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Steele EM, Whitmill MA, Amos A, Oaks ZA, McGurk R, Dance MJ, Mazur L, Weiner AA, Marks LB, Chera BS, Sud S. Incident Learning in an Academic Radiation Oncology Practice during the COVID Era. Int J Radiat Oncol Biol Phys 2023; 117:e440-e441. [PMID: 37785430 DOI: 10.1016/j.ijrobp.2023.06.1617] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Incident learning is key to developing and maintaining quality and safety in healthcare. We aimed to characterize acute and sustained changes in incident submissions, point of incident origin/detection, severity and associated contributing factors during the COVID-19 pandemic. HYPOTHESIS The frequency and pattern of incident origin/detection were changed by altered workflows in response to COVID-19. MATERIALS/METHODS Events from our experienced incident learning system were analyzed between three 12-month intervals: pre-COVID (March 1, 2019 - February 29, 2020), early-COVID (March 1, 2020 - February 28, 2021), and late-COVID (March 1, 2021 - February 28, 2022). In addition to review by the department quality and safety committee, at least two physicians reviewed all incidents. Using descriptive statistics and chi-square test as applicable, we compared the reporting rates, incident severity, contributing factors, points of origin/ detection according to time the pre-specified time intervals prior to and during COVID. RESULTS See Table. CONCLUSION During COVID the number of reported incidents, particularly incidents reaching the patient, markedly declined. The number of incidents per patient increased with early-COVID altered workflows. This suggests that existing quality and safety checks were effective during early-COVID. The point of incident origin was similar across time periods. During early-COVID, the point of incident detection shifted to earlier points in the care pathway (e.g., pre-RT chart checks vs chart checks during RT), p<0.001. During late-COVID, as clinical workflows adapted, the point of detection shifted to later in the care pathway consistent with pre-COVID patterns. During COVID, workload was implicated in fewer incidents (in the setting of reduced treatment volumes), while communication and hand-offs were more frequently cited as contributing factors (in the setting of remote work). Our data supports the utility of consistent standards, minimizing inter-provider variations and maintaining robust quality and safety checks to optimize communication and safe patient care in radiation oncology.
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Affiliation(s)
- E M Steele
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M A Whitmill
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A Amos
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Z A Oaks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - R McGurk
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M J Dance
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L Mazur
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - S Sud
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Sud S, Kanchi K, Hayward M, Wijetunga A, Corcoran D, Weiner AA. Genomic Characterization of Low and High Grade Cervical Intraepithelial Neoplasia in Comparison to Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e547. [PMID: 37785684 DOI: 10.1016/j.ijrobp.2023.06.1847] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Screening reduces incidence of cervical cancer (CC) through identification and treatment of cervical intraepithelial neoplasia (CIN). Triage of CIN must balance between overtreatment versus progression as invasive therapies increase the risk of side effects including obstetric complications. The majority of CIN 1-2 lesions regress and a subset of CIN 3 lesions progress, however, due to inability to differentiate lesions likely to progress, the majority of CIN 2-3 lesions are treated with resection. Improved genomic and molecular identifiers of disease represent an urgent unmet clinical need. MATERIALS/METHODS Using next generation sequencing of a targeted exome panel of 1109 genes (previously validated), we characterized somatic mutations in 36 CIN (14 CIN 1, 11 CIN 2, 11 CIN 3) and 13 CC samples. Sequencing of CIN samples was performed on exfoliated cervical cells. CIN diagnosis and grade was confirmed on biopsy. Mutation profiles between CIN grades and CC were compared to identify genomic patterns that distinguish these groups. RESULTS Across the 49 samples sequenced, we identified a total of 5142 somatic mutations, including 2178 missense, 2522 synonymous, 171 nonsense, 62 splice site, 135 inframe indels, and 74 frameshift mutations. The mutation frequency was significantly higher in CC vs CIN1-3 (Table), p<0.01 (Wilcoxon signed-rank test). The difference in mutation frequency and type (Table) was not significant between CIN grades 1, 2 and 3 (p = 0.07, Kruskal-Wallis test). Cancer related pathway signatures were analyzed for the percentage of CC vs CIN samples with at least one altered variant as follows: RTK-RAS (92% vs 31%), PI3K (92% vs 17%), NOTCH (100% vs 39%), WNT (85% vs 14%) and cell cycle (53% vs 3%). Ninety percent of CC samples versus only 30% of CINs had nonsynonymous variants in the RTK-RAS and NOTCH pathways as well as the PI3K pathway which is implicated as a late event in cervical carcinogenesis. We observed recurrent missense variants in ABL1, IGF1R, TSC2 in the CIN2, CIN3 and CC samples, particularly in genes that belong to the RTK-RAS, PI3K, NOTCH pathway signatures. Potential driver mutations in EGFR, PIK3CA, ERBB4, MTOR, CSF1R genes were exclusive to CC samples. CONCLUSION Our results show that there is a clear distinction of mutational burden and type between cervical cancer and CIN1-3. However, the pathologic grading of CIN is not consistently associated with dynamic changes in overall mutation burden, type, or specific genes with escalating CIN grade. This data supports the hypothesis that late genetic events in CIN accompany a transition to invasive cervical cancer.
