardiovascular Risk Factors in Patients with Type-2 Diabetes Mellitus: Summary from Development Trials. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.146] [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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21
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Parveez MQ, Ponnappan K, Tandon M, Sharma A, Jain P, Singh A, Pandey CK, Vyas V. Preoperative Glycated Haemoglobin Level and Postoperative Morbidity and Mortality in Patients Scheduled for Liver Transplant. Indian J Endocrinol Metab 2019; 23:570-574. [PMID: 31803599 PMCID: PMC6873256 DOI: 10.4103/ijem.ijem_208_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is high prevalence of diabetes mellitus in patients of end stage liver disease and it has been implicated for complications in post-transplant patients. Glycated hemoglobin is now targeted as a modifiable preoperative risk factors for postoperative complications. Data describing the course and severity of postoperative liver transplant complication and their relation with pre-operative glycated hemoglobin level is sparse. In this study, we looked for co-relation between the preoperative HbA1c level and post-operative mortality and morbidity in patients scheduled for liver transplant. MATERIALS AND METHODS Retrospective data in 400 adult patients operated for liver transplant were retrieved. After exclusion, data were analyzed for 224 patients. Patients were divided into two groups on the basis of glycated hemoglobin levels (Group 1 (HbA1C ≥6.5) and Group 2 (HbA1C <6.5)). RESULTS Glycated hemoglobin levels were not associated with postoperative death during stay in intensive care unit, incidence of postoperative cardiovascular, renal, and central nervous complications. No difference was seen between 2 groups for need for renal replacement therapy, incidence of infections, rejection, need for re-exploration surgery and duration of intensive care unit and hospital stay. Glycated hemoglobin cannot predict 30 day survival (Area under curve {AUC} = 0.629, P value 0.05). CONCLUSION Preoperative glycated hemoglobin level is not associated with postoperative morbidity and mortality in patients scheduled for liver transplant. TRIAL REGISTRATION NUMBER CTRI/2018/04/012966.
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Affiliation(s)
- Mohd Qurram Parveez
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karthik Ponnappan
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manish Tandon
- Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyanka Jain
- Statistician, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Akhil Singh
- Departments of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandra Kant Pandey
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Varuna Vyas
- Department of Pediatrics (Endocrinology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tausch E, Bahlo J, Robrecht S, Schneider C, Bloehdorn J, Schrell S, Galler C, Al-Sawaf O, Fink A, Eichhorst B, Kreuzer K, Tandon M, Humphrey K, Jiang Y, Schary W, Porro Lurà M, Döhner H, Fischer K, Hallek M, Stilgenbauer S. GENETIC MARKERS AND OUTCOME IN THE CLL14 TRIAL OF THE GCLLSG COMPARING FRONT LINE OBINUTUZUMAB PLUS CHLORABMUCIL OR VENETOCLAX IN PATIENTS WITH COMORBIDITY Best abstract submitted by a young investigator / travel grant recipient. Hematol Oncol 2019. [DOI: 10.1002/hon.53_2629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E. Tausch
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - C. Schneider
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - J. Bloehdorn
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - S. Schrell
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - C. Galler
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche; Welwyn Garden City United Kingdom
| | - Y. Jiang
- Oncology Biomarker Development; Genentech; South San Francisco United States
| | - W. Schary
- Oncology; Abbvie Inc; North Chicago United States
| | - M. Porro Lurà
- Pharmaceuticals Division; F. Hoffmann - La Roche Ltd; Basel Switzerland
| | - H. Döhner
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - S. Stilgenbauer
- Department of Internal Medicine 3; Ulm University; Ulm Germany
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Tausch E, Bahlo J, Robrecht S, Schneider C, Bloehdorn J, Schrell S, Galler C, Al-Sawaf O, Fink AM, Eichhorst B, Kreuzer KA, Tandon M, Humphrey K, Jiang Y, Schary W, Porro Lurà M, Döhner H, Fischer K, Hallek M, Stilgenbauer S. S105 GENETIC MARKERS AND OUTCOME IN THE CLL14 TRIAL OF THE GCLLSG COMPARING FRONT LINE OBINUTUZUMAB PLUS CHLORAMBUCIL OR VENETOCLAX IN PATIENTS WITH COMORBIDITY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000558640.93333.00] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Fischer K, Porro Lurà M, Al-Sawaf O, Bahlo J, Fink A, Tandon M, Dixon M, Robrecht S, Warburton S, Humphrey K, Samoylova O, Liberati A, Pinilla-Ibarz J, Opat S, Sivcheva L, Le Dû K, Fogliatto L, Utoft Niemann C, Weinkove R, Robinson S, Kipps T, Boettcher S, Tausch E, Schary W, Eichhorst B, Wendtner C, Langerak A, Kreuzer K, Goede V, Stilgenbauer S, Mobasher M, Ritgen M, Hallek M. FIXED-DURATION VENETOCLAX PLUS OBINUTUZUMAB IMPROVES PFS AND MINIMAL RESIDUAL DISEASE NEGATIVITY IN PATIENTS WITH PREVIOUSLY UNTREATED CLL AND COMORBIDITIES. Hematol Oncol 2019. [DOI: 10.1002/hon.52_2629] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Porro Lurà
- Pharmaceuticals Division; PDGo, F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - M. Dixon
- Biostatistics; Roche Products Limited; Welwyn Garden City United Kingdom
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - S. Warburton
- Product Development - Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - O. Samoylova
- Hematology Department; Regional Clinical Hospital N.A. Semashko; Nizhny Novgorod Russian Federation
| | - A.M. Liberati
- Division of Onco-Hematology; Santa Maria Terni Hospital, University of Perugia; Perugia Italy
