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Jaiswal KN, Talwar A, Vayyat S, Bade GG. Effect of somatotypes on lung volumes, capacities and respiratory impedance: A pilot study. Lung India 2024; 41:3-10. [PMID: 38160452 PMCID: PMC10883451 DOI: 10.4103/lungindia.lungindia_230_23] [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] [Received: 05/08/2023] [Accepted: 09/16/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The current morphological condition of an individual is described by a somatotype, which is a three-number scale. The endomorph, mesomorph and ectomorph components are presented in the same sequence, and each number corresponds to one of the three basic components of body composition. METHODS We recruited 50 healthy male subjects with a mean age of 24.10 ± 4.55 yrs. Somatotype was determined by the Heath and Carter method. Impulse oscillometry was performed followed by spirometry according to the European Respiratory Society (ERS) or American Thoracic Society (ATS) guidelines. Resistance at 5 Hz (R5) %pred, R20%pred, R5-R20, X5%pred, X20, area of reactance (Ax) and resonant frequency (Fres) were obtained by doing impulse oscillometry. Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio and maximum mid-expiratory flow (MMEF) were assessed by doing spirometry. RESULTS Endomorphs (0.05 (0.00-0.09) vs 0.01 (0.00-0.04); P < 0.0001) and mesomorphs (0.04 (0.000.09) vs 0.01 (0.00-0.04); P = 0.002) had significantly higher R5-R20 than ectomorphs. Similarly, endomorphs (0.32 (0.07-0.82) vs 0.15 (0.08-0.35); P = 0.001) and mesomorphs (0.28 (0.17-0.64) vs 0.15 (0.08-0.35); P = 0.015) also showed significantly higher Ax than ectomorphs, Fres of endomorphs (15.37 (8.43-21.85) vs 10.08 (8.94-14.30); P < 0.0001) and mesomorphs (14.32 (10.24-20.86) vs 10.08 (8.94-14.30); P < 0.0001) were significantly high than ectomorphs. Moreover, spirometric measures reveal significant variation in which mesomorphs had significantly higher values of % predicted of FVC than ectomorphs (92.49 ± 7.211 vs 83.86 ± 7.861; P = 0.042) and the ratio of FEV1 to FVC was significantly higher in ectomorphs than in endomorphs (89.00 ± 5.80 vs 85.04 ± 5.73; P = 0.03). CONCLUSION Peripheral airway dysfunction was observed in endomorphs and mesomorphs as compared to ectomorphs. Mesomorphs had a relatively higher FVC that may be due to their greater muscular strength.
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Karim A, Shameem M, Talwar A, Talwar D. Impact of comorbidities and inflammatory markers on mortality of COVID-19 patients. Lung India 2024; 41:40-46. [PMID: 38160458 PMCID: PMC10883455 DOI: 10.4103/lungindia.lungindia_162_23] [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] [Received: 04/06/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes coronavirus disease 2019 (COVID-19) is a serious global health concern. The severity of the disease can be determined by serologic indicators such as C-reactive protein, lactate dehydrogenase, D-dimer, ferritin, and interleukin-6. (IL-6). Patients with preexisting conditions such as respiratory, cardiovascular, and pulmonary disease could be at risk of adverse outcomes. It is crucial to provide adequate medical care to manage these patients and increase their chances of survival. AIM The study examined the impact of comorbidity and inflammatory markers on the severity and mortality of hospitalised COVID-19 patients. MATERIALS AND METHODS This retrospective study included 101 COVID-19 patients who had comorbidities and were hospitalised from April 2021 to April 2022. RESULTS Patients with a severe COVID-19 infection could be anticipated to have higher levels of inflammatory markers in their blood. Patients with chronic kidney and coronary artery disease have a worse prognosis than those with other comorbidities (P value <0.001). However, tuberculosis had no statistically significant effect on mortality and showed a minimal chance of death (P value = 0.303). In addition, tocilizumab performed poorly and was ineffective against the COVID-19 treatment. However, ivermectin exhibited a statistically significant probability of survival in COVID-19 patients. CONCLUSION The inflammatory markers D-dimer, ferritin, and IL-6 were identified as valuable indicators of disease severity. Further, chronic kidney disease and coronary artery disease were identified as risk factors for mortality, while tuberculosis showed potential protective effects. The study showed that higher neutrophil levels were linked to mortality in tocilizumab-treated patients, while ivermectin showed promise in increasing survival rates.
