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Nelson M, Pal N, Kertai MD. Aortic Valve in the Mitral Position. Anesthesiology 2024; 140:859-860. [PMID: 38227474 DOI: 10.1097/aln.0000000000004822] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Mark Nelson
- Virginia Commonwealth University School of Medicine, Richmond, Virginia (M.N.).
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2
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Kertai MD, Makkad B, Bollen BA, Grocott HP, Kachulis B, Boisen ML, Raphael J, Perry TE, Liu H, Grant MC, Gutsche J, Popescu WM, Hensley NB, Mazzeffi MA, Sniecinski RM, Teeter E, Pal N, Ngai JY, Mittnacht A, Augoustides YGT, Ibekwe SO, Martin AK, Rhee AJ, Walden RL, Glas K, Shaw AD, Shore-Lesserson L. Development and Publication of Clinical Practice Parameters, Reviews, and Meta-analyses: A Report From the Society of Cardiovascular Anesthesiologists Presidential Task Force. Anesth Analg 2024; 138:878-892. [PMID: 37788388 DOI: 10.1213/ane.0000000000006619] [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: 10/05/2023]
Abstract
The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes.
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Affiliation(s)
- Miklos D Kertai
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benu Makkad
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Hilary P Grocott
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jacob Raphael
- Department of Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Tjorvi E Perry
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
| | - Hong Liu
- Department of Anesthesiology, University of California Davis Health, Sacramento, California
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Wanda M Popescu
- Department of Anesthesiology, Yale School of Medicine, Hartford, Connecticut
| | - Nadia B Hensley
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Michael A Mazzeffi
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Roman M Sniecinski
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Emily Teeter
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jennie Y Ngai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, New York
| | - Alexander Mittnacht
- Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Yianni G T Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Stephanie O Ibekwe
- Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | | | - Amanda J Rhee
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel L Walden
- Eskind Biomedical Library, Vanderbilt University, Nashville, Tennessee
| | - Kathryn Glas
- Department of Anesthesiology, College of Medicine Tucson, Tucson, Arizona
| | - Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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3
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Tran BW, May KA, Pal N. Academic Anesthesiology: What Does It Mean for Most of Us? Anesth Analg 2024; 138:e15-e16. [PMID: 38489800 DOI: 10.1213/ane.0000000000006898] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Affiliation(s)
- Bryant W Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia,
| | - Keith A May
- Department of Anesthesiology, University of Tennessee, Knoxville, Tennessee
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
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Tran BW, Nelson M, Pal N. Association of preoperative anaesthesia consultation before elective noncardiac surgery with patient and health system outcomes. Comment on Br J Anaesth 2023; 131: 937-46. Br J Anaesth 2024; 132:433-434. [PMID: 38042724 DOI: 10.1016/j.bja.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Bryant W Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
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Nelson M, Pal N, Kertai MD. Sedatives and Postoperative Delirium: Comment. Anesthesiology 2023; 139:708. [PMID: 37589561 DOI: 10.1097/aln.0000000000004657] [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: 08/18/2023]
Affiliation(s)
- Mark Nelson
- Vanderbilt University School of Medicine, Richmond, Virginia (M.N.).
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Nelson M, Pal N, Kertai MD. Perioperative Anaphylaxis: Comment. Anesthesiology 2023; 139:358-359. [PMID: 37247348 DOI: 10.1097/aln.0000000000004595] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Mark Nelson
- Virginia Commonwealth University School of Medicine, Richmond, Virginia (M.N.).