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Affiliation(s)
- S Sud
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - K Kanchi
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Hayward
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Wijetunga
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - D Corcoran
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Sud S, Poellmann M, Garg V, King T, Casey DL, Wang AZ, Hong S, Weiner AA. Prospective Characterization of Circulating Tumor Cell Kinetics in Patients with Localized Lung Cancer Treated with Radiotherapy or Chemoradiotherapy with Definitive Intent. Int J Radiat Oncol Biol Phys 2023; 117:e60. [PMID: 37785811 DOI: 10.1016/j.ijrobp.2023.06.778] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To characterize circulating tumor cell (CTC) kinetics in response to definitive therapy in patients with local or locoregional lung cancer and identify CTC kinetic profiles associated with favorable disease response versus progression. MATERIALS/METHODS In this single-institution prospective correlative biomarker study, we enrolled patients receiving definitive intent radiotherapy (RT) or chemoradiotherapy for non-metastatic lung cancer. Blood specimens were collected prior to RT (baseline), during RT and at follow up visits up to 24 months post RT. Subsequent lines of therapy were administered per standard of care. CTCs were captured and enumerated using a previously reported nanotechnology-based assay functionalized with aEpCAM, aHER-2, and aEGFR to facilitate biomimetic cell rolling and dendrimer-mediated multivalent binding. Disease status was assessed per RECIST 1.1 criteria. CTC kinetics and absolute values were analyzed to identify patterns associated with disease control versus progression. RESULTS We enrolled 24 patients with median follow up of 8 months corresponding to 114 CTC measurements. Seven patients (30%) had biopsy proven disease, while 17 (70%) were diagnosed based on clinical and radiographic features alone. Nineteen patients (79%) received stereotactic body radiation therapy. Median baseline CTC count was 12.6 CTCs/ml (range 0-290) and post RT decreased to median 4 CTCs/ml (0-42.7). For 95% of patients, a favorable kinetic profile (defined as stable CTC count, decreased CTC count or <24 CTCs/ml corresponding to the 80th percentile) during radiotherapy or at the time of first follow up corresponded to local control of the irradiated lesion. Five patients (20%) experienced disease progression within the follow up period. In the two patients with local progression of the irradiated lesion, the CTC count rose >10 fold prior to or at the time of radiographic detection of progression. In the three patients with systemic progression, CTC count rose 1.46-5.8-fold at the time of progression. Notably, four of the five patients with disease progression did not have initial biopsy confirmation of disease but did experience a CTC elevation at the time of progression. CONCLUSION Our data suggests CTCs may serve as a biomarker for response to therapy in patients being treated with RT with definitive intent for early stage or locally advanced lung cancer. This finding is of importance given important limitations in obtaining pathologic confirmation of disease in select patients and challenges distinguishing disease progression versus benign post radiotherapy radiographic changes. Further studies are needed to characterize the predictive and prognostic value of circulating biomarker levels and kinetics in lung cancer.
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Affiliation(s)
- S Sud
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M Poellmann
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI
| | - V Garg
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T King
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - D L Casey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A Z Wang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; UT Southwestern Department of Radiation Oncology, Dallas, TX
| | - S Hong
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Hall J, Sud S, Casey D, Poellmann M, Bu J, Wang A, Hong S, Shen C. Prospective Characterization of Circulating Tumor Cell Kinetics in Patients with Locoregional Head and Neck Cancer Receiving Definitive Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shumway J, Sud S, Elmore S, Repka M, Tatko S, Wang A, Chen R, Royce T. Comparing Patient-Reported Urinary Symptoms after Prostate Radiation Therapy across Different Radiation Modalities. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1690] [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: 11/28/2022]
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Sud S, Thapa D, Gerringer B, Wacaser B, Tatko S, Wang A, Chen R, Royce T. A Prospective Analysis of Toxicity Associated with Intraoperative, Real-Time Planned Low Dose Rate Brachytherapy or Intensity-Modulated Radiotherapy Boost for High/Intermediate Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.429] [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: 10/31/2022]
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Schmid S, Minnella E, Pilon Y, Rokah M, Rayes R, Najmeh S, Cools-Lartigue J, Ferri L, Mulder D, Sirois C, Owen S, Shieh B, Ofiara L, Wong A, Sud S, Baldini G, Carli F, Spicer J. EP05.02-015 Neoadjuvant Prehabilitation Therapy for Locally Advanced Non-small-Cell Lung Cancer: Optimizing Outcomes throughout the Trajectory of Care. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.497] [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: 10/14/2022]
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Sud S. Avalung: A saviour in avalanche. Med J Armed Forces India 2022; 78:S335-S336. [PMID: 36147393 PMCID: PMC9485737 DOI: 10.1016/j.mjafi.2020.04.011] [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: 12/26/2019] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Saurabh Sud
- Classified Specialist (Anaesthesia & Critical Care), 403 Field Hospital, C/O 56 APO, India
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Sud S, Shree S, Bhardwaj S, Devi U. Cow dung – An unusual cause of halitosis. J Mar Med Soc 2022. [DOI: 10.4103/jmms.jmms_103_21] [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: 11/04/2022] Open