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Affiliation(s)
- Azmat Karim
- Department of TB and Respiratory Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Shameem
- Department of TB and Respiratory Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Science, New Delhi, India
| | - Deepak Talwar
- Department of Pulmonary Critical Care and Sleep Medicine, Metro Center for Respiratory Diseases, Metro Hospital Noida, Uttar Pradesh, India
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Sampath M, Bade G, Guleria R, Mohan A, Sen S, Dey D, Talwar A. Phenotypic Profiling of Immune Cells and Their Mediators in Chronic Obstructive Pulmonary Disease. Biomedicines 2023; 11:2166. [PMID: 37626663 PMCID: PMC10452296 DOI: 10.3390/biomedicines11082166] [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] [Received: 07/01/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder and has been proposed to have an imbalance between pro-inflammatory and anti-inflammatory factors. METHODS This study was conducted on 41 participants {18 COPD patients (smokers, COPD S (n = 9); reformed smokers, COPD RS (n = 9)) and 23 controls (non-smokers, CNS (n = 14); smokers, CS (n = 9))}. Flow cytometry was used to identify circulatory immune cells and correlated with serum cytokines. RESULTS On comparison, significantly lower frequency of CD3+ T cells were observed in COPD S as compared to CNS (p < 0.01) and CS (p < 0.01); CD4+ T cells were lower in COPD S (p < 0.05), COPD RS (p < 0.05) and CNS (p < 0.01) as compared to CS. CD8+ T cells were elevated in COPD S as compared to CS (p < 0.05). Lower frequency of cDCs were observed in COPD S as compared to CS (p < 0.05) and COPD RS as compared to CNS (p < 0.01) and CS (p < 0.01). Lower frequency of pDCs were observed in COPD RS as compared to COPD S (p < 0.05), CNS (p < 0.05) and CS (p < 0.01). Lower frequency of Tregs was observed in COPD S as compared to CNS (p < 0.05) and CS (p < 0.05). CONCLUSIONS Characteristic changes observed indicate a significant impact of immune cells in the progression of the disease.
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Affiliation(s)
- Meghashree Sampath
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India; (M.S.); (G.B.)
| | - Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India; (M.S.); (G.B.)
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India; (R.G.); (A.M.)
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India; (R.G.); (A.M.)
| | - Sudip Sen
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi 110029, India; (S.S.); (D.D.)
| | - Devanjan Dey
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi 110029, India; (S.S.); (D.D.)
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India; (M.S.); (G.B.)
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Anil AK, Mannan R, Shanmugasundaram K, Bade G, Talwar A, Deepak KK. Comparative study of the effect of N95 facemask and Powered Air-purifying Respirator (2 fans, N95 filter) on cardiovascular parameters of healthy individuals during exercise. Ind Health 2023; 61:125-133. [PMID: 35444091 PMCID: PMC10079503 DOI: 10.2486/indhealth.2021-0279] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
N95 masks filter 95% of the small particles and respiratory droplets (>0.3 µm diameter). Therefore, they are widely used both by general public and health workers during pandemic. When physical activity or exercise is performed wearing N95 mask, it induces hypercapnic environment. The heat burden is also increased leading to discomfort and reduced compliance. This study was done to compare physiological effects and subjective perceptions while wearing N95 mask and powered air-purifying respirator (PAPR) (2 fans, N95 filter) during incremental exercise. ECG, respiratory movement, SpO2, temperature inside the mask were recorded and perception of discomfort was also assessed. Heart rate variability (HRV) values during baseline were within normal limits in both the mask conditions signifying that cardiac autonomic tone is comparable. During incremental exercise, fall in SpO2 was significantly lesser in PAPR as compared to N95 mask at 60-70% and 70-80% of maximum achievable heart rate. The temperatures inside both the mask conditions were significantly higher than ambient temperature. The scores of humid, hot, breath resistance and fatigue were significantly lower in PAPR than N95 mask. In conditions where prolonged use of mask is required with strenuous physical exertion or exercise, PAPR could be preferred over N95 mask.
