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Dhanda Patil R, Suurna MV, Steffen A, Soose R, Coxe J, Chan T, Ishman SL. Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation. OTO Open 2024; 8:e134. [PMID: 38646184 PMCID: PMC11032643 DOI: 10.1002/oto2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024] Open
Abstract
Objective In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes. Study Design Observational. Setting Multicenter registry. Methods We included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea-Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction. Results No relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Among all patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery. Conclusion In ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CincinnatiCincinnatiOhioUSA
- Surgical ServicesCincinnati Veterans Affairs Medical CenterCincinnatiOhioUSA
| | - Maria V. Suurna
- Department of Otolaryngology–Head and Neck SurgeryUniversity of MiamiMiamiFloridaUSA
| | - Armin Steffen
- Department of OtorhinolaryngologyUniversity of LubeckLubeckGermany
| | - Ryan Soose
- Department of OtolaryngologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - James Coxe
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CincinnatiCincinnatiOhioUSA
| | - Teresa Chan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas‐Southwestern Medical CenterDallasTexasUSA
| | - Stacey L. Ishman
- Division of Otolaryngology–Head and Neck SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Sarber KM, Patil RD. Comorbid Insomnia and Sleep Apnea: Challenges and Treatments. Otolaryngol Clin North Am 2024:S0030-6665(24)00032-X. [PMID: 38531753 DOI: 10.1016/j.otc.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Cognitive behavioral therapy for insomnia is the first line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA). Surgery, particularly hypoglossal nerve stimulation, appears to be well tolerated and may improve insomnia in those with COMISA. Otolaryngologists must be cognizant of the common presentation of COMISA in patients seeking surgical treatment and utilize a multidisciplinary approach.
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Affiliation(s)
- Kathleen M Sarber
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Otolaryngology, Wilford Hall Ambulatory Surgery Center, 1100 Wilford Hall Loop, San Antonio, TX 78236, USA.
| | - Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA; Department of Otolaryngology-Head and Neck Surgery, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
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Dhanda Patil R, Ishman SL, Chang JL, Thaler E, Suurna MV. In response to Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry. Laryngoscope 2024. [PMID: 38511429 DOI: 10.1002/lary.31412] [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: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
- Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
| | - Stacey L Ishman
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jolie L Chang
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Healthcare System, San Francisco, California, U.S.A
| | - Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, U.S.A
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Dhanda Patil R, Ishman S, Li C. Sleep Renewed: Innovations in Sleep Apnea Care for Adults and Children. Otolaryngol Clin North Am 2024:S0030-6665(24)00031-8. [PMID: 38458954 DOI: 10.1016/j.otc.2024.02.018] [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: 03/10/2024]
Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, MSB 6507, 231 Albert Sabin Way, Cincinnati, OH 45267-0528, USA.
| | - Stacey Ishman
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, K4/719 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Carol Li
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
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Patil YJ, Yakoub M, Moreno KF, Cotton C, Tabangin ME, Altaye M, Patil RD, Tang A, Zender C, Domack A. The effect of transfusion on survival in head and neck cancer after free tissue reconstruction. Laryngoscope Investig Otolaryngol 2024; 9:e1215. [PMID: 38362201 PMCID: PMC10866597 DOI: 10.1002/lio2.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objective To examine if perioperative blood transfusion affects overall survival (OS) and recurrence-free survival (RFS) in head and neck cancer patients who undergo free tissue reconstruction. Design Retrospective cohort study. Methods The medical records of free tissue flaps between 2007 and 2010 were reviewed. Differences in demographics and clinical factors based on the level of transfused packed red blood cells (PRBC) were examined using chi-squared tests, Kruskal-Wallis tests, and/or ANOVA tests. Survival time was compared using a Cox proportional hazard model. Results Data were available for 183 patients. Patients who had PRBC transfusion significantly differed from the non-transfused group by flap type, flap with bone, Charlson Comorbidity Index (CCI), and hemoglobin and hematocrit. When stratified into three groups based on units of PRBC; flap type, flap with bone, CCI, preoperative hemoglobin, and hematocrit were found to differ significantly. The 2-year Kaplan-Meier plot demonstrated improved OS for those who did not receive any PRBC transfusion. The use of more than 3 units of blood decreased 2-year OS significantly when compared to the non-transfused group. Finally, after adjusting for CCI using a Cox proportional hazard model, survival was significantly affected by CCI. Conclusion After controlling for patient age, oncologic stage, cancer subsite, histology, type of free flap, vascularized bone-containing flap, recurrence type, CCI, and preoperative hemoglobin and hematocrit, patients who received 3 or more units of PRBC in the perioperative period had significantly decreased OS. RFS did not differ between the transfused versus non-transfused groups. Level of Evidence Level 4.
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Affiliation(s)
- Yash J. Patil
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Mohamed Yakoub
- Department of Pathology and Laboratory MedicineUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Kattia F. Moreno
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Colin Cotton
- University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Meredith E. Tabangin
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Mekibib Altaye
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Reena Dhanda Patil
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Alice Tang
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Chad Zender
- Department of Otolaryngology Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Aaron Domack
- Head and Neck DepartmentAdventHealthOrlandoFloridaUSA
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Dhanda Patil R, Ishman SL, Chang JL, Thaler E, Suurna MV. Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry. Laryngoscope 2024; 134:471-479. [PMID: 37560883 DOI: 10.1002/lary.30933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/19/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE We aimed to determine the preoperative prevalence of insomnia in the Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) and to examine serial sleep-related data longitudinally, in particular the Insomnia Severity Index (ISI), to compare outcomes between patients with no/subthreshold insomnia (ISI < 15) and moderate/severe insomnia (ISI ≥ 15) at baseline. METHODS We analyzed observational data from ADHERE between March 2020 and September 2022. Baseline demographic and mental health (MH) data, apnea hypopnea index (AHI), ISI, and ESS (Epworth Sleepiness Scale) were recorded. At post-titration (PT) and final visits, AHI, ISI, ESS and nightly usage were compared between baseline ISI < 15 and ISI ≥ 15 subgroups. RESULTS A baseline ISI was obtained in 928 patients (62% with ISI ≥ 15). Of the 578 and 141 patients reaching the 12- and 24-month time periods to complete PT and final visits, 292 (50.5%) and 91 (64.5%) completed the ISI, respectively. Baseline MH conditions were higher with ISI ≥ 15 than ISI < 15 (p < 0.001). AHI reduction and adherence did not differ between patients with baseline ISI ≥ 15 and ISI < 15. Patients with ISI ≥ 15 experienced greater improvement in ESS than ISI < 15 at post-titration and final visits (p = 0.014, 0.025). All patients had improved nocturnal, daytime, and overall ISI scores at follow-up visits (p < 0.001), especially for those with baseline ISI ≥ 15 compared with ISI < 15 (p < 0.05). CONCLUSION HGNS therapy efficacy and adherence were similar between ISI severity subgroups at follow-up visits. Insomnia and sleepiness scores improved in all patients with HGNS therapy and to a greater degree in patients with baseline moderate/severe insomnia. LEVEL OF EVIDENCE 4 Laryngoscope, 134:471-479, 2024.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- Department of Community and Population Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jolie L Chang
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
- Surgical Services, San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA
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Sarber KM, Patil RD. Comorbid Insomnia and Sleep Apnea: Challenges and Treatments. Otolaryngol Clin North Am 2023:S0030-6665(23)00196-2. [PMID: 38042666 DOI: 10.1016/j.otc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Therapy can be challenging as treatment of 1 disease may worsen the other. Cognitive behavioral therapy for insomnia is the first-line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA), such as mandibular advancement devices or emerging pharmacotherapies. Surgery, particularly hypoglossal nerve stimulation, appears to be well tolerated and may improve insomnia in those with COMISA. Otolaryngologists must be cognizant of the common presentation of COMISA in patients seeking surgical treatment and utilize a multidisciplinary approach to the treatment of these complex patients.