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Pal N, Nelson M, Butterworth J. Preoperative Medical Consultation-Questioning a Long-Standing Practice. JAMA Intern Med 2023; 183:1034. [PMID: 37459068 DOI: 10.1001/jamainternmed.2023.2920] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Nelson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
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Affiliation(s)
- Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia,
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Nelson M, Pal N, Kertia MD. Less Blood Pressure But Not Less AKI. Anesth Analg 2023; 137:e13. [PMID: 37450912 DOI: 10.1213/ane.0000000000006527] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA,
| | - Miklos D Kertia
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
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Ben Ltaief L, Sishodia K, Mandal S, De S, Krishnan SR, Medina C, Pal N, Richter R, Fennel T, Mudrich M. Efficient Indirect Interatomic Coulombic Decay Induced by Photoelectron Impact Excitation in Large Pure Helium Nanodroplets. Phys Rev Lett 2023; 131:023001. [PMID: 37505945 DOI: 10.1103/physrevlett.131.023001] [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] [Received: 03/02/2023] [Accepted: 06/05/2023] [Indexed: 07/30/2023]
Abstract
Ionization of matter by energetic radiation generally causes complex secondary reactions that are hard to decipher. Using large helium nanodroplets irradiated by extreme ultraviolet (XUV) photons, we show that the full chain of processes ensuing primary photoionization can be tracked in detail by means of high-resolution electron spectroscopy. We find that elastic and inelastic scattering of photoelectrons efficiently induces interatomic Coulombic decay (ICD) in the droplets. This type of indirect ICD even becomes the dominant process of electron emission in nearly the entire XUV range in large droplets with radius ≳40 nm. Indirect ICD processes induced by electron scattering likely play an important role in other condensed-phase systems exposed to ionizing radiation as well, including biological matter.
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Affiliation(s)
- L Ben Ltaief
- Department of Physics and Astronomy, Aarhus University, 8000 Aarhus C, Denmark
| | - K Sishodia
- Quantum Center of Excellence for Diamond and Emergent Materials and Department of Physics, Indian Institute of Technology Madras, Chennai 600036, India
| | - S Mandal
- Indian Institute of Science Education and Research, Pune 411008, India
| | - S De
- Quantum Center of Excellence for Diamond and Emergent Materials and Department of Physics, Indian Institute of Technology Madras, Chennai 600036, India
| | - S R Krishnan
- Quantum Center of Excellence for Diamond and Emergent Materials and Department of Physics, Indian Institute of Technology Madras, Chennai 600036, India
| | - C Medina
- Institute of Physics, University of Freiburg, 79104 Freiburg, Germany
| | - N Pal
- Elettra-Sincrotrone Trieste, 34149 Basovizza, Trieste, Italy
| | - R Richter
- Elettra-Sincrotrone Trieste, 34149 Basovizza, Trieste, Italy
| | - T Fennel
- Institute for Physics, University of Rostock, 18051 Rostock, Germany
| | - M Mudrich
- Department of Physics and Astronomy, Aarhus University, 8000 Aarhus C, Denmark
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Pal N, Kertai MD, Nelson M. Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease. JAMA 2023; 329:939. [PMID: 36943222 DOI: 10.1001/jama.2023.0061] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee
| | - Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
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12
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Pal N, Nelson M. Prothrombin Complex Concentrate and Cardiac Surgery. JAMA Surg 2023; 158:222-223. [PMID: 36449283 DOI: 10.1001/jamasurg.2022.5801] [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: 12/02/2022]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - Mark Nelson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
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Pal N, Kertai MD, Butterworth J. Fluid Bolus Administration and Cardiovascular Collapse in Critically Ill Patients Undergoing Tracheal Intubation. JAMA 2022; 328:2070-2071. [PMID: 36413240 DOI: 10.1001/jama.2022.17499] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond
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Provencio Pulla M, Perez Parente D, Campos Balea B, Rodriguez Abreu D, Hasan H, Olson S, Pal N, Wilkinson S, De Oro Pulido F, Ruiz Gracia P, Cobo Dols M. 1064P Genomic characterization of first line advanced or metastatic non-small cell lung cancer (aNSCLC) patients (pts) subgroups associated with good/bad prognosis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1190] [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: 11/01/2022] Open
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Provencio M, Pérez Parente D, Hasan H, Campos Balea B, Rodríguez Abreu D, López Brea Piqueras M, Olson S, Pal N, Wilkinson S, de Oro-Pulido F, Ruiz Gracia P, Cobo Dols M. EP08.01-065 Prevalence of Non-driver Mutations and Characterization of Patients with Advanced or Metastatic Non-small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.637] [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]
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Pal N, Abrams BA, Kertai M. Cardiothoracic Anesthesiology: Novel Milestone and Renewed Opportunities. Semin Cardiothorac Vasc Anesth 2022; 26:169-172. [DOI: 10.1177/10892532221121115] [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: 11/17/2022]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin A. Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Miklos Kertai
- Department of Anesthesiology, Vanderbilt University, Nashville, TN, USA
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Kutkut I, Worrall E, Pal N, Shah PR, Grizzard JD, Naz NA, Gertz ZM. Coronary Air Embolism and Pneumomediastinum After a MitraClip Procedure. JACC Cardiovasc Interv 2022; 15:1770-1772. [DOI: 10.1016/j.jcin.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
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Pal N, Karuppiah A, Butterworth J. Nasal High-Flow Therapy during Neonatal Endotracheal Intubation. N Engl J Med 2022; 387:382. [PMID: 35939593 DOI: 10.1056/nejmc2207316] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA
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Pal N, Yajnik V. Prone Positioning of Intubated Patients with an Elevated BMI. N Engl J Med 2022; 387:96. [PMID: 35793218 DOI: 10.1056/nejmc2206168] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA
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Pérol M, Felip E, Dafni U, Polito L, Pal N, Tsourti Z, Ton TGN, Merritt D, Morris S, Stahel R, Peters S. Effectiveness of PD-(L)1 Inhibitors Alone or in Combination With Platinum-Doublet Chemotherapy in First-Line (1L) Non-Squamous Non-Small Cell Lung Cancer (nsq-NSCLC) With PD-L1-High Expression Using Real-World Data. Ann Oncol 2022; 33:511-521. [PMID: 35218887 DOI: 10.1016/j.annonc.2022.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 11/15/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-PD-(L)1 therapy alone (cancer immunotherapy [CIT]-mono) or combined with platinum-based chemotherapy (CIT-chemo) is used as first-line treatment for patients with metastatic non-small cell lung cancer (NSCLC). Our study compared clinical outcomes with CIT-mono vs CIT-chemo in the specific clinical scenario of non-squamous (Nsq)-NSCLC with a high PD-L1 expression of ≥50% (tumor proportion score (TPS) or tumor cells (TC)). METHODS This was a retrospective cohort study using a real-world de-identified database. Patients with metastatic Nsq-NSCLC with high PD-L1 expression initiating first-line CIT-mono or CIT-chemo between 24 October 2016 and 28 February 2019 were followed up to 28 February 2020. We compared overall survival (OS) and real-world progression-free survival (rwPFS) using Kaplan-Meier methodology. Hazard ratios (HR) were adjusted (aHR) for differences in baseline key prognostic characteristics using inverse probability of treatment weighting methodology. RESULTS Patients with PD-L1-high Nsq-NSCLC treated with CIT-mono (n=351), were older and less often presented with de novo stage IV disease than patients treated with CIT-chemo (n=169). With a median follow-up of 19.9 months for CIT-chemo vs 23.5 months for CIT-mono, median OS and rwPFS did not differ between the two groups (median OS: CIT-chemo, 21.0 months vs CIT-mono, 22.1 months, aHR=1.03, 95% CI 0.77-1.39, P=0.83; median rwPFS: CIT-chemo, 10.8 months vs CIT-mono, 11.5 months, aHR=1.04, 95% CI 0.78-1.37, P=0.81). CIT-chemo showed significant and meaningful improvement in OS and rwPFS vs CIT-mono only in the never-smoker subgroup, albeit among a small sample of patients (n=50; OS HR=0.25, 95% CI 0.07-0.83, interaction P=0.02; rwPFS HR=0.40, 95% CI 0.17-0.95, interaction P=0.04). CONCLUSION Except in the subgroup of never-smoker patients, sparing the chemotherapy in first-line CIT treatment does not appear to impact survival outcomes in Nsq-NSCLC patients with high PD-L1 expression.