| | - J. Pinilla-Ibarz
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL United States
| | - S. Opat
- Haematology Department; School of Clinical Sciences at Monash Health; Monash University Victoria Australia
| | - L. Sivcheva
- First Internal Department; MHAT Hristo Botev; AD, Vratsa Bulgaria
| | - K. Le Dû
- Hematology Department; Clinique Victor Hugo; Le Mans France
| | - L.M. Fogliatto
- Department of Hematology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - C. Utoft Niemann
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - R. Weinkove
- Wellington Blood & Cancer Centre; Capital & Coast District Health Board, Wellington, New Zealand and Cancer Immunotherapy Programme, Malaghan Institute of Medical Research; Wellington New Zealand
| | - S. Robinson
- Department of Medicine; Division of Hematology, QEII Health Sciences Center; Halifax NS Canada
| | - T.J. Kipps
- Moores Cancer Center; UC San Diego Health; San Diego CA United States
| | - S. Boettcher
- Department III of Internal Medicine; University Hospital Rostock; Rostock Germany
| | - E. Tausch
- Department III of Internal Medicine; Ulm University; Ulm Germany
| | - W.L. Schary
- Clinical Development Oncology; AbbVie Inc.; North Chicago IL United States
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - C. Wendtner
- Department of Hematology; Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing Munich Germany
| | - A.W. Langerak
- Department of Immunology; Laboratory Medical Immunology, Erasmus MC; Rotterdam Netherlands
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - V. Goede
- Oncogeriatric Unit; Dept. of Geriatric Medicine, St. Marien Hospital; Cologne Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine, Ulm University, Ulm, Germany and Department for Hematology, Oncology and Rheumatology; Saarland University Medical School; Homburg/Saar Germany
| | - M. Mobasher
- Product Development Oncology; Genentech, Inc.; South San Francisco CA United States
| | - M. Ritgen
- Department II of Internal Medicine; Campus Kiel, University of Schleswig-Holstein; Kiel Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, CECAD (Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases); University of Cologne; Cologne Germany
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Al-Sawaf O, Lilienweiss E, Bahlo J, Robrecht S, Fink A, Patz M, Tandon M, Humphrey K, Jiang Y, Schary W, Porro Lurà M, Ritgen M, Tausch E, Stilgenbauer S, Eichhorst B, Fischer K, Hallek M, Kreuzer K. HIGH EFFICACY OF VENETOCLAX PLUS OBINUTUZUMAB IN PATIENTS WITH COMPLEX KARYOTYPE (CKT) AND CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): A PROSPECTIVE ANALYSIS FROM THE CLL14 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.68_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - E. Lilienweiss
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Patz
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - Y. Jiang
- Oncology Biomarker Development; Genentech Inc.; South San Francisco CA United States
| | - W. Schary
- Clinical Development; Oncology, AbbVie Inc.; North Chicago IL United States
| | - M. Porro Lurà
- Pharmaceuticals Division, PDGo; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - M. Ritgen
- Department II of Internal Medicine, Campus Kiel; University of Schleswig-Holstein; Kiel Germany
| | - E. Tausch
- Department III of Internal Medicine; Ulm University; Ulm Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine, Ulm University, Ulm, Germany, and Department for Hematology, Oncology and Rheumatology; Saarland University Medical School; Homburg/Saar Germany
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, CECAD (Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases); University of Cologne; Cologne Germany
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
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26
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Pandey CK, Prakash K, Karna ST, Nayak SL, Tandon M, Jain P. Detection of Coagulopathy in Chronic Renal Disease using Thromboelastography and its comparison with Conventional Tests. J Assoc Physicians India 2019; 67:34-37. [PMID: 31311216] [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: 06/10/2023]
Abstract
PURPOSE OF THE STUDY Thromboelastography provides a holistic picture of blood coagulation including fibrin formation, cross, linking and fibrinolysis. Coagulaopathy in end stage renal disease (ESRD) is multifactorial. The present evaluated the thromboelastographic profile of ESRD patients and compared it to conventional tests of coagulation. STUDY DESIGN In this observational case control study, fifty ESRD patients and 50 controls were recruited. Venous samples were withdrawn and platelet count, International Normalization Ratio and fibrinogen levels were measure. Simultaneously a thromboelastography (TEG) was performed. All samples were drawn prior to initiation of dialysis. RESULTS The fibrinogen concentration was higher in the ESRD group compared to control (455.51±83.39 vs. 233.84±71.71 mg/dl, P<0.05). The maximum amplitude in ESRD group was 76.94 ± 15.11 mm, which was significantly higher than control group 65.10±10.31 mm (P<0.05).Out of 50 ESRD patients,39 had maximum amplitude (MA) >73mm, 3 had MA <55 mm while 8 patients had normal MA. Further, it was seen that in four out if the five patients whose INR was greater than 1.5. TEG was hypercoaguable. Also, three patients whose platelet count was less than x105/dl had normal thromboelastographs. Two patients with normal platelet count, fibrinogen and INR had hypercoaguable thromboelastographs. Thromboelastography could detect fibrinolysis in 5 patients of end stage renal disease. CONCLUSION The present study demonstrated that INR, platelet count and fibrinogen levels do not reflect the actual coagulation status in patients of ESRD. Thromboelastography is a better tool to detect coagulopathy in this group of patients.