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Sud S, Bhardwaj S, Jairam A, Dwivedi D, Garg A. Telemedicine – A way forward for medical consultation at high altitude. J Mar Med Soc 2022. [DOI: 10.4103/jmms.jmms_20_21] [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: 11/04/2022] Open
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Dwivedi D, Sud S, Kumar Y, Bharadwaj S, Kumar A, Garg A. Role of point-of-care ultrasound in grading the severity and early diagnosis of high-altitude pulmonary edema at a peripheral hospital. J Mar Med Soc 2022. [DOI: 10.4103/jmms.jmms_138_20] [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: 11/04/2022] Open
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Amos A, Sud S, Oaks Z, McGurk R, Dance M, Luciano A, Mazur L, Marks L, Chera B. Incident Learning in a Radiation Oncology Practice During the COVID Era. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sud S, Tatko S, Tan X, Gu D, Harris S, Lafata J, Shen C, Royce T. Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1008] [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]
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Sud S, Hall J, Tan X, Roberts O, Green R, Park S, Poellmann M, Bu J, Hong S, Wang A, Casey D. Prospective Characterization of Circulating Tumor Cell Kinetics in Patients With Oligometastatic Disease Receiving Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yogesh Kumar YS, Sud S, Bhardwaj S, Pareek TK. Acute coronary syndrome in young males after a prolonged stay at high altitude. Med J Armed Forces India 2021; 77:490-493. [PMID: 34594081 DOI: 10.1016/j.mjafi.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
The Indian population is predisposed to acute coronary syndrome at a younger age, but very few cases are reported at high altitude. Acute coronary syndrome is frequently associated with multiple cardiovascular risk factors. During management of seven young patients with acute coronary syndrome, it was found that none of them had conventional cardiovascular risk factors including recent physical exertion. It is a known fact that the risk of vascular thrombosis increases by 30 times in Indian soldiers after a long stay at high altitude. Therefore, it is necessary to carry out the tests for procoagulant markers to know whether the acute coronary syndrome was because of the prothrombotic state, and if yes, was high altitude responsible for the procoagulant state or whether the person per se had a procoagulant syndrome. With the absence of these tests at hospitals at high-altitude areas, it becomes difficult to ascertain the exact cause of acute coronary syndrome. This study highlights the importance of aggressively testing for procoagulant markers in young patients presenting with chest pain at high altitude, even in the absence of traditional risk factors.
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Affiliation(s)
- Y S Yogesh Kumar
- Graded Specialist (Medicine), 403 Field Hospital, C/o 56 APO, India
| | - Saurabh Sud
- Classified Specialist (Anaesthesia & Critical Care), 403 Field Hospital, C/o 56 APO, India
| | - Saurabh Bhardwaj
- Classified Specialist (Aviation Medicine) & Commanding Officer, 403 Field Hospital, C/o 56 APO, India
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Sud S, Kumar Y, Bhardwaj S, Dwivedi D. Homocysteinemia-induced upper-extremity deep-vein thrombosis: A sinister at high altitude. Indian J Vasc Endovasc Surg 2021. [DOI: 10.4103/ijves.ijves_112_20] [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: 11/04/2022] Open
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Gupta A, Singh S, Khandelwal A, Sud S. An unusual cause of double-lumen tube obstruction in mechanically ventilated patient. Ann Card Anaesth 2021; 24:275-276. [PMID: 33884996 PMCID: PMC8253019 DOI: 10.4103/aca.aca_22_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ankur Gupta
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shalendra Singh
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
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Dwivedi D, Sud S, Dudeja P, Hooda B, Singh S, Aggarwal M. A cross-sectional study to compare anesthesia techniques employed for the conduct of upper gastrointestinal endoscopic procedures in a gastroenterology suite of a tertiary care hospital. J Med Sci 2021. [DOI: 10.4103/jmedsci.jmedsci_189_20] [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: 11/04/2022] Open
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Singh S, Sreenivasulu P, Sud S, Sasidharan S, Gupta A. A Rare Case of Dengue Hemorrhagic Fever with Myocarditis and Intracranial Hemorrhage. J Pediatr Neurosci 2020; 15:320-321. [PMID: 33531958 PMCID: PMC7847097 DOI: 10.4103/jpn.jpn_48_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/29/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022] Open
Abstract
We present a rare case of dengue hemorrhagic fever presenting with severe myocardial dysfunction along with intracranial hemorrhage and coagulopathy. It warrants every clinician to be vigilant in diagnosis and management so as to prevent life-threatening morbidity and mortality.
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Affiliation(s)
- Shalendra Singh
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Pothireddy Sreenivasulu
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shibu Sasidharan
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankur Gupta
- Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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Hooda B, Sud S, Dwivedi D, Yadav SK. Dilated Cardiomyopathy and Prone Position: An Anesthetic Challenge. J Neuroanaesth Crit Care 2020. [DOI: 10.1055/s-0040-1713726] [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: 10/24/2022] Open
Abstract
AbstractThe anesthetic management of a patient with dilated cardiomyopathy (DCM) for noncardiac surgery is challenging due to associated congestive heart failure, malignant dysrhythmias, sudden cardiac arrest, implanted rhythm devices, and thromboembolism. We report successful conduct of a case of DCM on cardiac resynchronization device with Cauda equina syndrome (CES) under general anesthesia in prone position. The anesthetic concerns specific to the pathophysiology of DCM are also discussed.