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Affiliation(s)
- Kathleen M Sarber
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Otolaryngology, Wilford Hall Ambulatory Surgery Center, 1100 Wilford Hall Loop, San Antonio, TX 78236, USA.
| | - Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, 3113 Bellevue Avenue, Cincinnati, OH 45219, USA; Department of Otolaryngology-Head and Neck Surgery, Cincinnati Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA
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Petito GT, Tripathi SH, Dhanda Patil R. Outcomes of Cochlear Implantation in Age Subgroups of Veterans Over 50 Years Old. Otol Neurotol Open 2023; 3:e037. [PMID: 38515639 PMCID: PMC10950163 DOI: 10.1097/ono.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/13/2023] [Indexed: 03/23/2024]
Abstract
Objective This study aimed to determine whether there was a difference in postoperative Arizona Biomedical (AzBio) speech recognition scores in 2 differently aged subgroups of veterans 50 years and older after cochlear implantation (CI). Study Design Retrospective chart review. Setting Tertiary referral center. Patients Seventy-one patients aged 50 to 74 years (younger cohort) were compared with 56 patients aged 75 years and older (older cohort) at the time of CI. Interventions Patients underwent therapeutic CI. Main Outcome Measures Comparison of AzBio speech recognition test scores in a quiet environment between the 2 differently aged cohorts of veterans 50 years and older. Results Despite no significant differences in preoperative AzBio score between the younger (mean 22.2%) and older cohorts (mean, 17.3%; P > 0.05), when examining the 6- and 12-month postoperative time points, the older cohort had significantly lower mean AzBio scores (50%, 55.8%; P < 0.05) than the younger cohort (69.8%, 71.9%; P < 0.05). Conclusions All patients aged >50 years experienced significant improvement in speech recognition scores following CI, although the cohort of ages 50 to 74 years scored significantly higher in later follow-up visits. These findings suggest that CI should be offered to appropriate candidates, regardless of age, although earlier intervention may be more advantageous.
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Affiliation(s)
- Gabrielle T. Petito
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Siddhant H. Tripathi
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Reena Dhanda Patil
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Otolaryngology, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
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Patil RD, Ishman S, Chang J, Thaler E, Suurna M. 0775 Impact of insomnia, depression and anxiety on adherence to upper airway stimulation for obstructive sleep apnea: ADHERE registry update. Sleep 2022. [DOI: 10.1093/sleep/zsac079.771] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Insomnia, depression and anxiety are common comorbid conditions in patients with obstructive sleep apnea (OSA) and can negatively impact positive airway pressure (PAP) therapy adherence. Subsequent intolerance to PAP may lead to surgical treatment such as upper airway stimulation (UAS). We sought to determine the impact of baseline insomnia, anxiety or depression on UAS therapy adherence using data from a large multi-center registry.
Methods
The ADHERE registry collects information on patients undergoing UAS (Inspire Medical, Golden Valley, MN) including baseline history of insomnia, depression, anxiety and the Insomnia Severity Index (ISI) questionnaire. We determined overall prevalence of insomnia, depression and/or anxiety, as well as UAS adherence after 6 months of therapy in groups with insomnia, depression, anxiety or none of these conditions. Using ISI to quantify insomnia, adherence in patients with no/mild insomnia (ISI < 15) was compared to those with moderate/severe insomnia (ISI ≥ 15).
Results
1639 patients were included; 10% reported a history of insomnia, 23% depression and 16% anxiety. There was no difference in UAS adherence between groups with or without a history of insomnia, depression, or anxiety. A baseline ISI score was available in 470 patients with no history of insomnia, and in 81 patients with a history of insomnia. In patients with no history of insomnia, 59% had ISI scores ≥15, while in those with a history of insomnia, 85% had ISI scores ≥15 (p < 0.001). There was no difference in therapy usage between patients with ISI scores <15 and ≥15 (6.7 ± 2.2 hours/night versus 6.4 ± 2.5 hours/night, p = 0.5).
Conclusion
This study examined the impact of insomnia, depression or anxiety on adherence to UAS therapy for OSA. Patients with and without these conditions had similar UAS adherence. We found that insomnia as objectively based on the ISI score may be underdiagnosed in UAS patients who have no subjective history of insomnia at baseline. Despite this, ISI severity did not impact UAS adherence. Longer term follow-up with serial ISI scores and adherence data is needed to further understand how insomnia severity impacts UAS therapy outcomes and usage.