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Affiliation(s)
- Chandra Kant Pandey
- Senior Professor and Head,Institute of Liver and biliary Sciences, New Delhi; *Corresponding Author
| | - Kelika Prakash
- Assistant Professor, Institute of Liver and biliary Sciences, New Delhi
| | | | - Suman Lata Nayak
- Associate Professor,Institute of Liver and biliary Sciences, New Delhi
| | - Manish Tandon
- Associate Professor,Institute of Liver and biliary Sciences, New Delhi
| | - Priyanka Jain
- Statistican, Institute of Liver and biliary Sciences, New Delhi
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Subramanian KKK, Tandon M, Pandey CK, Jain P. Patients with Cirrhosis of Liver Operated for Non-transplant Surgery: A Retrospective Analysis. J Clin Transl Hepatol 2019; 7:9-14. [PMID: 30944813 PMCID: PMC6441638 DOI: 10.14218/jcth.2018.00043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/15/2018] [Accepted: 01/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: Patients with cirrhosis of the liver have high mortality after surgery. We investigated the mortality in patients with cirrhosis of the liver who underwent surgery other than liver transplant and applied the Mayo clinic model to predict mortality and compare with the observed mortality. We also studied the association of the observed mortality with the Child-Turcotte-Pugh (CTP) class and the model for end-stage liver disease (MELD) and model for end-stage liver disease-sodium (MELD-Na) scores. Methods: The electronic records database of our hospital was accessed to analyze the data of 133 cirrhotic patients who underwent various surgeries under general anesthesia from October 2009 to June 2017. The Mayo risk score was applied to each and used to calculate predicted mortality; the MELD and MELD-Na scores were also calculated. Telephonic interview was performed with the patients and or their relative to ascertain survival or time of death after surgery, when the information was not available from the hospital records. Results: The all-cause observed mortality rates at postoperative days 30 and 90 and at 1 year were 12%, 20.3% and 26.3% respectively. The area under the receiver operating characteristic curve values for the Mayo model as a predictor of 30-day, 90-day and 1-year mortality were 0.836, 0.828 and 0.744 respectively. Good correlation was seen for observed mortality with CTP class and with MELD and MELD-Na scores. Conclusions: The Mayo model for predicting postoperative mortality in patients with cirrhosis of the liver demonstrated good correlation in this study. The strength of prediction of mortality by Mayo risk score calculation was similar at postoperative days 30 and 90 but decreased at 1-year after the surgery. Good correlation was seen for the observed mortality with MELD, MELD-Na and CTP scores.
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Affiliation(s)
| | - Manish Tandon
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
- *Correspondence to: Manish Tandon, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, D-1, Vasant kunj, New Delhi, India. Tel: +91-9871437478, Fax: +91-1146300010, E-mail:
| | - Chandra Kant Pandey
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Priyanka Jain
- Department of Research, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India
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28
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Pandey CK, Sharma S, Tandon M, Karna ST, Prakash K, Singh SA, Jain P. Effect of Magnesium Sulphate on Coagulation and Thromboelastographic ArticleTitlemeters in Chronic Liver Disease Patients. J Assoc Physicians India 2019; 67:100. [PMID: 31304726] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Chandra Kant Pandey
- Senior Professor, Anaesthesiology, 6Statistician, Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
| | - Sandeep Sharma
- Ex. Senior Resident, Anaesthesiology, 6Statistician, Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
| | - Manish Tandon
- Associate Professor, Anaesthesiology, 6Statistician, Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
| | - Sunaina Tejpal Karna
- Associate Professor, Anaesthesiology, 6Statistician, Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
| | - Kelika Prakash
- Assistant Professor, Anaesthesiology, 6Statistician, Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
| | - Shweta Agarwal Singh
- Ex. Additional Professor, Anaesthesiology,Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
| | - Priyanka Jain
- Statistician, Clinical Research, Institute of Liver and Biliary Sciences, New Delhi
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Agarwal A, Yadav G, Gupta D, Tandon M, Dhiraaj S, Singh PK. Comparative evaluation of Myolaxin and EM LA cream for attenuation of venous cannulation pain: A prospective, randomised, double blind study. Anaesth Intensive Care 2019; 35:726-9. [DOI: 10.1177/0310057x0703500511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a Visual Analogue Scale (VAS) of O-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain.
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Affiliation(s)
- A. Agarwal
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - G. Yadav
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D. Gupta
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M. Tandon
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - S. Dhiraaj
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - P. K. Singh
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Rodier S, Marshall GT, Moore S, DiMaggio C, Frangos SG, AyoungChee P, Tandon M, Bukur M. Weight-Based Enoxaparin for Venous Thromboembolic Event Prophylaxis in Adult Trauma Patients Results in Improved Prophylaxis. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.541] [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: 11/25/2022]
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Tandon M, Karna ST, Pandey CK, Chaturvedi R, Jain P. Multimodal temperature management during donor hepatectomy under combined general anaesthesia and neuraxial analgesia: Retrospective analysis. Indian J Anaesth 2018; 62:431-435. [PMID: 29962524 PMCID: PMC6004754 DOI: 10.4103/ija.ija_123_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Unintended hypothermia (UIH) during surgery under general anaesthesia has adverse implications. A retrospective analysis of the perioperative temperature records of healthy voluntary liver donors was done to evaluate the efficacy of a multimodal protocol for temperature management. Methods: Records of 50 American Society of Anesthesiologists physical status Class 1 patients operated for Donor Hepatectomy lasting >2 h under combined general and epidural anaesthesia were analysed. Ambient temperature was maintained 24°C–27°C before induction of GA and during insertion of epidural catheter. Active warming was done using warming mattress set to temperature 38°C, hot air blanket with temperature set to 38°C and fluid warming device (Hotline™) with preset temperature of 41°C. Nasopharyngeal temperature was continuously monitored. After induction of GA and draping of the patient, ambient temperature was decreased and maintained at 21°C–24°C and was again increased to 24°C–27°C at the conclusion of surgery. During surgery, for every 0.1°C above 37°C, one heating device was switched off such that at 37.3°C all the 3 devices were switched off. Irrigation fluid was pre-warmed to 39°C. Results: Baseline temperature was 35.9°C ± 0.4°C. Minimum temperature recorded was 35.7°C ± 0.4°C. Mean decrease in temperature below the baseline temperature was 0.2°C ± 0.2°C. Temperature at the end of surgery was 37.4°C ± 0.5°C. Conclusion: Protocol-based temperature management with simultaneous use of resistive heating mattress, forced-air warming blanket, and fluid warmer along with ambient temperature management is an effective method to prevent unintended perioperative variation in body temperature.