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Affiliation(s)
- Bhavna Hooda
- Department of Anaesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Sanjay K. Yadav
- Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India
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Dwivedi D, Sud S, Singh S, Sharma R. Surgeon-Assisted Continuous Transversus Abdominis Plane Block a Feasible Option for Perioperative Pain Relief in Pediatric Surgical Patients with Spinal Deformities. J Indian Assoc Pediatr Surg 2020; 25:126-128. [PMID: 32139996 PMCID: PMC7020674 DOI: 10.4103/jiaps.jiaps_90_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/30/2019] [Accepted: 10/06/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital (Southern Command) Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital (Southern Command) Armed Forces Medical College, Pune, Maharashtra, India
| | - Shalendra Singh
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Rakesh Sharma
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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Sud S, Singh S, Krishna V, Dwivedi D. Bilateral chylothorax: An uncommon complication of unilateral central venous catheter placement. Indian J Respir Care 2020. [DOI: 10.4103/ijrc.ijrc_2_20] [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: 11/04/2022] Open
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Affiliation(s)
- Shalendra Singh
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shreyas Kate
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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Dwivedi D, Sud S, Singh S, Gautam A. Multidisciplinary approach with favorable outcome in management of placenta accreta. J Obstet Anaesth Crit Care 2020. [DOI: 10.4103/joacc.joacc_29_19] [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: 11/04/2022] Open
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Dwivedi D, Sud S, Dwivedi G, Singh S. Face-mask ventilation leading to neurapraxia of buccal branch of the facial nerve. J Med Sci 2020. [DOI: 10.4103/jmedsci.jmedsci_67_19] [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: 11/04/2022] Open
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Sud S, Dwivedi D, Singh S, Kumar M. Postoperative pneumomediastinum with bilateral pneumothorax following percutaneous nephrolithotomy. Indian J Respir Care 2020. [DOI: 10.4103/ijrc.ijrc_32_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sud S, Hooda B, Dwivedi D, Singh S. Acute pressor response in prone position during spinal surgery. CHRISMED J Health Res 2020. [DOI: 10.4103/cjhr.cjhr_3_19] [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: 11/04/2022] Open
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Dwivedi D, Bhatia JS, Hota RN, Sud S. Role of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange Therapy in the Management of a Twin Pregnancy with H1N1 Infection in Early Acute Respiratory Distress Syndrome. Anesth Essays Res 2019; 13:692-694. [PMID: 32009717 PMCID: PMC6937900 DOI: 10.4103/aer.aer_124_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/19/2019] [Accepted: 10/20/2019] [Indexed: 11/06/2022] Open
Abstract
Pregnancy with H1N1 infection presenting with early acute respiratory distress syndrome (ARDS) is a challenging situation, where the life of both mother and fetus are jeopardized. Morbidity and mortality in such a clinical situation are not uncommon; it may result in hypoxemic acute respiratory failure in a pregnant patient, leading to mechanical ventilation and poorer outcomes in neonates due to prematurity. An interdisciplinary approach involving obstetricians, respiratory physicians, neonatologist, and anesthesiologist is mandatory for a good outcome. This case report highlights the management strategy of the parturient infected with H1N1 in early ARDS with the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange therapy, which completely obviated the requirement of the invasive ventilation.
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Affiliation(s)
- Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital (SC) Armed Forces Medical College, Pune, Maharashtra, India
| | - Jagdeep Singh Bhatia
- Department of Anaesthesia and Critical Care, Command Hospital (SC) Armed Forces Medical College, Pune, Maharashtra, India
| | - Rabi Narayan Hota
- Department of Anaesthesia and Critical Care, Command Hospital (SC) Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital (SC) Armed Forces Medical College, Pune, Maharashtra, India
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Sud S, Gerringer B, Wacaser B, Tan X, Basak R, Royce T, Wang A, Chen R. Under-Ascertainment of Acute Toxicity during Prostate Cancer RT – Does This Vary By Patient Characteristics? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.579] [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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Dwivedi D, Ray A, Singh S, Sud S, Hooda B. Inadvertent sterile water injection in the epidural space: history revisited. Korean J Anesthesiol 2019; 73:562-563. [PMID: 31159538 PMCID: PMC7714630 DOI: 10.4097/kja.19100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Deepak Dwivedi
- Department of Anesthesiology and Critical Care, Command Hospital (Southern Command), Pune, India.,Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, India
| | - Arijit Ray
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, India
| | - Shalendra Singh
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, India
| | - Saurabh Sud
- Department of Anesthesiology and Critical Care, Command Hospital (Southern Command), Pune, India.,Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, India
| | - Bhavna Hooda
- Department of Anesthesiology and Critical Care, Command Hospital (Southern Command), Pune, India.,Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, India
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Dwivedi D, Sud S, Sawhney S, Singh I. Adulthood presentation of the neglected childhood temporomandibular joint ankylosis – “An airway challenge”. Med J DY Patil Vidyapeeth 2019. [DOI: 10.4103/mjdrdypu.mjdrdypu_138_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Singh S, Lahareesh BL, Sud S, Dwivedi D. Paediatric ventilating bougie a rescue device in an unanticipated difficult mask ventilation in a patient with an impacted foreign body. Indian J Anaesth 2019; 63:600-602. [PMID: 31391630 PMCID: PMC6644202 DOI: 10.4103/ija.ija_152_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shalendra Singh