Support (If Any)
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Suurna MV, Steffen A, Boon M, Chio E, Copper M, Patil RD, Green K, Hanson R, Heiser C, Huntley C, Kent D, Larsen C, Manchanda S, Maurer JT, Soose R, de Vries N, Walia HK, Thaler E. Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update. Laryngoscope 2021; 131:2616-2624. [PMID: 34626128 DOI: 10.1002/lary.29755] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/12/2020] [Revised: 06/06/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. STUDY DESIGN Prospective observational study. METHODS ADHERE captures UAS outcomes including apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1-year period. BMI ≤32 kg/m2 (BMI32 ) and 32 < BMI ≤35 kg/m2 (BMI35 ) group outcomes were examined. RESULTS One thousand eight hundred forty-nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (-20.9, P < .0001) and ESS (- 4.4, P < .0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P = .01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P = .01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI35 versus BMI32 patients (59.8% vs. 72.2%, P = .02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI32 versus 5.2 ± 2.2 hr/day in BMI35 (P = .028). CONCLUSIONS Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2616-2624, 2021.
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Affiliation(s)
- Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, U.S.A
| | - Armin Steffen
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Maurits Boon
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - Eugene Chio
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A
| | - Marcel Copper
- Department of Otolaryngology-Head and Neck Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Reena Dhanda Patil
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Department of Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
| | - Katherine Green
- Department of Otolaryngology, University of Colorado, Denver, Colorado, U.S.A
| | - Ronald Hanson
- Otolaryngology, St. Cloud Ear, Nose, Throat Clinic, St. Cloud, Minnesota, U.S.A
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany
| | - Colin Huntley
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - David Kent
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Christopher Larsen
- Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Andover, Kansas, U.S.A
| | - Shalini Manchanda
- Section of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, U.S.A
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ryan Soose
- Division of Sleep Surgery, Department of Otolaryngology, Pittsburgh School of Medicine, UPMC Mercy, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Nico de Vries
- Department of Ear, Nose and Throat, OLVG, Department of Oral Kinesiology, ACTA Amsterdam, Amsterdam, The Netherlands
| | - Harneet K Walia
- Cleveland Clinic, Sleep Disorders Center, Neurological Institute, Cleveland, Ohio, U.S.A
| | - Erica Thaler
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Wang JC, Elson NC, Epperson MV, Doarn CR, Altaye M, Tabangin ME, Patil RD, Patil YJ. A Report on the Use of Telehealth in Otolaryngology: In the Pre COVID-19 Era. Telemed J E Health 2021; 28:334-343. [PMID: 34028286 DOI: 10.1089/tmj.2021.0049] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the integration of and barriers to the utilization of telehealth technology and its components (telemedicine, e-Health, m-health) in daily otolaryngologic practice before the SARS CoV-2 (COVID-19) pandemic. Methods: This cross-sectional study was conducted at a tertiary academic center. A national survey of members of the American Academy of Otolaryngology-Head and Neck Surgery was administered. Descriptive analyses were performed to determine how telehealth was employed in otolaryngologists' practices. Results: A total of 184 surveys were completed. Telehealth technology was used by 50% of otolaryngologists surveyed. Regions with the largest percentage of physicians using telehealth were the Mid-Atlantic region (84%) and West Coast (67%). Most otolaryngologists indicated that they were familiar with telehealth or any of its components and how it is used in practice (52-83%), they had heard of telehealth or any of its components but were unsure what the terms specifically entailed (17-42%); 53% were satisfied with their current use of telehealth and electronic medical record (EMR); and 72% were comfortable utilizing smart devices for patient care. Most otolaryngologists (65%) indicated reimbursement as the biggest limitation to implementing telehealth, and 67% believed that typing was a hindrance to EMR utility. Conclusion: Half of the surveyed otolaryngologists used some form of telehealth at the time of the survey. The most commonly cited obstacle to physician adoption of telehealth was reimbursement. Although the adoption of telehealth technology was still limited in the field of otolaryngology based on this study, we are now seeing significant change due to the COVID-19 pandemic.
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Affiliation(s)
- James C Wang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Nora C Elson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Madison V Epperson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Charles R Doarn
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
| | - Yash J Patil
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,This manuscript was presented at the Triological Society Combined Sections Meeting January 23-25, 2020
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12
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Abstract
OBJECTIVE Insomnia and sleep apnea frequently co-occur, with additive effects of both disorders presenting clinicians with unique treatment challenges compared to one disorder alone. The hypoglossal nerve stimulator (HNS) is a promising treatment for patients with comorbid insomnia and sleep apnea (COMISA), many of whom have positive airway pressure (PAP) intolerance. Our aim was to determine adherence to and efficacy of HNS in veterans with COMISA refractory to PAP therapy compared to those with obstructive sleep apnea alone (OSA only). STUDY DESIGN Retrospective case series. SETTING A single, academic Veterans Affairs medical center. METHODS Review of clinical records, pre- and postoperative polysomnography, and clinical measures of obstructive sleep apnea (OSA), sleepiness, and insomnia was conducted in 53 consecutive cases of veterans with OSA undergoing HNS implantation. HNS adherence was obtained at postoperative visits. HNS adherence and efficacy were compared between individuals with COMISA and OSA only. RESULTS COMISA was noted in 30 of 53 (56.6%) veterans studied. There was no significant difference between HNS adherence in patients with COMISA and OSA only (5.6 vs 6.4 h/night, P = .17). HNS implantation improved polysomnographic and clinical measures of OSA and sleepiness in both COMISA and OSA only, and 56.5% (13/23) of patients with COMISA self-reported improvement in insomnia after surgery. CONCLUSION HNS was successful in treating a complex veteran population with COMISA refractory to PAP when examining measures of treatment adherence and efficacy. Future studies of patients with COMISA undergoing HNS will examine effective combination therapy targeting insomnia and a multidisciplinary effort to optimize treatment adherence.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Michael P Hong