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Affiliation(s)
- M Pérol
- Medical Oncology, Centre Leon Berard, Lyon, France
| | - E Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - U Dafni
- National and Kapodistrian University of Athens, Athens, & Frontier Science Foundation Hellas, Athens, Greece
| | - L Polito
- Product Development Data Sciences, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - N Pal
- Product Development Data Sciences, Genentech, Inc., South San Francisco, CA, USA
| | - Z Tsourti
- Frontier Science Foundation Hellas, Athens, Greece
| | - T G N Ton
- Product Development Data Sciences, Genentech, Inc., South San Francisco, CA, USA
| | - D Merritt
- Product Development Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - S Morris
- Product Development Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - R Stahel
- European Thoracic Oncology Platform (ETOP), Coordinating Office, Bern, Switzerland.
| | - S Peters
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
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Krebs M, Lin J, Pal N, Polito L, Trinh H, Hilton M, Smoljanovic V, Kurtsikidze N, Archer V, Zhang Q. 1201P Real-world comparative effectiveness of 1L alectinib (ALC) vs crizotinib (CRZ) in patients (pts) with ALK+ advanced NSCLC with or without baseline CNS metastases (mets). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1806] [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: 10/20/2022] Open
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22
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Pal N, Butterworth J. Comment on: Variation in propofol induction doses administered to surgical patients over age 65. J Am Geriatr Soc 2021; 69:2678-2679. [PMID: 34185880 DOI: 10.1111/jgs.17328] [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] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia, USA
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Pal N, Weitzel N, Kertai MD. The Year 2020 in Review: Coronavirus Disease 2019 Cloud and Its Impact Excelling the Clinical Practice. Semin Cardiothorac Vasc Anesth 2021; 25:85-93. [PMID: 34000905 PMCID: PMC8689102 DOI: 10.1177/10892532211016152] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
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Peters S, Dafni U, Perol M, Felip E, Polito L, Pal N, Ton T, Merritt D, Morris S, Stahel R. VP2-2021: Effectiveness of PD-(L)1 inhibitors alone or in combination with platinum-doublet chemotherapy in first-line (1L) non-squamous non-small cell lung cancer (Nsq-NSCLC) with high PD-L1 expression using real-world data. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Pal N, Abernathy JH, Taylor MA, Bollen BA, Shah AS, Feng X, Shotwell MS, Kertai MD. Dexmedetomidine, Delirium, and Adverse Outcomes: Analysis of the STS Adult Cardiac Surgery Database. Ann Thorac Surg 2021; 112:1886-1892. [PMID: 33901455 DOI: 10.1016/j.athoracsur.2021.03.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND We tested the hypothesis that dexmedetomidine was associated with a reduced incidence of postoperative delirium (POD) and adverse outcomes in cardiac surgery patients from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) including the Adult Cardiac Anesthesiology subsection. METHODS We identified 55905 patients in the STS ACSD who underwent cardiac surgery between July 2014 and December 2018. Using propensity score weighted regression analysis, we analyzed the effect of intraoperative dexmedetomidine (intraDex) on the primary (POD) and secondary outcomes (highest pain score on day 3 and at discharge, stroke, prolonged ventilation, postoperative intubation/reintubation, additional postoperative hours ventilated, renal failure, atrial fibrillation, and 30-day mortality). In separate propensity score weighted analyses, we examined the effect of postoperative dexmedetomidine (postopDex) on the highest postoperative pain score at discharge and 30-day mortality. RESULTS The rate of intraDex use was 25.5% (n=13963), and its administration was associated with increased odds for POD (odds ratio [OR], 1.85; 95% CI, 1.60-2.13), a small higher average pain score on day 3 (difference in mean [MD], 0.08; 95% CI, 0.02 to 0.14), increased odds for postoperative intubation/reintubation (OR, 1.29; 95% CI, 1.12-1.48), and a small lower average pain score at discharge (MD, -0.31; 95% CI, -0.21 to -0.41). PostDex was associated with a small higher average pain score at discharge (MD, 0.27, 95% CI, 0.21 to 0.34), and higher odds for 30-day mortality (OR, 1.25, 95% CI, 1.07-1.46). CONCLUSIONS In this registry of cardiac surgical patients dexmedetomidine administration was associated with POD and adverse outcomes.