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Affiliation(s)
- Manish Tandon
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chandra Kant Pandey
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ravindra Chaturvedi
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Priyanka Jain
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
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Rodier SG, DiMaggio CJ, Wall S, Sim V, Frangos SG, Ayoung-Chee P, Bukur M, Tandon M, Todd SR, Marshall GT. Subway-Related Trauma: An Urban Public Health Issue with a High Case-Fatality Rate. J Emerg Med 2018; 55:165-171.e1. [PMID: 29753571 DOI: 10.1016/j.jemermed.2018.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/06/2017] [Revised: 02/20/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Between 1990 and 2003, there were 668 subway-related fatalities in New York City. However, subway-related trauma remains an understudied area of injury-related morbidity and mortality. OBJECTIVE The objective of this study was to characterize the injuries and events leading up to the injuries of all patients admitted after subway-related trauma. METHODS We conducted a retrospective case series of subway-related trauma at a Level I trauma center from 2001 to 2016. Descriptive epidemiology of patient demographics, incident details, injuries, and outcomes were analyzed. RESULTS Over 15 years, 254 patients were admitted for subway-related trauma. The mean (standard error of the mean) age was 41 (1.0) years, 80% were male (95% confidence interval [CI] 74-84%) and median Injury Severity Score was 14 (interquartile range [IQR] 5-24). The overall case-fatality rate was 10% (95% CI 7-15%). The most common injuries were long-bone fractures, intracranial hemorrhage, and traumatic amputations. Median length of stay was 6 days (IQR 1-18 days). Thirty-seven percent of patients required surgical intervention. At the time of injury, 55% of patients (95% CI 49-61%) had a positive urine drug or alcohol screen, 16% (95% CI 12-21%) were attempting suicide, and 39% (95% CI 33-45%) had a history of psychiatric illness. CONCLUSIONS Subway-related trauma is associated with a high case-fatality rate. Alcohol or drug intoxication and psychiatric illness can increase the risk of this type of injury.
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Affiliation(s)
- Simon G Rodier
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Charles J DiMaggio
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Stephen Wall
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Vasiliy Sim
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Spiros G Frangos
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Patricia Ayoung-Chee
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Marko Bukur
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Manish Tandon
- Department of Surgery, New York University School of Medicine, New York, New York
| | - S Rob Todd
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Gary T Marshall
- Department of Surgery, New York University School of Medicine, New York, New York
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Pandey CK, Saluja V, Gaurav K, Tandon M, Pandey VK, Bhadoria AS. K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis: A pilot study. Indian J Med Res 2018; 145:84-89. [PMID: 28574019 PMCID: PMC5460579 DOI: 10.4103/ijmr.ijmr_749_14] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background & objectives: Coagulation and haemostasis are dynamic processes. The haemostatic changes in liver disease affect all aspects of coagulation. The prothrombin time (PT)/international normalized ratio (INR) was developed to monitor oral anticoagulant therapy and the activated partial thromboplastin time to investigate inheritable single factor deficiencies. Viscoelastic tests such as thromboelastogram (TEG) give information about dynamics of clot formation (coagulation factor and anticoagulant activity), clot strength (platelets and fibrinogen) and clot stability (finbrinolysis and factor XIII). Administration of blood products before invasive procedures is still guided by INR and platelet count in patients of liver disease. This study was aimed to evaluate the validity of TEG to predict post-procedural bleed after central venous cannulation in patients with cirrhosis. Methods: Ninety patients aged 20-70 yr diagnosed with liver cirrhosis requiring elective central venous catheter (CVC) insertion were studied. Platelet count, INR, serum creatinine, TEG and Child-Turcotte-Pugh (CTP) score were recorded before the procedure. Right-sided internal jugular vein was cannulated. On the basis of presence or absence of post-procedural bleed, patients were divided into bleeding and non-bleeding groups. The CTP score, component of TEG (R - reaction time, K - coagulation time, MA - maximum amplitude and α - angle) and laboratory parameters of both the groups were compared. Results: Bleeding was seen more when CTP scores were ≥10 (P=0.05). The K time of 3.05 min or more on thromboelastograph was a significant predictor of bleeding [area under the curve (AUC) 0.694, P=0.047]. MA of 48.8 mm or more was a significant predictor of non-bleeding. INR ≥2.6 was a significant predictor of bleeding (AUC 0.765, P=0.005). K time had a low-positive predictive value of 20 per cent and the positive and negative likelihood ratios of 1.87 and 0.48, respectively. Interpretation & conclusions: Our results show that the cut-off value for INR ≥2.6 and K time ≥3.05 min predict bleeding and MA ≥48.8 mm predicts non-bleeding in patients with cirrhosis undergoing central venous pressure catheter cannulation.