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Divisions of Pediatric Otolaryngology and Pulmonary Medicine, Cincinnati, Ohio, USA
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Dhanda Patil R, Sarber KM, Epperson MV, Tabangin M, Altaye M, Mesa F, Ishman SL. Hypoglossal Nerve Stimulation: Outcomes in Veterans with Obstructive Sleep Apnea and Common Comorbid Post-traumatic Stress Disorder. Laryngoscope 2020; 131 Suppl 3:S1-S11. [PMID: 33295673 DOI: 10.1002/lary.29292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Veterans have an increasing prevalence of obstructive sleep apnea (OSA) and high levels of intolerance to positive airway pressure (PAP). The hypoglossal nerve stimulator (HNS) is a promising alternative surgical treatment for OSA in these patients, many of whom suffer from mental health conditions such as post-traumatic stress disorder (PTSD) that may negatively affect their ability to use PAP. Our aims were: 1) to assess postoperative changes in OSA severity and sleepiness in a veteran only population after HNS; 2) to compare postoperative changes in OSA severity, sleepiness and HNS adherence between veterans with and without PTSD; and 3) to compare HNS adherence in our population to HNS adherence in the current literature as well as published PAP adherence data. STUDY DESIGN Retrospective and prospective case series. METHODS Clinical data on consecutive patients undergoing HNS in a Veterans Affairs hospital were examined for demographic data as well as medical, sleep, and mental health comorbidities. The overall cohort as well as subsets of patients with and without PTSD were examined for postoperative changes in OSA severity (apnea hypopnea index [AHI], lowest oxygen saturation (LSAT]), and sleepiness (Epworth sleepiness scale [ESS]), as well as for device adherence. PTSD and depression symptomatology were measured using the PTSD Checklist 5 (PCL-5) and Patient Health Questionnaire 9 (PHQ-9). RESULTS Forty-six veterans were included. Forty-four patients were male (95.6%), 45 were white (97.8%), and the mean age was 61.3 years. Twenty-six patients met PCL-5 criteria for PTSD and 17 did not. OSA severity and sleepiness improved significantly in the overall cohort after HNS; median (IQR) AHI decreased from 39.2 (24.0, 63.0) to 7.4 (1.2, 20.8) events/hour (P < .0001), mean LSAT increased from 81% to 88% (P < .0001) and mean ESS decreased from 10.9 to 6.7 (P < .0001). These improvements were similar between patients with and without PTSD (P = .434-.918). Overall device adherence was 6.1 hours/night for the overall cohort and was not significantly different between patients with and without PTSD (P = .992). CONCLUSIONS HNS is an efficacious therapy in a veteran population, providing patients with significant improvements in OSA severity and sleepiness. Veterans with and without PTSD benefited similarly from HNS when comparing improvements in sleep apnea severity and sleepiness as well as device usage. Adherence was similar to previously published HNS adherence data and better than PAP adherence reported in the literature. LEVEL OF EVIDENCE 4 Laryngoscope, 131:S1-S11, 2021.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Department of Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
| | - Kathleen M Sarber
- Department of Otolaryngology, 96th Medical Group, Eglin Air Force Base, Florida, U.S.A
| | - Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Franklin Mesa
- Department of Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
| | - Stacey L Ishman
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Larsen C, Boyd C, Villwock M, Steffen A, Heiser C, Boon M, Huntley C, Doghramji K, Soose RJ, Kominsky A, Waters T, Withrow K, Parker N, Thaler E, Dhanda Patil R, Green KK, Chio E, Suurna M, Schell A, Strohl K. Evaluation of Surgical Learning Curve Effect on Obstructive Sleep Apnea Outcomes in Upper Airway Stimulation. Ann Otol Rhinol Laryngol 2020; 130:467-474. [PMID: 32924533 DOI: 10.1177/0003489420958733] [Citation(s) in RCA: 2] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE An increasing number of facilities offer Upper Airway Stimulation (UAS) with varying levels of experience. The goal was to quantify whether a surgical learning curve exists in operative or sleep outcomes in UAS. METHODS International multi-center retrospective review of the ADHERE registry, a prospective international multi-center study collecting UAS outcomes. ADHERE registry centers with at least 20 implants and outcomes data through at least 6-month follow-up were reviewed. Cases were divided into two groups based on implant order (the first 10 or second 10 consecutive implants at a given site). Group differences were assessed using Mann-Whitney U-tests, Chi-squared tests, or Fisher's Exact tests, as appropriate. A Mann-Kendall trend test was used to detect if there was a monotonic trend in operative time. Sleep outcome equivalence between experience groups was assessed using the two one-sided tests approach. RESULTS Thirteen facilities met inclusion criteria, contributing 260 patients. Complication rates did not significantly differ between groups (P = .808). Operative time exhibited a significant downward trend (P < .001), with the median operative time dropping from 150 minutes for the first 10 implants to 134 minutes for the subsequent 10 implants. The decrease in AHI from baseline to 12-month follow-up was equivalent between the first and second ten (22.8 vs 21.2 events/hour, respectively, P < .001). Similarly, the first and second ten groups had equivalent ESS decreases at 6 months (2.0 vs 2.0, respectively, P < .001). ESS outcomes remained equivalent for those with data through 12-months. CONCLUSIONS Across the centers' first 20 implants, an approximately 11% reduction operative time was identified, however, no learning curve effect was seen for 6-month or 12-month AHI or ESS over the first twenty implants. Ongoing monitoring through the ADHERE registry will help measure the impact of evolving provider and patient specific characteristics as the number of implant centers increases.