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Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mark A Taylor
- Cleveland Clinic Foundation/Anesthesiology Institute, Cleveland, OH, USA
| | | | | | - Xiaoke Feng
- Department of Biostatistics, Nashville, TN, USA
| | | | - Miklos D Kertai
- Department of Anesthesiology Vanderbilt University Medical Center, Nashville, TN, USA.
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Pal N, Lim A, Karamchandani K. Sepsis-Induced Myocardial Dysfunction: "Right Ventricular Dysfunction" or "Biventricular Dysfunction"? Chest 2021; 159:1684-1685. [PMID: 34022004 DOI: 10.1016/j.chest.2020.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology,Virginia Commonwealth University, Richmond, VA.
| | - Aaron Lim
- Department of Anesthesiology,Virginia Commonwealth University, Richmond, VA
| | - Kunal Karamchandani
- Department of Anesthesiology and Critical Care, Penn State Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
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Pal N, Weitzel NS, Kertai MD. A Change of Tide or the Beginning of the End: COVID-19. Semin Cardiothorac Vasc Anesth 2021; 25:5-10. [PMID: 33554769 DOI: 10.1177/1089253221989132] [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: 11/15/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
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Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA
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Pal N, Padala S, Klein K. Letter by Pal et al Regarding Article, "Impact of Left Atrial Appendage Exclusion on Short-Term Outcomes in Isolated Coronary Artery Bypass Graft Surgery". Circulation 2020; 142:e501-e502. [PMID: 33347332 DOI: 10.1161/circulationaha.120.049738] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond (N.P., K.K.)
| | - Santosh Padala
- Virginia Commonwealth University Medical Center, Richmond (S.P.)
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Dronavalli M, Fletcher-Lartey S, Lord H, Boonwaat L, Pal N, Alexander K. Antiviral prophylaxis is effective in reducing influenza outbreak severity in residential care. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.884] [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] Open
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Pal N, Nelson M, Butterworth J. Redefining Left Ventricular Assist Device Indications and Strategies. JAMA Cardiol 2020; 6:119. [PMID: 32965487 DOI: 10.1001/jamacardio.2020.4303] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - Mark Nelson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
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Menon-Johansson AS, Curtis H, Mohammad H, Hamlyn E, Hughes A, McClean H, Pal N, Tayal S, Sullivan AK. Improved results demonstrated in the 2017 national audit of early syphilis management in the United Kingdom. Int J STD AIDS 2020; 31:375-379. [PMID: 32041481 DOI: 10.1177/0956462419896706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The revised British Association of Sexual Health and HIV UK guidelines on the management of syphilis were published in 2015 and this audit measures performance against those standards and recommendations. Although not included in the guideline recommendations, an exploratory question on clinics’ HIV testing policy was also included. The audit was conducted over a two-month period in 2017 in genitourinary medicine (GUM) clinics across the UK of cases presenting in 2016. A total of 161 GUM clinics participated, and data were collected for 3017 cases. The standard for adherence to recommended treatment was met (97%, standard: 97%) and almost met for documented pre-treatment syphilis serology (95%, standard: 97%). Even though only 74% of patients had a documented action in relation to informing sexual contacts (standard: 97%), the standard for contacts seen and tested per index case within four weeks was met (0.9, standard: 0.6). Finally, those clinics with a formal policy on HIV testing after a syphilis diagnosis were twice as likely to test after the HIV window period, compared to clinics without a policy; a concurrent HIV diagnosis was made in 75 (3%) patients. More work is required to standardize documented delivery of effective partner notification and a formal policy on HIV testing appears to be effective.