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Affiliation(s)
- Chandra K Pandey
- Department of Anaesthesia & Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Vandana Saluja
- Department of Anaesthesia & Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Kumar Gaurav
- Department of Anaesthesia & Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Manish Tandon
- Department of Anaesthesia & Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Vijay K Pandey
- Department of Anaesthesia & Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Ajeet S Bhadoria
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
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Binmadi NO, Basile JR, Perez P, Gallo A, Tandon M, Elias W, Jang SI, Alevizos I. miRNA expression profile of mucoepidermoid carcinoma. Oral Dis 2018; 24:537-543. [PMID: 29095552 DOI: 10.1111/odi.12800] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/17/2017] [Revised: 09/21/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES MicroRNAs (miRNAs) are single-stranded RNAs that have been implicated in cancer initiation and progression and act as tumour suppressors or oncogenes. In this study, miRNA profiling was conducted on the most frequent malignancy of salivary glands, mucoepidermoid carcinoma (MEC), in comparison with normal tissues. MATERIALS AND METHODS The TaqMan Human miRNA Cards Array was used for the miRNA profiling of MEC and normal tissues. To validate the differentially expressed miRNAs in MEC, we used real-time PCR (qRT-PCR). RESULTS miR-302a was the most significantly increased miRNA in cancer tissues (p < .05). Here, we demonstrate that the upregulation of miR-302a expression in SGT cell lines induced cancer cell invasion in vitro. CONCLUSIONS These promising results suggest the need for further studies to establish mir-302a as a marker of invasion and aggressiveness in MEC.
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Affiliation(s)
- N O Binmadi
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - J R Basile
- Department of Oncology and Diagnostic Sciences, University of Maryland Dental School, Baltimore, MD, USA.,Greenebaum Cancer Centre, Baltimore, MD, USA
| | - P Perez
- Molecular Physiology and Therapeutics branch, Sjögren's Syndrome and Salivary Gland Dysfunction Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - A Gallo
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo peri Trapiantie Terapie ad alta specializzazione), Palermo, Italy
| | - M Tandon
- Molecular Physiology and Therapeutics branch, Sjögren's Syndrome and Salivary Gland Dysfunction Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - W Elias
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S I Jang
- Molecular Physiology and Therapeutics branch, Sjögren's Syndrome and Salivary Gland Dysfunction Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - I Alevizos
- Molecular Physiology and Therapeutics branch, Sjögren's Syndrome and Salivary Gland Dysfunction Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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Sharma A, Karna ST, Tandon M, Pandey CK, Chaturvedi R, Vyas V, Goel AD. Use of ultrasound-guided preoperative diaphragmatic thickness as a predictor of postoperative weaning failure in recipients and donors scheduled for living donor liver transplant surgery. Saudi J Anaesth 2018; 12:406-411. [PMID: 30100839 PMCID: PMC6044153 DOI: 10.4103/sja.sja_12_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives: The present study was designed to explore the utility of ultrasound-guided diaphragmatic thickness in the preoperative period in healthy controls scheduled for live-related donor hepatectomy and patients suffering from chronic liver disease scheduled for liver transplantation (LT) and its use as a predictor of postoperative weaning failure. Materials and Methods: This prospective observational study was conducted in a tertiary health care center and 65 adult (18–70 years) participants (30 healthy liver donors and 35 liver transplant recipients) were enrolled for this study. Right diaphragmatic thickness of both donors and recipients was measured by B-mode ultrasound using a 10 MHz linear array transducer in the supine position in the operation theater just before induction of anesthesia. For subgroup analysis of the recipients, we further divided them into two groups – Group 1 (diaphragmatic thickness < 2 mm) and Group 2 (diaphragmatic thickness > 2 mm), and comparison was done for duration of mechanical ventilation. Intergroup comparison was made for duration of mechanical ventilation and various other parameters. Results: The sonographic measurement of diaphragm revealed that its thickness is decreased in patients with chronic liver disease patients (2.12 ± 0.54 mm) as compared to healthy donors (3.70 ± 0. 58 mm). On multiple logistic regression, higher duration of mechanical ventilation was associated with diaphragmatic thickness < 2 mm (Group 1 of recipients) (adjusted odds ratio 0.86; 95% confidence interval: 0.75–0.99; P = 0.013) after adjusting for age, gender, and body mass index. Conclusions: Diaphragmatic thickness is decreased in patients with chronic liver disease as compared to healthy liver donors. Preoperative measurement of ultrasound-guided right hemidiaphragm thickness can be used to predict weaning failure in patients undergoing LT. Other studies are needed to confirm these finding on different group of patients.
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Affiliation(s)
- Ankur Sharma
- Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manish Tandon
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chandra Kant Pandey
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ravindra Chaturvedi
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Varuna Vyas
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Biostatistics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tandon M, Kumaraswamy P, Sood AK, Pamecha V. Leucocytosis before liver transplant, source could be hiding in heart: Case report. Indian J Anaesth 2018; 62:1000-1002. [PMID: 30636807 PMCID: PMC6299768 DOI: 10.4103/ija.ija_473_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tandon M, Karna ST, Pandey CK, Chaturvedi R. Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series. World J Hepatol 2017; 9:1253-1260. [PMID: 29312528 PMCID: PMC5745586 DOI: 10.4254/wjh.v9.i33.1253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/18/2017] [Accepted: 10/15/2017] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) following liver transplant (LT) surgery is a distinct clinical entity with high mortality. It is known to occur in absence of obvious risk factors. No preoperative workup including electrocardiogram, echocardiography at rest and on stress, reasonably prognosticates the risk. In patients of chronic liver disease, cirrhotic cardiomyopathy, alcoholic cardiomyopathy, and stress induced cardiomyopathy have each been implicated as a cause for HF after LT. However distinguishing one etiology from another not only is difficult, several etiologies may possibly coexist in a given patient. Diagnostic dilemma is further compounded by the fact that presentation and management of HF irrespective of the possible underlying cause, remains the same. In this case series, 6 cases are presented and in the light of existing literature modification in the preoperative workup are suggested.