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Byadarahalli L Lahareesh
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital (SC) Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital (SC) Armed Forces Medical College, Pune, Maharashtra, India
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Dwivedi D, Sud S, Bhatia J, Gautam A. A differently abled child with morbid obesity – An anesthetic challenge. J Mar Med Soc 2019. [DOI: 10.4103/jmms.jmms_80_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Davis J, Sreevastava DK, Dwivedi D, Gadgi S, Sud S, Dudeja P. A Comparison of Stress Response between Insertion of Gastro-laryngeal Tube and Endotracheal Intubation in Patients Undergoing Upper Gastrointestinal Endoscopic Procedures for Endoscopic Retrograde Cholangiopancreatography. Anesth Essays Res 2019; 13:13-18. [PMID: 31031473 PMCID: PMC6444943 DOI: 10.4103/aer.aer_9_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Complex gastrointestinal (GI) endoscopic procedures like endoscopic retrograde cholangiopancreatography (ERCP) require deep sedation or general anesthesia. Comorbidities with the poor physiological condition warrant endotracheal intubation to prevent hypoxia and aspiration. The gastro-laryngeal tube (GLT), a new supraglottic airway device with a separate channel for endoscope looks promising. AIMS The aim of the study is to compare the stress response during insertion of GLT and endotracheal intubation (ETT) in patients undergoing upper GI endoscopic procedures like ERCP. SUBJECTS AND METHODS This control versus comparison study comprised two groups with 30 patients each who underwent ETT and GLT insertion. The standard general anesthesia technique was used. In GLT group, the device was inserted without neuromuscular blocker. In ETT group, injection atracurium 0.5 mg/kg intravenous was administered as muscle relaxant for aiding endotracheal intubation. Hemodynamic parameters and time taken for the insertion of GLT/ETT were recorded. STATISTICAL ANALYSIS Data were analyzed using SPSS version 20. Student's t-test was used to compare quantitative data between the groups. ANOVA test was applied for intragroup comparisons between GLT and ETT groups. Categorical variables were analyzed using the Chi-square test. RESULTS Heart rate and mean arterial pressure increased from baseline in ETT group, following laryngoscopy and endotracheal intubation as well as with GLT insertion. However, the stress response caused by endotracheal intubation was significantly greater than that caused by GLT insertion. CONCLUSION GLT as an airway device is a safe alternative with decreased stress response compared to endotracheal intubation for upper GI endoscopy procedures.
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Affiliation(s)
- Josemine Davis
- Department of Anesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Deepak Kumar Sreevastava
- Department of Anesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Siddaramesh Gadgi
- Department of Anesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anesthesia and Critical Care, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Puja Dudeja
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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Dwivedi D, Sud S, Sawhney S, Bhatia J, Davis J, Dudeja P. Comparison of three different fluid warming techniques used to maintain euthermia in patients who underwent cesarean section – A retrospective audit. J Obstet Anaesth Crit Care 2019. [DOI: 10.4103/joacc.joacc_52_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dwivedi D, Sawhney S, Sud S, Dudeja P, Raman S, Dey S. Retrospective analysis of regional anesthesia techniques employed for postoperative pain management in pediatric patients undergoing pyeloplasty. Indian J Pain 2019. [DOI: 10.4103/ijpn.ijpn_27_19] [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: 11/04/2022] Open
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Sud S, O'Callaghan C, Jonker C, Karapetis C, Price T, Tebbutt N, Shapiro J, Van Hazel G, Pavlakis N, Gibbs P, Jeffrey M, Siu L, Gill S, Wong R, Jonker D, Tu D, Goodwin R. Hypertension as a predictor of advanced colorectal cancer outcome and cetuximab treatment response. ACTA ACUST UNITED AC 2018; 25:e516-e526. [PMID: 30607118 DOI: 10.3747/co.25.4069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/22/2022]
Abstract
Background Adrenergic receptor stimulation is involved in the development of hypertension (htn) and has been implicated in cancer progression and dissemination of metastases in various tumours, including colon cancer. Adrenergic antagonists such as beta-blockers (bbs) demonstrate inhibition of invasion and migration in colon cancer cell lines and have been associated with decreased mortality in colorectal cancer (crc). We examined the association of baseline htn and bb use with overall (os) and progression-free survival (pfs) in patients with pretreated, chemotherapy refractory, metastatic crc (mcrc). We also examined baseline htn as a predictor of cetuximab efficacy. Methods Using data from the Canadian Cancer Trials Group co.17 study [cetuximab vs. best supportive care (bsc)], we coded baseline htn and use of anti-htn medications, including bbs, for 572 patients. The chi-square test was used to assess the associations between those variables and baseline characteristics. Cox regression models were used for univariate and multivariate analyses of os and pfs by htn diagnosis and bb use. Results Baseline htn, bb use, and anti-htn medication use were not found to be prognostic for improved os. Baseline htn and bb use were not significant predictors of cetuximab benefit. Conclusions In chemorefractory mcrc, neither baseline htn nor bb use is a significant prognostic factor. Baseline htn and bb use are not predictive of cetuximab benefit. Further investigation to determine whether baseline htn or bb use have a similarly insignificant impact on prognosis in patients receiving earlier lines of treatment remains warranted.