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Affiliation(s)
| | | | - Mark Villwock
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Armin Steffen
- University Clinic Schleswig-Holstein, Lubeck, Germany
| | | | - Maurits Boon
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | | | - Noah Parker
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erica Thaler
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Eugene Chio
- The Ohio State University, Columbus, OH, USA
| | | | - Amy Schell
- University Hospitals, Cleveland, OH, USA
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15
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Sarber KM, Chang KW, Ishman SL, Epperson MV, Dhanda Patil R. Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations. Laryngoscope 2020; 130:866-872. [DOI: 10.1002/lary.28175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/28/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Kathleen M. Sarber
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | | | - Stacey L. Ishman
- Division of Pediatric Otolaryngology Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Cincinnati College of Medicine Cincinnati OH USA
| | | | - Reena Dhanda Patil
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Cincinnati College of Medicine Cincinnati OH USA
- Department of OtolaryngologyCincinnati Veterans Affairs Medical Center Cincinnati Ohio U.S.A
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16
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Sarber KM, Chang KW, Epperson MV, Tabangin ME, Altaye M, Ishman SL, Dhanda Patil R. Hypoglossal Nerve Stimulation in Veterans with Obstructive Sleep Apnea. Laryngoscope 2019; 130:2275-2280. [DOI: 10.1002/lary.28422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Kathleen M. Sarber
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
- Division of Pediatric OtolaryngologyCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | | | | | - Meredith E. Tabangin
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Mekibib Altaye
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Stacey L. Ishman
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
- Division of Pediatric OtolaryngologyCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
| | - Reena Dhanda Patil
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Department of OtolaryngologyCincinnati Veterans Affairs Medical Center Cincinnati Ohio U.S.A
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17
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Sarber KM, Ishman SL, Patil RD. Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2019; 145:389-390. [DOI: 10.1001/jamaoto.2018.4077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kathleen M. Sarber
- Division of Pulmonology Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stacey L. Ishman
- Division of Pulmonology Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Reena Dhanda Patil
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, Cincinnati VA, Cincinnati, Ohio
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Chang KW, Steward DL, Tabangin ME, Altaye M, Malhotra V, Patil RD. Clinical use of the STOP-BANG questionnaire to determine postoperative risk in veterans. Laryngoscope 2018; 129:259-264. [PMID: 30194731 DOI: 10.1002/lary.27295] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine whether STOP-BANG (snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, gender) scores are associated with immediate postoperative adverse events in veterans undergoing surgery. METHODS In this prospective cohort study, veterans presenting to the presurgical clinic at a Veterans Affairs hospital answered the STOP-BANG questionnaire, which was scored as high risk (5-8), intermediate risk (3-4), and low risk (0-2) for obstructive sleep apnea (OSA), during a 6-month study period. Immediate postoperative respiratory and cardiovascular adverse events were recorded. RESULTS The patient population included 1,080 veterans. Ninety-five patients (8.8%) experienced adverse events, of which 74 (6.9%) were respiratory and 21 (1.9%) were cardiovascular in nature. Patients with high-risk STOP-BANG scores (5-8) had significantly greater odds of having an adverse event odds ratio (OR) 2.1 (95% confidence interval [CI]: 1.4, 3.3) and hypoxia OR 2.8 (95% CI: 1.7, 4.6) compared to those with low- to intermediate-risk scores (0-4). Among patients with OSA, those with high-risk scores (5-8) had greater odds of an adverse event OR 3.9 (95% CI: 1.1, 13.9) and hypoxia OR 3.7 (95% CI: 1.1, 13.0) compared to those with low- to intermediate-risk scores (0-4). Patients without a history of OSA with high-risk scores (5-8) did not have significantly greater odds of an adverse event OR 1.5 (95% CI: 0.82, 2.6) or a hypoxic event OR 1.7 (95% CI: 0.87, 3.4) compared to those with low- to intermediate-risk scores (0-4). CONCLUSION The STOP-BANG questionnaire was useful in the veteran population because high-risk scores were predictive of adverse events, in particular, hypoxia for patients with a previous diagnosis of OSA. In the future, this may direct studies and clinical activities aimed at optimizing safe and effective perioperative practices. LEVEL OF EVIDENCE 2b Laryngoscope, 129:259-264, 2019.
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Affiliation(s)
- Katherine W Chang
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - David L Steward
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Meredith E Tabangin
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Vidhata Malhotra
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.,Department of Anesthesia, Cincinnati VA Medical Center, Cincinnati, Ohio, U.S.A
| | - Reena Dhanda Patil
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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19
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Thakur M, Asrani RK, Thakur S, Sharma PK, Patil RD, Lal B, Parkash O. Observations on traditional usage of ethnomedicinal plants in humans and animals of Kangra and Chamba districts of Himachal Pradesh in North-Western Himalaya, India. J Ethnopharmacol 2016; 191:280-300. [PMID: 27321279 DOI: 10.1016/j.jep.2016.06.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/25/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Abstract
ETHNOBOTANICAL RELEVANCE Medicinal plants are frequently used by Gaddi and Gujjar tribes of Kangra and Chamba districts of Himachal Pradesh, India to cure various ailments in humans and livestock. Therefore, extensive field work was conducted to document the traditional use of ethnomedicinal plants by these tribes. MATERIALS AND METHODS Direct interviews of 208 informants were conducted. The data generated through interviews was analysed using quantitative tools such as use-value (UV), factor informant consensus (Fic) and fidelity level (Fl). RESULTS A total of 73 plant species in 67 genera and 40 families were observed to be medicinal and used to cure 22 ailment categories. The highest number of ethnomedicinal plants was recorded from the family Asteraceae followed by Lamiaceae, Apiaceae, Acanthaceae, Caesalpiniaceae, Polygonaceae, Ranunculaceae, Rosaceae and Rutaceae. Leaves were the most frequently used plant part used to treat various ailments followed by whole plant and roots or rhizomes. Ajuga parviflora, Berberis lycium, Viola canescens, Vitex negundo and Zanthoxylum armatum were the most important medicinal plants used for treating human diseases, whereas Achyranthes bidentata, Aloe sp., Cassia fistula, Podophyllum hexandrum and Pogostemon benghalensis were the most important medicinal plants used for treating animal diseases as per use value. The important ailment categories classified on the basis of factor informant consensus were gastrointestinal and respiratory disorders. CONCLUSION The present study revealed that people of the study area are extensively using the ethnomedicinal plants to cure various ailments. Plants with high use value and fidelity level should be subjected to pharmacological investigation for scientific validation.
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Affiliation(s)
- Meenakshi Thakur
- Department of Veterinary Pathology, Dr. G.C. Negi College of Veterinary and Animal Sciences, CSK HPKV, Palampur 176062, Himachal Pradesh, India
| | - R K Asrani
- Department of Veterinary Pathology, Dr. G.C. Negi College of Veterinary and Animal Sciences, CSK HPKV, Palampur 176062, Himachal Pradesh, India.