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Affiliation(s)
- Manish Tandon
- Institute of Liver and Biliary Sciences, New Delhi 110070, India
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Tandon M, Vasulu T, Trivedi R, Kashyap V. Genetic Affinity Between Two Ethnically Diverse Caste Groups of North India: A Study Based Upon 15 Microsatellite Loci. INT J HUM GENET 2017. [DOI: 10.1080/09723757.2004.11885866] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Tandon
- DNA Typing Unit, Central Forensic Science Laboratory, Kolkata, India
| | - T.S. Vasulu
- Anthropology and Human Genetics Unit, Indian statistical Institute, Kolkata, India
| | - R. Trivedi
- DNA Typing Unit, Central Forensic Science Laboratory, Kolkata, India
| | - V.K. Kashyap
- DNA Typing Unit, Central Forensic Science Laboratory, Kolkata, India
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Abstract
Hand, foot, and mouth disease (HFD) is a common systemic infection occurring in childhood or immunocompromised adults caused by enteroviruses, the most common being coxsackievirus A16 and enterovirus 71. It is characterized by maculopapular eruptions over the hands and feet and ulcerative stomatitis. Ocular involvement is a rare complication and commonly manifests as inflammatory macular pathology. We report a case of HFD in an immunocompetent adult male with unilateral ocular involvement presenting as hemorrhagic maculopathy and its management with complete anatomical and functional recovery.
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Affiliation(s)
- Manish Tandon
- Department of Retina and Vitreous, Aravind Eye Hospitals Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Abhishek Gupta
- Department of Retina and Vitreous, Aravind Eye Hospitals Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Priyanka Singh
- Department of Retina and Vitreous, Aravind Eye Hospitals Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Gnanavelu N Subathra
- Department of Retina and Vitreous, Aravind Eye Hospitals Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Tandon M, Othman AH, Ashok V, Stein GS, Pratap J. The role of Runx2 in facilitating autophagy in metastatic breast cancer cells. J Cell Physiol 2017; 233:559-571. [PMID: 28345763 DOI: 10.1002/jcp.25916] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 02/06/2023]
Abstract
Breast cancer metastases cause significant patient mortality. During metastases, cancer cells use autophagy, a catabolic process to recycle nutrients via lysosomal degradation, to overcome nutritional stress for their survival. The Runt-related transcription factor, Runx2, promotes cell survival under metabolic stress, and regulates breast cancer progression and bone metastases. Here, we identify that Runx2 enhances autophagy in metastatic breast cancer cells. We defined Runx2 function in cellular autophagy by monitoring microtubule-associated protein light chain (LC3B-II) levels, an autophagy-specific marker. The electron and confocal microscopic analyses were utilized to identify alterations in autophagic vesicles. The Runx2 knockdown cells accumulate LC3B-II protein and autophagic vesicles due to reduced turnover. Interestingly, Runx2 promotes autophagy by enhancing trafficking of LC3B vesicles. Our mechanistic studies revealed that Runx2 promotes autophagy by increasing acetylation of α-tubulin sub-units of microtubules. Inhibiting autophagy decreased cell adhesion and survival of Runx2 knockdown cells. Furthermore, analysis of LC3B protein in clinical breast cancer specimens and tumor xenografts revealed significant association between high Runx2 and low LC3B protein levels. Our studies reveal a novel regulatory mechanism of autophagy via Runx2 and provide molecular insights into the role of autophagy in metastatic cancer cells.
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Affiliation(s)
- Manish Tandon
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ahmad H Othman
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Vivek Ashok
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Gary S Stein
- University of Vermont Cancer Center and Department of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Jitesh Pratap
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois
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Warnack E, Heyer J, Sethi M, Tandon M, DiMaggio C, Pachter HL, Frangos SG. Urban Bicyclist Trauma: Characterizing the Injuries, Consequent Surgeries, and Essential Sub-Specialties Providing Care. Am Surg 2017; 83:16-22. [PMID: 28234112 PMCID: PMC5737017] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the United States in 2013, nearly 500,000 bicyclists were injured and required emergency department care. The objectives of this study were to describe the types of injuries which urban bicyclists sustain, to analyze the number and type of surgeries required, and to better delineate the services providing care. This is an observational study of injured bicyclists presenting to a Level I trauma center between February 2012 and August 2014. Most data were collected within 24 hours of injury and included demographics, narrative description of the incident, results of initial imaging studies, Injury Severity Score, admission status, length of stay, surgical procedure, and admitting and discharging service. A total of 706 injured bicyclists were included in the study, and 187 bicyclists (26.4%) required hospital admission. Of those admitted, 69 (36.8%) required surgery. There was no difference in gender between those who required surgery and those who did not (P = 0.781). Those who required surgery were older (mean age 39.1 vs 34.1, P = 0.003). Patients requiring surgery had higher Abbreviated Injury Scores for head (P ≤ 0.001), face (P ≤ 0.001), abdomen (P = 0.012), and extremity (P ≤ 0.001) and higher mean Injury Severity Scores (12.6 vs 3.7, P < 0.001). Sixty-nine patients required surgery and were brought to the operating room 82 times for 89 distinct procedures. Lower extremity injuries were the reason for 43 (48.3%) procedures, upper extremity injuries for 14 (15.7%), and facial injuries for 15 (16.9%). Orthopedic surgery performed 50 (56.2%) procedures, followed by plastic surgery (15 procedures; 16.8%). Trauma surgeons performed five (5.6%) procedures in four patients. The majority of admitted patients were admitted and discharged by the trauma service (70.1%, 56.7%, respectively) followed by the orthopedics service (13.9%, 19.8%, respectively). Injured bicyclists represent a unique subset of trauma patients. Orthopedic surgeons are most commonly involved in their operative management and rarely are the operative skills of a general traumatologist required. From a resource perspective, it is more efficient to direct the inpatient care of bicyclists with single-system trauma to the appropriate surgical subspecialty service soon after appropriate initial evaluation and treatment by the trauma service.