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Affiliation(s)
- Abhijith K Anil
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raihan Mannan
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - K Shanmugasundaram
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Shanmugasundaram K, Bade G, Sampath M, Talwar A. Effect of Obesity on Airway Mechanics. Indian J Endocrinol Metab 2023; 27:161-166. [PMID: 37292068 PMCID: PMC10245307 DOI: 10.4103/ijem.ijem_363_22] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/15/2023] [Accepted: 01/27/2023] [Indexed: 06/10/2023] Open
Abstract
Background Obesity is known to induce lung function impairment. Previous studies of decline in lung function associated with obesity are well established. Materials and Methods In this cross-sectional study, to evaluate the effects of different obesity indices on lung mechanics, healthy subjects (males-23 and females-22) were recruited. Anthropometric parameters like body mass index (BMI), waist circumference (WC), hip circumference (HC) and neck circumference (NC) were measured and waist-hip ratio (WHR) was derived. Spirometry, impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) measurements were performed to assess lung function. Subgroups were divided and analysed. Results In males, increased WHR is associated with increased total airway resistance (R5). BMI correlates positively with R5, R5% predicted, resistance at 20 Hz (R20) and R20% predicted; likewise, WHR shows a positive correlation with R5. In females, increased WHR has significantly higher R5, R5% predicted, R20, R20% predicted, area of reactance (Ax), resonant frequency (Fres) and decreased reactance at 5 Hz (X5), reactance at 20 Hz (X20), X20% predicted. The female group with higher WC shows significantly increased R5, R5% predicted, R20, R20% predicted, Ax, Fres and lower fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC), X5, X20, X20% predicted. The group with higher NC has a lower FEV1/FVC ratio. WHR positively correlated with R5% predicted and Fres while WC correlated positively with R5, R5% predicted, Ax and Fres; same way, NC with X5% predicted. Conclusion Obesity/overweight causes significant changes in lung volumes, capacity and airway mechanics, Higher WC and WHR are associated with significant changes in lung mechanics, which are more prominent in females than in males. NC is not associated with changes in lung mechanics.
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Affiliation(s)
| | - Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Meghashree Sampath
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Walker WL, Schmit KM, Welch EC, Vonnahme LA, Talwar A, Nguyen M, Stojanovic D, Langer AJ, Cocoros NM. Using the Food and Drug Administration´s Sentinel System for surveillance of TB infection. Int J Tuberc Lung Dis 2022; 26:1170-1176. [PMID: 36447322 PMCID: PMC9793953 DOI: 10.5588/ijtld.22.0259] [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] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: We examined patterns in care for individuals treated for latent TB infection (LTBI) in the US Food and Drug Administration´s Sentinel System.METHODS: Using administrative claims data, we identified patients who filled standard LTBI treatment prescriptions during 2008-2019. In these cohorts, we assessed LTBI testing, clinical management, and treatment duration.RESULTS: Among 113,338 patients who filled LTBI prescriptions, 80% (90,377) received isoniazid (INH) only, 19% (21,235) rifampin (RIF) only, and 2% (1,726) INH + rifapentine (RPT). By regimen, the proportion of patients with documented prior testing for TBI was 79%, 54%, and 91%, respectively. Median therapy duration was 84 days (IQR 35-84) for the 3-month once-weekly INH + RPT regimen, 60 days (IQR 30-100) for the 6- to 9-month INH regimen, and 30 days (IQR 2-60) for the 4-month RIF regimen.CONCLUSIONS: Among the cohorts, INH-only was the most commonly prescribed LTBI treatment. Most persons who filled a prescription for LTBI treatment did not have evidence of completing recommended treatment duration. These data further support preferential use of shorter-course regimens such as INH + RPT.