| | - Shalini Thakur
- Department of Veterinary Pathology, Dr. G.C. Negi College of Veterinary and Animal Sciences, CSK HPKV, Palampur 176062, Himachal Pradesh, India
| | - P K Sharma
- Krishi Vigyan Kendra Hamirpur, CSK HPKV, Palampur 176062, Himachal Pradesh, India
| | - R D Patil
- Department of Veterinary Pathology, Dr. G.C. Negi College of Veterinary and Animal Sciences, CSK HPKV, Palampur 176062, Himachal Pradesh, India
| | - Brij Lal
- Institute of Himalayan Bioresource Technology, Palampur 176062, Himachal Pradesh, India
| | - Om Parkash
- Institute of Himalayan Bioresource Technology, Palampur 176062, Himachal Pradesh, India
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20
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Patil RD, Meinzen-Derr JK, Hendricks BL, Patil YJ. Improving access and timeliness of care for veterans with head and neck squamous cell carcinoma: A multidisciplinary team's approach. Laryngoscope 2015; 126:627-31. [PMID: 26267427 DOI: 10.1002/lary.25528] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 01/14/2015] [Revised: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS With the prevalence of head and neck squamous cell carcinoma (HNSCC) nearly twice as high in veterans (6%) than general populations (3%), the noted problems of long waits and access to care in United States Veterans Affairs (VA) hospitals across the country are pressing. We examined primary outcome measures of timeliness and access to care for our patients with HNSCC assessing a multidisciplinary team approach at our VA hospital. STUDY DESIGN Retrospective chart review. METHODS Our patients newly diagnosed with HNSCC were identified from two 24-month periods: diagnosis before (group 1, 2005-2006) and after (group 2, 2008-2009) implementing our multidisciplinary team in 2007. No significant differences in age (P = .13) or disease stage (P = .18) occurred between groups. Primary and secondary outcomes (i.e., treatment modality, imaging, completion of treatment, survival) were compared. RESULTS Timeliness to care improved for all measures. Improvement was significant for times from consult placed to seen in clinic (27.5-16.5 days; P < 0.0001) and from positive biopsy reported to date of initiating definitive treatment (35-27 days; P = 0.04). Pretreatment consults to various services represented by the multidisciplinary team increased from one to four (P < 0.0001). Two-year mortality was approximately the same between group 1 (33%) and group 2 (36%) (P = 0.035). Five-year mortality was slightly better in group 2 (50%) versus group 1 (61%), although not statistically significant. CONCLUSION Our veteran population with HNSCC had improved timeliness and access to care with our multidisciplinary approach. LEVEL OF EVIDENCE 4. Laryngoscope, 126:627-631, 2016.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.,Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
| | - Jareen K Meinzen-Derr
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A
| | - Brian L Hendricks
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.,Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
| | - Yash J Patil
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.,Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
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21
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Park AM, Dhanda Patil R, Paniello RC. Prevention of post-traumatic reinnervation with microtubule inhibitors. Laryngoscope 2015; 125:E333-7. [PMID: 26147345 DOI: 10.1002/lary.25258] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 01/20/2015] [Accepted: 02/17/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Functional recovery after a recurrent laryngeal nerve or facial nerve injury may be impaired due to aberrant reinnervation. Previous work in a rat peripheral nerve injury model found vincristine to be a potent inhibitor of reinnervation, and it has since been used to effectively block neural regeneration in other animal models. However, vincristine's narrow therapeutic index may limit its utility; therefore, another microtubule inhibitor, paclitaxel, which has a higher therapeutic index, was tested. STUDY DESIGN Animal (rat) study. METHODS After controlled injury to the rat posterior tibial (PT) nerve, the gastrocnemius/soleus complex was injected with saline (control, n = 14), vincristine (n = 30), or paclitaxel (n = 20). Injections without a crush injury were performed using saline (n = 5) or paclitaxel (n = 9). The functional recovery (FR) of the PT nerve was assessed using walking track analysis. RESULTS At 6 weeks, controls had already recovered to baseline (FR = 1.0), whereas the paclitaxel group had FR = 0.724 ± 0.064 and the vincristine group had FR = 0.709 ± 0.078. At 6 months, the paclitaxel rats had FR = 0.798 ± 0.167 and the vincristine rats had FR = 0.754 ± 0.240. These differences were significantly different from baseline, but the two agents were not different from each other. Paclitaxel did not affect the FR in the absence of a nerve injury. CONCLUSIONS Intramuscular paclitaxel and vincristine both significantly inhibit regeneration of the PT nerve after crush injury for at least 6 months. Potential clinical uses of inhibition of reinnervation are discussed. LEVEL OF EVIDENCE NA
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Affiliation(s)
- Andrea M Park
- Department of Otolaryngology-Head and Neck Surgery at the Washington University School of Medicine, St. Louis, MO, and the St. Louis V.A. Medical Center, St. Louis, Missouri, U.S.A
| | - Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery at the Washington University School of Medicine, St. Louis, MO, and the St. Louis V.A. Medical Center, St. Louis, Missouri, U.S.A
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery at the Washington University School of Medicine, St. Louis, MO, and the St. Louis V.A. Medical Center, St. Louis, Missouri, U.S.A
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Katoch S, Sharma M, Patil RD, Kumar S, Verma S. In vitro and in vivo pathogenicity studies of Pasteurella multocida strains harbouring different ompA. Vet Res Commun 2014; 38:183-91. [PMID: 24604134 DOI: 10.1007/s11259-014-9601-6] [Citation(s) in RCA: 16] [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] [Accepted: 02/24/2014] [Indexed: 11/25/2022]
Abstract
Pasteurella multocida is a pathogenic, Gram-negative bacterium that is commonly found as normal flora in nasopharynx of variety of wild and domestic animals. Numerous virulence factors have been described for P. multocida isolates which include adherence and colonization factors, iron-regulated and acquisition proteins, extracellular enzymes such as neuraminidase, lipopolysaccharide (LPS), capsule and a variety of outer membrane proteins (Omp). OmpA has a significant role in stabilizing the cell envelope structure by providing physical linkage between the outer membrane & peptidoglycan. It has been shown to mediate P. multocida -host cells interaction via heparin and/or fibronectin binding and therefore act as an important invasive molecule which could determine the final outcome of initial infection. Comparative nucleotide sequence analysis of ompA gene of P. multocida has revealed that despite extensive genetic diversity in ompA of P. multocida, most sequences could be classified into two major allele classes namely ompA allele (I) and allele (II). The P. multocida recovered from nasal cavity of bovine and belonging to two ompA classes were tested for their differential virulence. In vitro pathogenicity studies on Madin Darby Bovine Kidney (MDBK) cell line employing adhesion and invasion assays indicated that P. multocida strain with ompA (I) is more invasive than P. multocida strain with ompA (II). In vivo studies in mice further reiterated that the isolates harbouring ompA(I) were comparatively more virulent to isolates harbouring ompA (II).