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Affiliation(s)
| | - H Curtis
- British HIV Association, London, UK
| | | | - E Hamlyn
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - H McClean
- Royal Society of Medicine, Cheshire, UK
| | - N Pal
- Berkshire Healthcare Foundation Trust, Garden Clinic, Upton Hospital, Slough, UK
| | | | - A K Sullivan
- Chelsea and Westminster NHS Foundation Trust, London, UK
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Pal N, Stansfield J, Mukhopadhyay N, Nelson M. Marginal Improvement in Survival Post-Heart Transplantation in Patients With Prior Left Ventricular Assist Device: A Temporal Analysis of United Network of Organ Sharing Registry. J Cardiothorac Vasc Anesth 2020; 34:392-400. [DOI: 10.1053/j.jvca.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
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Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Va
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Va.
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Pal N, Gay SH, Boland CG, Lim AC. Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes. Semin Cardiothorac Vasc Anesth 2020; 24:9-23. [DOI: 10.1177/1089253219898985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart transplantation is an established treatment for end-stage heart failure. Due to the increase in demand and persistent scarcity of organ, mechanical circulatory devices have played a major role in therapy for advanced heart failure. Usage of left ventricular assist device (LVAD) has gone up from 6% in 2006 to 43% in 2013 as per the United Network of Organ Sharing database. Majority of patients presenting for a heart transplantation are often bridged with an assist device prior for management of heart failure while on wait-list. On one hand, it is well established that LVADs improve survival on wait-list; on the other hand, the effect of LVAD on morbidity and survival after a heart transplantation is still unclear. In this article, we review the available literature and attempt to infer the outcomes given the risks and benefits of heart transplantation with prior LVAD patients.
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Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Aaron C. Lim
- Virginia Commonwealth University, Richmond, VA, USA
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Pal N, Worrall E, Butterworth J. Cerebral Autoregulation-Targeted Mean Arterial Pressure. JAMA Surg 2020; 155:92-93. [PMID: 31596435 DOI: 10.1001/jamasurg.2019.3790] [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: 11/14/2022]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
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Pal N, Lim A, Nelson M. Letter by Pal et al Regarding Article, "Impact of Bridge to Transplantation With Continuous-Flow Left Ventricular Assist Devices on Posttransplantation Mortality: A Propensity-Matched Analysis of the United Network of Organ Sharing Database". Circulation 2019; 140:e940-e941. [PMID: 31841368 DOI: 10.1161/circulationaha.119.042541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - Aaron Lim
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - Mark Nelson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond
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Pal N, Boland CG, Gay S. Letter by Pal et al Regarding Article, "Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery: Evidence From the Canadian Thoracic Aortic Collaborative". Circulation 2019; 140:e551-e552. [PMID: 31479315 DOI: 10.1161/circulationaha.119.040561] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology (N.P., C.G.B., S.G.), Virginia Commonwealth University, Richmond
- Division of Cardiac Anesthesiology (N.P.), Virginia Commonwealth University, Richmond
| | - Charles Gil Boland
- Department of Anesthesiology (N.P., C.G.B., S.G.), Virginia Commonwealth University, Richmond
| | - Samuel Gay
- Department of Anesthesiology (N.P., C.G.B., S.G.), Virginia Commonwealth University, Richmond
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39
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Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA
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Pal N. Postoperative Delirium—Amplifying the Confusion. JAMA Surg 2019; 154:366. [DOI: 10.1001/jamasurg.2018.5244] [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: 11/14/2022]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