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Affiliation(s)
- W L Walker
- Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K M Schmit
- Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E C Welch
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - L A Vonnahme
- Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Talwar
- Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M Nguyen
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - D Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - A J Langer
- Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N M Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Talwar A, Varghese J, Knight G, Katariya N, Caicedo-Ramirez J, Dietch Z, Borja-Cacho D, Ladner D, Christopher D, Baker T, Abecassis M, Mouli S, Desai K, Riaz A, Thornburg B, Salem R. Abstract No. 184 Pre-operative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic, obliterative portal vein thrombosis: outcomes following liver transplantation. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.265] [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: 11/15/2022] Open
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Simonson JL, Khan S, Pandya D, Greenberg HE, Talwar A. Importance of sleep fragmentation in patients with scleroderma-related lung disease. Sleep Breath 2022; 27:687-688. [DOI: 10.1007/s11325-022-02639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
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Trivedi A, Bade G, Madan K, Ahmed Bhat M, Guleria R, Talwar A. Effect of Smoking and Its Cessation on the Transcript Profile of Peripheral Monocytes in COPD Patients. Int J Chron Obstruct Pulmon Dis 2022; 17:65-77. [PMID: 35027824 PMCID: PMC8749770 DOI: 10.2147/copd.s337635] [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: 09/13/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Rationale Smoking is the primary cause of chronic obstructive pulmonary disease (COPD); however, only 10–20% of smokers develop the disease suggesting possible genomic association in the causation of the disease. In the present study, we aimed to explore the whole genome transcriptomics of blood monocytes from COPD smokers (COPD-S), COPD Ex-smokers (COPD-ExS), Control smokers (CS), and Control Never-smokers (CNS) to understand the differential effects of smoking, COPD and that of smoking cessation. Methods Exploratory analyses in form of principal component analysis (PCA) and hierarchical component analysis (uHCA) were performed to evaluate the similarity in gene expression patterns, while differential expression analyses of different supervised groups of smokers and never smokers were performed to study the differential effect of smoking, COPD and smoking cessation. Differentially expressed genes among groups were subjected to post-hoc enrichment analysis. Candidate genes were subjected to external validation by quantitative RT-PCR experiments. Results CNS made a cluster completely segregated from the other three subgroups (CS, COPDS and COPD-ExS). About 550, 8 and 5 genes showed differential expression, respectively, between CNS and CS, between CS and COPD-S, and between COPD-S and COPD-ExS. Apoptosis, immune response, cell adhesion, and inflammation were the top process networks identified in enrichment analysis. Two candidate genes (CASP9 and TNFRSF1A) found to be integral to several pathways in enrichment analysis were validated in an external validation experiment. Conclusion Control never smokers had formed a cluster distinctively separated from all smokers (COPDS, COPD-ExS, and CS), while amongst all smokers, control smokers had aggregated in a separate cluster. Smoking cessation appeared beneficial if started at an early stage as many genes altered due to smoking started reverting towards the baseline, whereas only a few COPD-related genes showed reversal after smoking cessation.
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Affiliation(s)
- Anjali Trivedi
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Muzaffer Ahmed Bhat
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Talwar A, Sampath M, Bade G, Goyal V, Srivastava A, Jaryal A, Deepak K. Respiratory dysfunction in parkinson's disease: Relation with dysautonomia. Ann Indian Acad Neurol 2022; 25:683-687. [PMID: 36211190 PMCID: PMC9540937 DOI: 10.4103/aian.aian_940_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Parkinson's disease (PD) is a neurodegenerative disease perceived as a motor disorder. It is most commonly associated with autonomic dysfunction, affecting multiple systems. This altered autonomic control might be reflected by a parallel change in the airway caliber of these patients. Aim: To correlate the pulmonary impairment in patients with Parkinson's disease with the underlying dysautonomia. Materials and Methods: A total of 30 patients with Parkinson's disease participated in the study. Heart rate (HR) variability was recorded for 5 min to assess the autonomic dysfunction, followed by impulse oscillometry (IOS) and spirometry. IOS being an effort independent technique uses sound waves at different frequencies (5–25 Hz) to measure the airway impedance. Results: There was a significant decrease in SDSD (6.60 (10.18–6.01) vs. 12.22 (13.95–11.30); P = 0.04), RMSSD (6.59 (10.17–5.50) vs. 12.20 (13.93–11.28); P = 0.04), and total power (315.8 (506.3–120.7) vs. 771.3 (799.0–643.6); P = 0.04) in stage II as compared to stage I. Resistance at 20 Hz (R20) was found to be positively correlated with SDSD (r = 0.40, P = 0.04), RMSSD (r = 0.40, P = 0.04), and HF (r = 0.41, P = 0.03). Conclusion: Amongst the PD population, any changes in the parasympathetic component (responsible for bronchoconstriction) due to the underlying dysautonomia might be reflected as increased airway resistance in the pulmonary system.