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Affiliation(s)
- Shailja Katoch
- Department of Veterinary Microbiology, Dr. G.C. Negi College of Veterinary & Animal Sciences, CSKHPKV, Palampur, Himachal Pradesh, 176062, India
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23
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Singh ND, Sharma AK, Patil RD, Rahman S, Leishangthem GD, Kumar M. Effect of feeding graded doses of Citrinin on clinical and teratology in female Wistar rats. Indian J Exp Biol 2014; 52:159-167. [PMID: 24597149] [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: 06/03/2023]
Abstract
Citrinin is the one of the well-known mycotoxins, which is possibly spread all over the world. The graded doses of citrinin (1, 3 and 5 ppm CIT in feed) in female Wistar rats 10 weeks prior to mating, during mating and during organogenesis resulted in resorptions and post implantation losses, decreased fetal body weights and crown-rump lengths in fetuses of all groups. Various developmental anomalies recorded in fetuses of treated rats included gross (wrist drop, curled tail, stretched forelimb, subcutaneous haematoma), skeletal (incomplete ossification of skull bones, incomplete fusion of vertebral bodies, complete and partial agenesis of sternaebrae, metacarpals, metatarsals and phalanges, fused ribs and swing out ribs) and visceral (internal and external hydrocephalus, cerebellar hypoplasia, microphthalmia, roundening of heart, contracted kidneys, dilated renal pelvis and cryptorchid testes). The results suggest that CIT has adverse effects on fetal development which may be due to the longer bioavailability of citrinin in the animals.
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Affiliation(s)
- N D Singh
- Division of Pathology Indian Veterinary Research Institute, Izatnagar 243 122, India
| | - A K Sharma
- Division of Pathology Indian Veterinary Research Institute, Izatnagar 243 122, India
| | - R D Patil
- Division of Pathology Indian Veterinary Research Institute, Izatnagar 243 122, India
| | - S Rahman
- Division of Pathology Indian Veterinary Research Institute, Izatnagar 243 122, India
| | - G D Leishangthem
- Division of Pathology Indian Veterinary Research Institute, Izatnagar 243 122, India
| | - M Kumar
- Division of Pathology Indian Veterinary Research Institute, Izatnagar 243 122, India
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Singh ND, Sharma AK, Dwivedi P, Telang AG, Kumar M, Patil RD. Studies on apoptotic changes in combined toxicity of citrinin and endosulfan in pregnant wistar rats and their fetuses. Toxicol Int 2012; 19:138-43. [PMID: 22778511 PMCID: PMC3388757 DOI: 10.4103/0971-6580.97207] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Citrinin (mycotoxin) and endosulfan (pesticide) both environmental contaminants easily enter the food chain and are caoomon causes of various toxicities. Materials and Methods: In the present investigation, citrinin (CIT) (10 mg/kg feed) and endosulfan (1 mg/kg body weight) were administered orally alone and in combination to pregnant Wistar rats from gestational day 6 to 20 to study their effect to cause apoptosis in the pregnant Wistar rats and their fetuses. Apoptosis was assessed in dams by agarose gel electrophoresis, flow cytometry and electron microscopy, while in the fetuses it was assessed by flow cytometry only. Result: Citrinin and endosulfan in the combination group caused apoptosis in an additive manner as there was increased number of apoptotic cells as compared to the individual toxin and control groups. The fetuses also showed increased number of apoptotic cells in the combination groups, which also indicated that both the toxins crossed the placental barrier. Conclusion: So it was concluded that apoptosis played a significant role in the pathogenesis of endosulfan and citrinin toxicity.
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Abstract
Objectives/Hypothesis. (1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA. Study Design. Survey study. Setting. Veterans Affairs hospitals with surgical services; sample size 102 facilities. Subjects. Veterans Affairs health care providers. Methods. The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors. Results. The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year. Conclusion. This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.
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Affiliation(s)
- Reena Dhanda Patil
- University of Cincinnati Department of Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio, USA
- Cincinnati VA Medical Center, Cincinnati, Ohio, USA
| | - Yash J. Patil
- University of Cincinnati Department of Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio, USA
- Cincinnati VA Medical Center, Cincinnati, Ohio, USA
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Jadhav SH, Sarkar SN, Patil RD, Tripathi HC. Effects of subchronic exposure via drinking water to a mixture of eight water-contaminating metals: a biochemical and histopathological study in male rats. Arch Environ Contam Toxicol 2007; 53:667-77. [PMID: 17882470 DOI: 10.1007/s00244-007-0031-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Accepted: 05/06/2007] [Indexed: 05/17/2023]
Abstract
In the current study, we examined whether subchronic exposure via drinking water to low doses of a mixture of metals (arsenic, cadmium, lead, mercury, chromium, manganese, iron, and nickel), found as contaminants in various water sources of India, and to concentrations equivalent to WHO maximum permissible limits (MPL) in drinking water for individual metals, can alter systemic physiology of male rats. Data on water contamination with metals in India were collected from the literature and metals were selected on the basis of their frequency of occurrence and contamination level above MPL. Male Wistar rats were exposed to the mixture at 0, 1, 10, and 100 times the mode concentrations (the most frequently occurring concentration) of the individual metals via drinking water for 90 days. One more group of rats was exposed to the mixture at a concentration equivalent to the MPL (WHO) in drinking water for individual metals. Toxic potential of the mixture was evaluated by assessing general toxicological end points, serum chemistry and histopathology of vital organs. The mixture decreased body weight and water consumption and increased weights of brain, liver, and kidneys with 10x and 100x doses. After 30 days of exposure, no appreciable changes were found in any blood clinical markers. After 60 days, only the 100x dose, while after 90 days both 10x and 100x doses increased activities of aspartate aminotransferase and alkaline phosphatase and levels of urea nitrogen and creatinine and decreased total protein and albumin levels, but alanine aminotransferase activity and glucose level were not affected. At 10x and 100x exposure levels, qualitatively similar, but dose-dependent vascular, degenerative, and necrotic changes were observed in brain, liver, and kidney. The results indicate that subchronic exposure to the metal mixture affected general health of male rats by altering the functional and structural integrity of kidney, liver, and brain at 10 and 100 times the mode concentrations of the individual metals in Indian water sources, but exposure at mode concentrations of contemporary water contamination levels or at concentrations equivalent to the MPL for individual metals in drinking water may not cause any health hazards in male rats.