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Warnack E, Heyer J, Sethi M, Tandon M, Dimaggio C, Pachter HL, Frangos SG. Urban Bicyclist Trauma: Characterizing the Injuries, Consequent Surgeries, and Essential Sub-Specialties Providing Care. Am Surg 2017. [DOI: 10.1177/000313481708300111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United States in 2013, nearly 500,000 bicyclists were injured and required emergency department care. The objectives of this study were to describe the types of injuries which urban bicyclists sustain, to analyze the number and type of surgeries required, and to better delineate the services providing care. This is an observational study of injured bicyclists presenting to a Level I trauma center between February 2012 and August 2014. Most data were collected within 24 hours of injury and included demographics, narrative description of the incident, results of initial imaging studies, Injury Severity Score, admission status, length of stay, surgical procedure, and admitting and discharging service. A total of 706 injured bicyclists were included in the study, and 187 bicyclists (26.4%) required hospital admission. Of those admitted, 69 (36.8%) required surgery. There was no difference in gender between those who required surgery and those who did not (P = 0.781). Those who required surgery were older (mean age 39.1 vs 34.1, P = 0.003). Patients requiring surgery had higher Abbreviated Injury Scores for head (P ≤ 0.001), face (P ≤ 0.001), abdomen (P = 0.012), and extremity (P ≤ 0.001) and higher mean Injury Severity Scores (12.6 vs 3.7, P < 0.001). Sixty-nine patients required surgery and were brought to the operating room 82 times for 89 distinct procedures. Lower extremity injuries were the reason for 43 (48.3%) procedures, upper extremity injuries for 14 (15.7%), and facial injuries for 15 (16.9%). Orthopedic surgery performed 50 (56.2%) procedures, followed by plastic surgery (15 procedures; 16.8%). Trauma surgeons performed five (5.6%) procedures in four patients. The majority of admitted patients were admitted and discharged by the trauma service (70.1%, 56.7%, respectively) followed by the orthopedics service (13.9%, 19.8%, respectively). Injured bicyclists represent a unique subset of trauma patients. Orthopedic surgeons are most commonly involved in their operative management and rarely are the operative skills of a general traumatologist required. From a resource perspective, it is more efficient to direct the inpatient care of bicyclists with single-system trauma to the appropriate surgical subspecialty service soon after appropriate initial evaluation and treatment by the trauma service.
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Affiliation(s)
| | | | - Monica Sethi
- NYU School of Medicine, New York, New York 10016
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Tandon M, Singh A, Saluja V, Dubey G, Pandey VK, Pandey CK, Karna ST, Singh SA. Post-operative hypertension, a surrogate marker of the graft function and predictor of survival in living donor liver transplant recipients: A retrospective study. Indian J Anaesth 2016; 60:463-9. [PMID: 27512161 PMCID: PMC4966349 DOI: 10.4103/0019-5049.186016] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS De novo hypertension (HTN) in liver transplantation recipients is a known entity. We investigated haemodynamic behaviour after a liver transplant to see if it can predict survival to discharge from the hospital. METHODS electronic records of Haemodynamic parameters and laboratory investigations of 95 patients of living donor liver transplant (LDLT) were retrospectively analysed. RESULTS Twenty-three patients were operated for acute liver failure (ALF) and 72 patients for chronic liver disease (CLD). Eight patients of CLD and four of ALF did not survive. CLD patients had statistically significant rise in systolic blood pressure from the post-operative day (POD) 1 to POD 4 and diastolic blood pressure (DBP) from POD 3 to POD 6. Heart rate (HR) significantly decreased from POD 3 to POD 5. Haemodynamic parameters returned to baseline values within 20 days. Diastolic HTN had a positive predictive value of 100% for survival with 100% sensitivity and specificity. Systolic HTN had a positive predictive value of 100% for survival (sensitivity-89%, specificity-100%). ALF patients had a significant decrease in HR from POD 2 to POD 10. Bradycardia (HR ≤60/min) had a positive predictive value of 100% for survival with a sensitivity of 45% and 58% in CLD and ALF, respectively, with a specificity of 100% in both the groups. Non-survivors had no significant change in haemodynamics. In CLD group, International Normalised Ratio had statistically significant, strong negative correlation with DBP. CONCLUSION Haemodynamic pattern of recovery may be used for predicting survival to discharge after LDLT.