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Bade G, Akhtar N, Trivedi A, Madan K, Guleria R, Talwar A. Impulse Oscillometry as a measure of airway dysfunction in Sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021037. [PMID: 34744428 PMCID: PMC8552576 DOI: 10.36141/svdld.v38i3.8674] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 08/23/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sarcoidosis is a systemic inflammatory granulomatous disease which commonly affects intrathoracic lymph nodes, lung parenchyma and airways. OBJECTIVES To measure respiratory impedance using Impulse Oscillometry (IOS) in patients with pulmonary sarcoidosis and compare the parameters with healthy controls. METHODS Patients diagnosed with sarcoidosis (n=28); and age and gender matched healthy controls (n=17) were recruited. Lung volumes and capacities were measured by spirometry and respiratory system impedance was assessed using Impulse Oscillometry System (IOS). Measurements were performed before and 15 minutes after inhalation of a short acting bronchodilator. The IOS and spirometric parameters were compared between two groups and correlated. ROC curve analysis was also performed to identify the IOS parameters which can discriminate between sarcoidosis and healthy controls. RESULTS Resistance at 5 and 20 Hz (R5 and R20), small airway resistance (R5-R20), resonant frequency (FRes) and area of reactance (AX) were significantly higher in Sarcoidosis subjects compared with controls. Reactance at 5 and 20 Hz (X5 and X20) were significantly lower in sarcoidosis. FEV1 (% predicted) and FVC (% predicted) were significantly lower in patients with sarcoidosis while FEV1/FVC ratio and peak expiratory flow rate (PEF) values were comparable. Post bronchodilator inhalation, there was improvement in airway resistance and reactance, but no significant changes observed in spirometric parameters. R5, X5 and R5-R20 are promising parameters to discriminate sarcoidosis from healthy controls. CONCLUSION Increased airway resistance is a better indicator of airway involvement than airflow limitation by spirometry in pulmonary sarcoidosis.
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Affiliation(s)
- Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nasim Akhtar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali Trivedi
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Yadav BS, Bade G, Guleria R, Talwar A. Exhaled Breath Temperature and Systemic Biomarkers for Assessment of Airway Inflammation in Asthmatics. J Assoc Physicians India 2021; 69:11-12. [PMID: 34431272] [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: 06/13/2023]
Abstract
OBJECTIVES Asthma is characterised by chronic airway inflammation and remodelling. Inflammation may alter the thermal balance of the affected tissues secondary to changes in the blood flow. Measurement of exhaled breath temperature (EBT) is a simple, safe and non-invasive technique to detect airway inflammation. The objective of this study was to measure EBT in asthma patients and compare it with healthy controls and also to correlate it with serum biomarkers of inflammation and remodelling. METHODS 24 male asthma patients and 23 age and gender matched healthy controls were recruited in the study. EBT and core body temperature were recorded followed by spirometry to measure forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR). Serum levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were quantified by ELISA. RESULTS Asthmatics had significantly lower FEV1% predicted compared to healthy subjects. EBT in asthma patients was significantly higher as compared to healthy controls while rate of rise of EBT was not significantly different. Serum biomarker of inflammation i.e. IL-6 and of tissue remodelling i.e. VEGF, MMP-9 and TIMP-1 were significantly raised in asthma patients while the ratio of MMP-9/TIMP-1 was comparable between two groups. But no correlation was observed between EBT and serum biomarkers. CONCLUSION EBT may be used as an adjunct tool for non-invasive assessment of airway inflammation and remodelling in asthma patients.