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Pal N, Weitzel N, Kertai MD. Repair, Replace, or Watchful Waiting: A Contemporary Management of Mitral Valve Disease and Its Related Conditions. Semin Cardiothorac Vasc Anesth 2019; 23:5-10. [PMID: 30791858 DOI: 10.1177/1089253218817856] [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: 11/16/2022]
Affiliation(s)
- Nirvik Pal
- 1 Virginia Commonwealth University-Medical College of Virginia, Richmond, VA, USA
| | - Nathaen Weitzel
- 2 University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Pal N, Butterworth J. Anesthesia Duration Does Not Exist in a Surgical Vacuum. JAMA FACIAL PLAST SU 2018; 20:525-526. [PMID: 30178003 DOI: 10.1001/jamafacial.2018.1129] [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: 11/14/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond
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Pal N, Butterworth J. Anesthesia Care Handovers and Risk of Adverse Outcomes. JAMA 2018; 319:2237. [PMID: 29872856 DOI: 10.1001/jama.2018.4450] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
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Pal N, Samanta SK, Chakraborty A, Chandra NK, Chandra AK. Interrelationship between iodine nutritional status of lactating mothers and their absolutely breast-fed infants in coastal districts of Gangetic West Bengal in India. Eur J Pediatr 2018; 177:39-45. [PMID: 29063209 DOI: 10.1007/s00431-017-3025-6] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Iodine nutritional status of 128 lactating mothers and their breast-fed infants (1-3 months) from iodine-replete villages during post-salt iodization period was evaluated. Mothers' urine, blood, and breast milk (BM) and infants' urine and blood were collected and analyzed for iodine and serum FT4 and TSH estimation. Mothers' and infants' age, parity, occupation, education, and household income were recorded. Median urinary iodine concentration (UIC) of infants was 250 μg/L, indicating their iodine intake was more than adequate. Mothers' median UIC was 185 μg/L, indicating adequate iodine nutrition; however, 13.28% had mild to severe deficiency. Median breast milk iodine concentration (BMIC) was 230 μg/L, which was more than their median UIC 185 μg/L. In iodine-deficient mothers, positive correlation was found between mothers' and infants' serum FT4 and TSH levels, and negative correlation was found between mothers' and infants' serum FT4 and TSH levels in excessive iodine nutrition group. CONCLUSION Iodine intake of breast-fed infants was at the limit of above requirement, and they are possibly at the risk of excess iodine intake. In iodine deficient and excessive iodine intake mothers, their infants' serum FT4 and TSH are independent on their iodine nutritional status but dependent on thyroid hormone profile of their mothers but differently. What is Known: • A median urinary iodine of 100 μg/L is used to define adequate iodine intake of lactating mothers and children < 2 years. However, adequate iodine intake in terms of urinary iodine of infants of age 1-3 months is not known. What is New: • Iodine intake of absolutely breast-fed infants (1-3 months) was more than adequate, though their mother's intake was adequate as breast milk contains more iodine than urine. The infants of iodine deficient and excessive iodine intake mothers, infants' hormonal profile is independent of their iodine nutritional status but dependent on their mothers thyroid hormone profile.
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Affiliation(s)
- N Pal
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University of Calcutta, University College of Science and Technology, 92, APC Road, Kolkata, West Bengal, 700 009, India
| | - S K Samanta
- Dr. B.C. Roy Post Graduate Institute of Paediatrics, 111, Narikeldanga Main Road, Kolkata, 700 054, India
| | - A Chakraborty
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University of Calcutta, University College of Science and Technology, 92, APC Road, Kolkata, West Bengal, 700 009, India
| | - N K Chandra
- Interdisciplinary Statistical Research Unit, Indian Statistical Institute, 203, BT Road, Kolkata, 700 108, India
| | - A K Chandra
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University of Calcutta, University College of Science and Technology, 92, APC Road, Kolkata, West Bengal, 700 009, India.