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Affiliation(s)
- S Sud
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - C O'Callaghan
- ncic Clinical Trials Group, Queen's University, Kingston, ON
| | - C Jonker
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - C Karapetis
- Flinders University and Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Bedford Park, SA
| | - T Price
- The Queen Elizabeth and University of Adelaide, Adelaide, SA
| | | | - J Shapiro
- Department of Medical Oncology, Monash University, Melbourne, VIC
| | | | - N Pavlakis
- Royal North Shore Hospital, Northern Clinical School, University of Sydney, St. Leonards, NSW
| | - P Gibbs
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - M Jeffrey
- Oncology Service, Christchurch Hospital, Christchurch, N.Z
| | - L Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - S Gill
- University of British Columbia, BC Cancer, Vancouver, BC
| | - R Wong
- CancerCare Manitoba, Winnipeg, MB
| | - D Jonker
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - D Tu
- ncic Clinical Trials Group, Queen's University, Kingston, ON
| | - R Goodwin
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
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Sud S, Dwivedi D, Sawhney S, Panjiyar SP. Intraoperative error in estimation of blood loss due to change in the size of abdominal swab. Indian J Anaesth 2018; 62:822-824. [PMID: 30443071 PMCID: PMC6190420 DOI: 10.4103/ija.ija_205_18] [Citation(s) in RCA: 2] [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: 11/23/2022] Open
Affiliation(s)
- Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital Southern Command, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital Southern Command, Pune, Maharashtra, India
| | - Sadhan Sawhney
- Department of Anaesthesia and Critical Care, Command Hospital Southern Command, Pune, Maharashtra, India
| | - Shyam P Panjiyar
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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39
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Sud S, Dwivedi D, Sawhney S, Gupta A. Postoperative visual disturbance: “A peril related to glycine toxicity”. J Mar Med Soc 2018. [DOI: 10.4103/jmms.jmms_24_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Sud S, Dwivedi D, Paul M, Singh SU. Incident Reporting of Adverse Drug Reaction to Intravenous Ranitidine in an Emergency Department. Anesth Essays Res 2018; 12:605-606. [PMID: 29962644 PMCID: PMC6020577 DOI: 10.4103/aer.aer_40_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Saurabh Sud
- Department of Anaesthesia and Critical Care, Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Manish Paul
- Department of Anaesthesia and Critical Care, Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sanasam Ushakiran Singh
- Department of Anaesthesia and Critical Care, Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
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Gotfrit J, Vickers M, Sud S, Asmis T, Cripps C, Goel R, Hsu T, Jonker D, Goodwin R. Real-life treatment of metastatic colorectal cancer with regorafenib: a single-centre review. ACTA ACUST UNITED AC 2017; 24:234-239. [PMID: 28874891 DOI: 10.3747/co.24.3562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
BACKGROUND Various tyrosine kinase signalling pathways affect the development and progression of colorectal cancer (crc). In clinical trials, regorafenib has been associated with a survival benefit in metastatic crc (mcrc). We assessed the safety and efficacy of regorafenib in real-world patients. METHODS In a retrospective review of patients with mcrc treated with regorafenib at our institution from 2013 to 2015, patient demographics, treatment, and survival data were collected. Progression-free survival (pfs) and overall survival (os) were estimated using the Kaplan-Meier method. RESULTS In total, 48 patients were offered regorafenib, and 35 (73%) started treatment. Of the patients who started regorafenib, 57% were men. Median age in the cohort was 61 years, and all patients had a performance status in the range 0-2. Time from diagnosis of mcrc to regorafenib treatment was more than 18 months in 71% of patients. Starting dose was 160 mg in 54% of the patients, 120 mg in 40%, and 80 mg in 6%. Dose reductions occurred in 34% of the patients, and interruptions, in 29%. Best response was progressive disease (60%) and stable disease (17%); response in the rest of the patients was unknown. The most common adverse events on regorafenib (any grade) were fatigue (57%), hyperbilirubinemia (43%), thrombocytopenia (37%), anorexia (31%), and hypertension (31%). The most common grade 3 or 4 adverse events were fatigue (29%), hypophosphatemia (17%), weight loss (11%), and hyperbilirubinemia (9%). Common reasons for discontinuing regorafenib included progressive disease (51%) and toxicity (26%). In patients treated with regorafenib, pfs was 2.4 months (95% confidence interval: 1.8 to 3.3 months) and os was 5.6 months (95% confidence interval: 3.7 to 8.9 months). No factors were associated with survival in univariate or multivariate analysis. CONCLUSIONS In a real-world setting, regorafenib is associated with survival similar to that reported in the randomized controlled trials, but at the expense of toxicity leading to discontinuation in many patients. Future studies of regorafenib should focus on identifying the patients most likely to benefit and on minimizing toxicity.