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Affiliation(s)
- Bhupendra Singh Yadav
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - Geetanjali Bade
- Department of Physiology, 3Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences New Delhi
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences New Delhi
| | - Anjana Talwar
- Department of Physiology, Critical Care and Sleep Medicine, All India Institute of Medical Sciences New Delhi; Corresponding author
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Trivedi A, Khan MA, Bade G, Talwar A. Orchestration of Neutrophil Extracellular Traps (Nets), a Unique Innate Immune Function during Chronic Obstructive Pulmonary Disease (COPD) Development. Biomedicines 2021; 9:53. [PMID: 33435568 PMCID: PMC7826777 DOI: 10.3390/biomedicines9010053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023] Open
Abstract
Morbidity, mortality and economic burden caused by chronic obstructive pulmonary disease (COPD) is a significant global concern. Surprisingly, COPD is already the third leading cause of death worldwide, something that WHO had not predicted to occur until 2030. It is characterized by persistent respiratory symptoms and airway limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles of gases. Neutrophil is one of the key infiltrated innate immune cells in the lung during the pathogenesis of COPD. Neutrophils during pathogenic attack or injury decide to undergo for a suicidal death by releasing decondensed chromatin entangled with antimicrobial peptides to trap and ensnare pathogens. Casting neutrophil extracellular traps (NETs) has been widely demonstrated to be an effective mechanism against invading microorganisms thus controlling overwhelming infections. However, aberrant and massive NETs formation has been reported in several pulmonary diseases, including chronic obstructive pulmonary disease. Moreover, NETs can directly induce epithelial and endothelial cell death resulting in impairing pulmonary function and accelerating the progression of the disease. Therefore, understanding the regulatory mechanism of NET formation is the need of the hour in order to use NETs for beneficial purpose and controlling their involvement in disease exacerbation. For example, DNA neutralization of NET proteins using protease inhibitors and disintegration with recombinant human DNase would be helpful in controlling excess NETs. Targeting CXC chemokine receptor 2 (CXCR2) would also reduce neutrophilic inflammation, mucus production and neutrophil-proteinase mediated tissue destruction in lung. In this review, we discuss the interplay of NETs in the development and pathophysiology of COPD and how these NETs associated therapies could be leveraged to disrupt NETopathic inflammation as observed in COPD, for better management of the disease.
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Affiliation(s)
- Anjali Trivedi
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (G.B.)
| | - Meraj A. Khan
- Translational Medicine, SickKids Research Institute, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (G.B.)
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (G.B.)
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Abstract
Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder. PD has
been traditionally perceived as a motor disorder. However, it is frequently
associated with pulmonary dysfunction which has been assessed by Spirometry,
an effort-dependent technique. Purpose: To evaluate in patients with PD the effect of disease severity on respiratory
impedance using Impulse Oscillometry (IOS) and to correlate with
Spirometry. Methods: The study was conducted on 30 patients diagnosed with PD. Pulmonary function
was assessed by IOS and spirometer. IOS is an effort-independent technique
that uses sound waves of different frequencies to measure airway resistance.
Spirometer measures the lung volume and generates flow–volume and
volume–time relationship. Results: The mean age of patients was 60.1±9.45. Resistance at 5 Hz (R5) was found to
be negatively correlated with forced expiratory volume in the first second
of the FVC manoeuver (FEV1) (r = –0.628,
P = .002), FEV1/FVC (forced vital capacity)
(r = –0.487, P = .025), and PEF
(r = –0.599, P = .004), and resistance
at 20 Hz (R20) with FEV1 (r = –0.474, P = .029) and PEF (r = –0.522,
P = .015). There was significant increase in R5
(0.32(0.36–0.28) vs 0.47(0.60–0.36); P = .04) and R20
(0.25(0.28–0.20) vs 0.30(0.40–0.25); P = .04) in stage II
as compared to stage I of Hoehn–Yahr scale. Conclusion: IOS might be a promising tool for diagnosis of respiratory dysfunction in
addition to Spirometry, especially in cases where patients are not able to
perform forced manoeuvers.
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Affiliation(s)
- Meghashree Sampath
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Attaway CC, Furth EE, Tondon R, Fortuna D, Talwar A. Key Differences in Final Pathology Compared to Pre-Operative Clinical Diagnoses in the Liver Transplant Population: Implications for Quality Improvement. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.105] [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: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
The pre-transplant clinical evaluation of patients with liver disease are critical components determining prognoses, eligibility and placement on the transplant waiting (eg. hepatocellular carcinoma (HCC) may decrease time on list), and surgical planning for the type of biliary anastomosis performed. For example, patients with Primary Sclerosing Cholangitis (PSC) are given direct liver to small bowel anastomosis, a type prone to ascending cholangitis, compared to duct to duct types in all other etiologies, and a clinical diagnoses of alcohol-induced cirrhosis impacts the patient’s and family’s psycho-social well-being. The goal of our study was to determine the frequency and types of differences in the clinical versus liver explant pathology diagnoses.