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Affiliation(s)
- Manish Tandon
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anshuman Singh
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vandana Saluja
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaurav Dubey
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vijay Kant Pandey
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chandra Kant Pandey
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shweta A Singh
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
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Rai S, Tandon M, Singh N, Kaur I. Development, optimization, standardization and validation of a simple in-house agar gradient method to determine vancomycin MIC's for Staphylococcus aureus. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.285] [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] Open
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Tandon M, Chen Z, Othman AH, Pratap J. Role of Runx2 in IGF-1Rβ/Akt- and AMPK/Erk-dependent growth, survival and sensitivity towards metformin in breast cancer bone metastasis. Oncogene 2016; 35:4730-40. [DOI: 10.1038/onc.2015.518] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/19/2015] [Accepted: 12/11/2015] [Indexed: 12/23/2022]
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Tandon M, Singh A, Saluja V, Dhankhar M, Pandey CK, Jain P. Validation of a New "Objective Pain Score" Vs. "Numeric Rating Scale" For the Evaluation of Acute Pain: A Comparative Study. Anesth Pain Med 2016; 6:e32101. [PMID: 27110530 PMCID: PMC4834447 DOI: 10.5812/aapm.32101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 08/04/2015] [Revised: 08/28/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Pain scores are used for acute pain management. The assessment of pain by the patient as well as the caregiver can be influenced by a variety of factors. The numeric rating scale (NRS) is widely used due to its easy application. The NRS requires abstract thinking by a patient to assign a score to correctly reflect analgesic needs, and its interpretation is subject to bias. Objectives: The study was done to validate a 4-point objective pain score (OPS) for the evaluation of acute postoperative pain and its comparison with the NRS. Patient and Methods: A total of 1021 paired readings of the OPS and NRS of 93 patients who underwent laparotomy and used patient-controlled analgesia were evaluated. Acute pain service (APS) personnel recorded the OPS and NRS. Rescue analgesia was divided into two incremental levels (level 1-paracetamol 1 g for NRS 2 - 5 and OPS 3, Level 2-Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). In cases of disagreement between the two scores, an independent consultant decided the rescue analgesia. Results: The NRS and OPS agreed across the range of pain. There were 25 disagreements in 8 patients. On 24 occasions, rescue analgesia was increased from level 1 to 2, and one occasion it was decreased from level 2 to 1. On all 25 occasions, the decision to supplement analgesia went in favor of the OPS over the NRS. Besides these 25 disagreements, there were 17 occasions in which observer bias was possible for level 2 rescue analgesia. Conclusions: The OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain. It may even be used to supplement NRS when it is indicative of mild or moderate pain.
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Affiliation(s)
- Manish Tandon
- Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
- Corresponding author: Manish Tandon, Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India. Tel: +91-9871437478, Fax: +91-1146300010, E-mail:
| | - Anshuman Singh
- Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vandana Saluja
- Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Mandeep Dhankhar
- Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chandra Kant Pandey
- Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Priyanka Jain
- Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
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Affiliation(s)
- Manish Tandon
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India. E-mail:
| | - Chandra Kant Pandey
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India. E-mail:
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Karna ST, Pandey CK, Sharma S, Singh A, Tandon M, Pandey VK. Postoperative coagulopathy after live related donor hepatectomy: Incidence, predictors and implications for safety of thoracic epidural catheter. J Postgrad Med 2016; 61:176-80. [PMID: 26119437 PMCID: PMC4943418 DOI: 10.4103/0022-3859.159419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Coagulopathy after living donor hepatectomy (LDH) may endanger donor safety during removal of thoracic epidural catheter (TEC). The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC) and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%), blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 × 105/mm3 on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student ‘t’ test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84) donors had coagulopathy on second day (mean INR 1.9 ± 0.42). Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5.
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Affiliation(s)
| | - C K Pandey
- Department of Anaesthesiology and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
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Beligere N, Perumalswamy V, Tandon M, Mittal A, Floora J, Vijayakumar B, Miller MT. Retinopathy of prematurity and neurodevelopmental disabilities in premature infants. Semin Fetal Neonatal Med 2015; 20:346-53. [PMID: 26235349 DOI: 10.1016/j.siny.2015.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prematurity is a major global health issue leading to high mortality and morbidity among the survivors. Neurodevelopmental disability (NDD) and retinopathy of prematurity (ROP) are the most common complications of prematurity. In fact, ROP is the second leading cause of childhood blindness in the world. Although there is much information regarding the occurrence of ROP and of NDD in premature infants, there have been few studies on ROP and its association with NDD. The objectives of this article are to review the current literature on the subject and to publish our own findings concerning the association between ROP and NDD in premature infants. The review suggests that although NDDs are related to degree of prematurity, NDD could also be the result of visual impairments resulting from ROP. Our own study shows a close association between NDD and zonal involvement of ROP: higher NDD if zone 1 is involved and less if zone 3 is involved.
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Affiliation(s)
- Nagamani Beligere
- Department of Pediatrics and Center for Global Health, University of Illinois at Chicago, Chicago, IL, USA.
| | | | - Manish Tandon
- Vitrio Retinal Surgery, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Amit Mittal
- Pediatric Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Jayasheele Floora
- Ophthalmic Therapy, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - B Vijayakumar
- Bio-Statistics, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Marilyn T Miller
- Department of Pediatric Ophthalmology, Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
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Hauschild A, Hansson J, Grob J, Kunstfeld R, Dréno B, Mortier L, Ascierto P, Dummer R, Licitra L, Fife K, Ernst D, Dutriaux C, Jouary T, Meyer N, Guillot B, Williams S, Tandon M, Hou J, Basset-Seguin N. 3343 Exploratory analysis of vismodegib (VISMO) treatment discontinuation in the STEVIE study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31861-5] [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: 10/22/2022]
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