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Affiliation(s)
- S H Jadhav
- Division of Pharmacology and Toxicology, Indian Veterinary Research Institute, 243 122 Izatnagar, Uttar Pradesh, India
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Abstract
1. Local modulation of adrenergic responses was examined in the hindlimb vasculature of chronically instrumented intact conscious rats. Sprague-Dawley rats (n = 22) were instrumented with a Doppler flow probe around the right common iliac artery, a polyethylene catheter inserted just distal to the flow probe and a left carotid arterial catheter. 2. The effects of various concentrations of the alpha 1-adrenergic receptor agonist phenylephrine (0.005-0.075 microgram kg-1), the alpha 2-adrenergic receptor agonist clonidine (0.1-0.7 microgram kg-1), and the endogenous adrenergic receptor agonist adrenaline (0.02-0.08 microgram kg-1), were investigated under control conditions, and in the presence of the nitric oxide (NO) synthase inhibitor N omega-nitro-L-arginine methyl ester hydrochoride (L-NAME) (NO-X, 0.2 mg kg-1) and the cyclo-oxygenase inhibitor indomethacin (CO-X, 10 mg kg-1). Results were presented as dose-response curves. 3. Heart rate and arterial pressure were not altered by any of the agents because all were locally injected into the hindlimb vasculature and the selected doses were lower than those which elicited systemic responses. 4. Maximal vasoconstrictor responses to phenylephrine were enhanced in the presence of NO-X (50 +/- 6%) and CO-X (70 +/- 9%). Maximal vasoconstrictor responses to clonidine were also enhanced in the presence of NO-X (75.3 +/- 4.8%) and CO-X (50.6 +/- 5.7%). 5. The responses to adrenaline were biphasic; NO-X significantly attenuated the vasodilator response (87 +/- 6%), and enhanced the vasoconstrictor response (51 +/- 7%). CO-X attenuated the vasoconstrictor response (71 +/- 6%). 6. These results demonstrate local modulation of responses to alpha 1- and beta-adrenergic receptor agonists by receptor-mediated dose-dependent release of NO and prostaglandins.
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Affiliation(s)
- S E DiCarlo
- Department of Physiology, Northeastern Ohio Universities, College of Medicine, Rootstown 44272, USA
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Patil RD, Bhambure NM, More N, Athawale A, Shah AC. Survival after attempted strangulation. J Assoc Physicians India 1994; 42:644-5. [PMID: 7868565] [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: 01/27/2023]
Affiliation(s)
- R D Patil
- Department of Respiratory Diseases, LTMM College, LTMG Hospital Sion, Bombay
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Abstract
Examining the hemodynamic responses to exercise provides a unique opportunity to analyze and integrate cardiovascular physiology because more is learned about how a system operates when it is forced to perform than when it is idle. We designed a laboratory exercise that examines the cardiovascular responses to exercise in a sedentary individual, an athlete, an individual with quadriplegia, and an individual with heart transplantation. The special populations were chosen because of their unique limitations and adaptations, which directly influence cardiovascular function. Basic anatomic and physiological data about the special populations are provided, and the students are challenged to analyze and assimilate information from figures, answer questions, make calculations, and plot graphs. The answers to the questions are provided in the APPENDIX. This laboratory exercise should be attempted in a group to foster discussions and interactions. The laboratory does not require any equipment or software. This exercise should be attempted after the cardiovascular section of the physiology course so that the students can integrate and apply the information presented during the course.
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Affiliation(s)
- R D Patil
- Department of Physiology, Northeastern Ohio Universities, College of Medicine, Rootstown 44272
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Abstract
The influence of the release of endothelium-derived nitric oxide (NO) on the vasoconstrictor response to phenylephrine (PE) was evaluated before and after a single bout of dynamic exercise. Each rat ran on a motor-driven treadmill at 12-18 m/min, 10-18% grade until exhaustion (avg time 45 min). Sprague-Dawley rats (n = 6) were instrumented with a Doppler ultrasonic flow probe around the right common iliac artery. Just distal to the flow probe, a catheter was placed into the right iliac artery for local infusions. A Teflon catheter was placed in the descending aorta to measure mean arterial blood pressure (MAP) and heart rate (HR). PE (0.005-0.075 microgram/kg) and NO inhibitor N omega-nitro-L-arginine methyl ester hydrochloride (L-NAME, 0.2-0.25 mg/kg) were injected into the functionally isolated hindlimb. HR and MAP were not altered by any of the injections because we selected doses below those which elicited systemic responses. Dose-response curves to PE were generated in the control and postexercise condition, with and without the NO synthase inhibitor L-NAME. Exercise significantly attenuated the maximal vasoconstrictor response to PE (45.6 +/- 1.6%). L-NAME enhanced the maximal vasoconstrictor response to PE 49.8 +/- 4.5% in the control condition and 121.4 +/- 5.9% in the postexercise conditions. Thus, although NO inhibition enhanced the vasoconstrictor response to PE in the control and postexercise conditions, the enhanced vasoconstrictor response to PE after L-NAME was significantly greater in the postexercise condition. Results suggest that NO contributes to the exercise induced attenuation of alpha 1-adrenergic receptor stimulation.
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Affiliation(s)
- R D Patil
- Department of Physiology, Northeastern Ohio Universities College of Medicine, Rootstown 44272
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Gokhale YA, Ramnath, Patil RD, Prasar S, Kamble P, Balani S, Kelkar PN, Rammurthi K, Menon PS. Rhinocerebral mucormycosis associated with diabetic ketoacidosis. J Assoc Physicians India 1991; 39:970-1. [PMID: 1816232] [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: 12/28/2022]
Abstract
Rhinocerebral mucormycosis with hemiparesis occurred in a young woman who was not a known diabetic. Rhyzopus species grew from the initial nasal biopsy. The patient was treated with amphotericin B, in addition to control of diabetic ketoacidosis. Surgical intervention was not done. The patient died on the fourth day of hospitalisation.
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Affiliation(s)
- Y A Gokhale
- Department of Medicine, LTM Medical College, Bombay
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Gokhale YA, Marathe P, Patil RD, Prasar S, Kamble P, Hase NK, Agrawal MB, Deshmukh SN, Menon PS. Rhabdomyolysis and acute renal failure following a single dose of succinylcholine. J Assoc Physicians India 1991; 39:968-70. [PMID: 1816231] [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: 12/28/2022]
Abstract
A 30-year old with rhabdomyolysis and acute renal failure is presented. The attack followed a minor operation under general anaesthesia during which succinylcholine was administered as muscle relaxant. The fasciculations which occurred immediately after injection of succinylcholine may possibly have precipitated rhabdomyolysis.
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Affiliation(s)
- Y A Gokhale
- Department of Medicine, Municipal Medical College, Bombay
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