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Affiliation(s)
- J Gotfrit
- The Ottawa Hospital Research Institute and
| | - M Vickers
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
| | - S Sud
- The Ottawa Hospital Research Institute and
| | - T Asmis
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
| | - C Cripps
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
| | - R Goel
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
| | - T Hsu
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
| | - D Jonker
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
| | - R Goodwin
- The Ottawa Hospital Research Institute and.,Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
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Yokom D, Sud S, Marginean H, Asmis T, Jonker D, Martel G, Gown A, Daneshmand M, Marginean E, Goodwin R. Signal transducer and activator of transcription–3 (STAT3) expression concordance in paired primary and metastatic colorectal cancers (mCRC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.71] [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: 11/12/2022] Open
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Tsvetkova E, Sud S, Aucoin N, Biagi J, Burkes R, Samson B, Brule S, Cripps C, Colwell B, Falkson C, Dorreen M, Goel R, Halwani F, Marginean C, Maroun J, Michaud N, Tehfe M, Thirlwell M, Vickers M, Asmis T. Corrigendum: Eastern Canadian Gastrointestinal Cancer Consensus Conference 2014. ACTA ACUST UNITED AC 2016; 23:e435. [PMID: 27536192 DOI: 10.3747/co.23.3283] [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: 11/15/2022]
Abstract
[This corrects the article DOI: 10.3747/co.22.2603.].
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Affiliation(s)
- E Tsvetkova
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - S Sud
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - N Aucoin
- Hôpital de la Cité-de-la-Santé de Laval, Laval, QC
| | - J Biagi
- Queen's University, Kingston, Toronto, ON
| | - R Burkes
- Mount Sinai Hospital, Toronto, ON
| | - B Samson
- Monteregie Cancer Centre, Charles-LeMoyne Hospital, Longueil, QC
| | - S Brule
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - C Cripps
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | | | - C Falkson
- Queen's University, Kingston, Toronto, ON
| | | | - R Goel
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - F Halwani
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - C Marginean
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - J Maroun
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - N Michaud
- Centre de Santé et de Services sociaux de Sept Îles, Sept-Îles, Montreal, QC
| | - M Tehfe
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M Thirlwell
- McGill University Health Centre, Montreal, QC
| | - M Vickers
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - T Asmis
- The Ottawa Hospital Cancer Centre, Ottawa, ON
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Lai P, Sud S, Zhang T, Asmis T, Wheatley-Price P. Palliative chemotherapy in advanced colorectal cancer patients 80 years of age and older. Curr Oncol 2016; 23:144-53. [PMID: 27330342 PMCID: PMC4900825 DOI: 10.3747/co.23.2996] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Colorectal cancer (crc) has a median diagnostic age of 68 years. Despite significant progress in chemotherapy (ctx) options, few data on outcomes or toxicity from ctx in patients 80 years of age and older are available. We investigated ctx in such patients with metastatic crc (mcrc), hypothesizing high rates of hospitalization and toxicity. METHODS A retrospective chart review identified patients 80 years of age and older with mcrc who initiated ctx between 2005-2010 at our institution. Patient demographics and ctx data were collected. Endpoints included rates of hospitalization, ctx discontinuation because of toxicity, and overall survival. RESULTS In 60 patients, ctx was initiated on 88 occasions. Median age in the cohort was 83 years; 52% were men; 72% lived with family; 53% had a modified Charlson comorbidity index of 2 or greater; and 31% were taking 6 or more prescription medications at baseline. At baseline, 33% of the patients were anemic (hemoglobin < 100 g/L), 36% had leukocytosis (white blood cells > 11×10(9)/L), and 48% had renal impairment (estimated glomerular filtration rate < 60 mL/min/1.73 m(2)). In 53%, ctx was given as first-line treatment. The initial ctx dose was adjusted in 67%, and capecitabine was the most common chemotherapeutic agent (45%). In 19 instances (22%), the patient was hospitalized during or within 30 days of ctx; in 26 instances (30%), the ctx was discontinued because of toxicity, and in 48 instances (55%), the patient required at least 1 dose reduction, omission, or delay. Median overall survival was 17.8 months (95% confidence interval: 14.3 to 20.8 months). CONCLUSIONS In the population 80 years of age and older, ctx for mcrc is feasible; however, most recipients will require dose adjustments, and a significant proportion will be hospitalized or stop ctx because of toxicity. Prospective research incorporating geriatric assessment tools is required to better select these older patients for ctx.
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Affiliation(s)
- P. Lai
- University of Ottawa, Ottawa, ON
| | - S. Sud
- Department of Medicine, The Ottawa Hospital, Ottawa, ON
| | - T. Zhang
- Methods Centre, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - T. Asmis
- Department of Medicine, The Ottawa Hospital, Ottawa, ON
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Tsvetkova E, Sud S, Aucoin N, Biagi J, Burkes R, Samson B, Brule S, Cripps C, Colwell B, Falkson C, Dorreen M, Goel R, Halwani F, Maroun J, Michaud N, Tehfe M, Thirlwell M, Vickers M, Asmis T. Eastern Canadian Gastrointestinal Cancer Consensus Conference 2014. ACTA ACUST UNITED AC 2015; 22:e305-15. [PMID: 26300681 DOI: 10.3747/co.22.2603] [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: 11/15/2022]
Abstract
The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, 23-25 October 2014. Expert radiation, medical, and surgical oncologists and pathologists involved in the management of patients with gastrointestinal malignancies participated in presentations and discussions resulting in consensus statements on such hot topics as management of neuroendocrine tumours, advanced and metastatic pancreatic cancer, and metastatic colorectal cancer.