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Shah PR, Reynolds PS, Pal N, Tang D, McCarthy H, Spiess BD. Hydroxocobalamin for the treatment of cardiac surgery-associated vasoplegia: a case series. Can J Anaesth 2017; 65:560-568. [DOI: 10.1007/s12630-017-1029-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022] Open
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Pal N, Mukhopadhyay A. Cancer and our loved ones, how a “we can do it” can change: Diary of a small cancer support group from Eastern India. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx676.033] [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: 11/13/2022] Open
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Westin S, Sun C, Broaddus R, Pal N, Woodall M, Urbauer D, Ramondetta L, Lu K, Coleman R, Bodurka D. Challenging the paradigm of progesterone-only therapy for early endometrial cancer: Results of a prospective trial of the levonorgestrel intrauterine system. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haldar J, Pal N, Ray R, Maiti PK. Use of an Innovative Simple Method for Anaerobiosis in the Diagnosis and Management of Infections in Two Unusual Cases. Ann Med Health Sci Res 2016; 6:56-8. [PMID: 27144078 PMCID: PMC4849118 DOI: 10.4103/2141-9248.180275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/04/2022] Open
Abstract
Technical limitations restrict routine anaerobe isolation from clinical materials in resource-limited laboratories. An innovative two steps combustion candle jar technique may be suitable for such setup. This system was tried with one case of chronic osteomyelitis developed on supracondyler compound fracture. Porphyromonas spp. was isolated and identified. Vancomycin was recommended based on in vitro sensitivity test, but the leg was amputed after receiving a resistant drug gentamycin. While in another child with hydrocephalous, V-P shunt associated infection by Peptostreptococcus anaerobius was successfully controlled by sensitive drug vancomycin. These two eye-opener cases insisted us for large scale application of the technique.
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Affiliation(s)
- J Haldar
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Pal
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - R Ray
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - P K Maiti
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Pal N, Hooja S, Sharma R, Maheshwari RK. Phenotypic Detection and Antibiogram of β-lactamase-producing Proteus Species in a Tertiary Care Hospital, India. Ann Med Health Sci Res 2016; 6:267-273. [PMID: 28503342 PMCID: PMC5414437 DOI: 10.4103/amhsr.amhsr_413_15] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Proteus species cause a variety of community- and hospital-acquired illnesses. Synthesis of β-lactamases is the predominant mechanism for resistance to β-lactam antibiotics. Among the β-lactamases, extended spectrum β-lactamases (ESBLs) and AmpC β-lactamases are the most common. Aim: The objective of this study was to determine the occurrence of ESBL and AmpC β-lactamases in Proteus species among various clinical isolates at a tertiary care hospital, India. Materials and Methods: This study was done to identify various species of Proteus from clinical samples (n = 3922). Antimicrobial susceptibility was performed by Kirby–Bauer disc diffusion method. ESBL production was detected by modified double-disc synergy test and indirect modified three-dimensional tests and AmpC β-lactamase production by AmpC disc test and modified Hodge test. Results: Proteus species were isolated in 5.4% (101/1876) specimens. Three Proteus species isolated were Proteus mirabilis 62.4% (63/101), Proteus vulgaris 29.7% (30/101), and Proteus penneri 7.9% (8/101). ESBL producers confirmed by both tests were of 88.1% (89/101). Only AmpC β-lactamase was produced by four isolates. Coproduction of ESBL and AmpC β-lactamase was observed in 58.4% (52/89) of isolates. Twelve isolates were non-β-lactamase producers. Multidrug resistance (MDR) was found in 95.1% (96/101) of isolates, 50.5% (51/101) were possibly extensively drug resistant and none were pan drug resistant. None of the isolates were resistant to piperacillin-tazobactam. P. penneri isolates exhibited high resistance to most of the antibiotics. Conclusions: A high prevalence of ESBL and AmpC β-lactamases was found that concurrently showed MDR. Phenotypic methods for the detection of β-lactamases are easy and simple and can be implemented in routine diagnostic laboratories along with susceptibility testing. These data will assist the clinicians in the management and control of infections.
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Affiliation(s)
- N Pal
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
| | - S Hooja
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
| | - R Sharma
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
| | - R K Maheshwari
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
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