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Affiliation(s)
- E Tsvetkova
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - S Sud
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - N Aucoin
- Hôpital de la Cité-de-la-Santé de Laval, Laval, QC
| | - J Biagi
- Queen's University, Kingston, ON
| | - R Burkes
- Mount Sinai Hospital, Toronto, ON
| | - B Samson
- Monteregie Cancer Centre, Charles-LeMoyne Hospital, Longueil, QC
| | - S Brule
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - C Cripps
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | | | | | | | - R Goel
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - F Halwani
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - J Maroun
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - N Michaud
- Centre de Santé et de Services sociaux de Sept-Îles, Sept-Îles, QC
| | - M Tehfe
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M Thirlwell
- McGill University Health Centre, Montreal, QC
| | - M Vickers
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - T Asmis
- The Ottawa Hospital Cancer Centre, Ottawa, ON
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Sawhney S, Agarwal M, Roy S, Buxi S, Sud S, Singh S. A patient with rashes and limb weakness. Indian Pediatr 2009; 46:867-873. [PMID: 19887692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- S Sawhney
- Pediatric Rheumatology Unit, Centre for Child Health, Department of Histopathology, North MRI Scan and Research Centre, Sir Ganga Ram Hospital, New Delhi, India.
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Sud S, Chaturvedi S, Buxi TBS, Singh S. Posterior atlantoaxial dislocation without associated fracture. Skeletal Radiol 2002; 31:529-31. [PMID: 12195506 DOI: 10.1007/s00256-002-0540-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2002] [Revised: 05/13/2002] [Accepted: 05/14/2002] [Indexed: 02/07/2023]
Abstract
We report on a 38-year-old man with post-traumatic posterior displacement of the atlas with respect to the axis without any associated fracture or neurological deficit caused by the displacement. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) revealed posterior displacement of the atlas with the odontoid peg lying anterior and to the right of the anterior arch of the atlas.
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Affiliation(s)
- S Sud
- Department of CT & MRI, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi--110060, India.
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Abstract
Retroviral vectors encoding the human IL-1 antagonist (IL-1Ra) gene and the human tumor necrosis factor soluble receptor (sTNF-R) gene were investigated using an in vivo model of the inflammatory response to orthopedic wear debris. Air pouches established in BALB/c mice were injected with polymethylmethacrylate (PMMA) particles to provoke an inflammatory reaction, and infected with retroviral vectors expressing IL-1Ra, sTNF-R or a LacZ marker gene. Pouch membranes and fluids were harvested after 48 or 72 hours for analyses. Positive PCR reactions for Neo genes were observed specifically in DNA extracted from the membrane of retroviral-infected pouches. ELISA assays revealed the presence of human IL-1 Ra in pouch fluid from DFG-IRAP-Neo transduced mice, but not control animals. Histological evaluation indicated that the IL-1Ra gene transfer was associated with markedly decreased inflammation in the model, with resolution of the edematous phase of the reaction, decreased pouch fluid accumulation, and lowered macrophage influx. The data suggest that the air pouch model represents a useful tool to evaluate gene therapy, and demonstrate that IL-1Ra gene therapy may be an appropriate therapeutic approach to inflammation.
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Affiliation(s)
- S Sud
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Ml 48201, USA
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Gyetko MR, Sud S, Sonstein J, Polak T, Sud A, Curtis JL. Antigen-driven lymphocyte recruitment to the lung is diminished in the absence of urokinase-type plasminogen activator (uPA) receptor, but is independent of uPA. J Immunol 2001; 167:5539-42. [PMID: 11698423 DOI: 10.4049/jimmunol.167.10.5539] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The requirement for urokinase plasminogen activator (uPA) and uPA receptor (uPAR) in T lymphocyte migration is unknown. uPA(-/-) mice have fewer pulmonary lymphocytes in response to certain infections, but its unknown whether this is due to diminished recruitment. Primed, recipient mice were IT inoculated with Ag. Three days later, fluorescently labeled lymphoblasts from background-matched control wild-type (WT), uPA(-/-), or uPAR(-/-) donor mice were injected i.v., and their recruitment was determined. Approximately twice the number of uPA(-/-) compared with WT lymphoblasts were recruited to the lungs of WT recipients. This difference was eliminated when uPA(-/-) and WT lymphoblasts were injected into uPA(-/-) recipients. Thus, the reduced number of lung lymphocytes in infected uPA(-/-) mice is not due to reduced recruitment. However, uPAR is critically involved in recruitment. Markedly fewer uPAR(-/-) compared with WT lymphoblasts were recruited to the lung. These findings suggest that uPAR may be a novel target for immune modulation in T lymphocyte-mediated disorders.
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Affiliation(s)
- M R Gyetko
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center and University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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