Methods
A search for “liver explant” for all in-house cases between 7/15/2019 to 7/15/2018 and 1/1/2010 to 12/31/2010 identified 105 and 108 cases, respectively. For each case, pre-operative clinical diagnoses determined by the electronic medical record was compared to pathologic diagnosis. Cases with non-concordance were divided into two groups: 1. Concordant etiology but incidental malignancy identified in explant 2. Non-concordant etiology.
Results
In the 2018–2019 group, of the 105 liver explants, 6 had concordant etiology but previously unknown HCC and 9 cases had non-concordant diagnoses. Similarly, the 2010 group, of the 108 liver explants, 6 had consistent etiology but previously unknown HCC and 8 cases non-concordant diagnoses. Of the total 17 non-concordant cases, 4 carried a pre-transplant diagnosis of PSC and were reversed to autoimmune hepatitis (2), chronic rejection, and primary biliary cholangitis on explant pathology and 3 carried a diagnosis of alcohol-induced cirrhosis and were reversed to portal tract venopathy, viral hepatitis, and alpha-1 antitrypsin.
Conclusion
There are clinically significant discordances between pre-transplant and explant diagnoses with 6% incidental malignancies and 8% etiology changes. Of particular importance for anastomoses complications and psycho-social issues are patients with a pre-operative diagnoses of PSC or alcohol whose diagnosis was changed by pathology explant assessment, respectfully. Strategies to refine and improve pre-operative liver disease diagnoses particularly with regard to biliary and alcohol diagnoses will be explored.
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Affiliation(s)
- C C Attaway
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - E E Furth
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - R Tondon
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - D Fortuna
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - A Talwar
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
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Gupta S, Mukherjee A, Lodha R, Kabra M, Deepak KK, Khadgawat R, Talwar A, Kabra SK. Effects of Exercise Intervention Program on Bone Mineral Accretion in Children and Adolescents with Cystic Fibrosis: A Randomized Controlled Trial. Indian J Pediatr 2019; 86:987-994. [PMID: 31281938 DOI: 10.1007/s12098-019-03019-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate effect of one year exercise intervention program on bone mineral accrual in children and adolescent with cystic fibrosis (CF). METHODS Fifty-two CF children (mean age 149.79 mo) were randomized into experimental (15 boys and 10 girls) and control groups (15 boys and 12 girls). Experimental group performed prescribed exercises three times/week, while control group continued with routine physical activities for one year. Following were assessed at baseline and at one year: Bone mineral density (BMD) of whole body and lumbar spine, pulmonary function, exercise capacity, quality of life and habitual activity. RESULTS Change in whole body and lumbar spine BMD over 12 mo in experimental group was lower by 0.006 g/cm2 (95% CI -0.02 to 0.02) and higher by 0.001 g/cm2 (95% CI -0.04 to 0.03) than controls, respectively. However, difference between groups was non-significant for both parameters. Experimental group had a significant improvement in their exercise capacity (p = 0.006), quality of life, and serum vitamin D (p = 0.007) levels. Differences between groups for changes in pulmonary function and habitual activity were non-significant. CONCLUSIONS Exercise regime was not associated with significant improvement in BMD of CF patients, but it had a positive impact on both physical and psychological health of these patients.
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Affiliation(s)
- Sumita Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Talwar A, Lee MFH, Bassin L, Harden M, Mathur M, Brereton J, Brady P, Marshman D. Comparison of Direct Versus Side-Arm Graft Cannulation of the Axillary Artery in Patients With Acute Type A Aortic Dissection. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.051] [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: 10/26/2022]
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Hengsbach A, Lakis S, Heitz F, Talwar A, Sehouli J, Bommert M, Bertrand M, Ataseven B, Müller JN, Schneider S, Mariotti E, Prader S, Menon R, Leenders F, Heukamp LC, Braicu I, Glöckner C, du Bois A, Heuckmann JM. Liquid biopsy zur objektiven Beurteilung des post-operativen Tumorrestes bei Patientinnen mit fortgeschrittenem high-grade serösem Ovarialkarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Hengsbach
- Kliniken Essen-Mitte (KEM), Gynäkologische Onkologie, Essen, Deutschland
| | - S Lakis
- NEO New Oncology, Köln, Deutschland
| | - F Heitz
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | - A Talwar
- NEO New Oncology, Köln, Deutschland
| | - J Sehouli
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Bommert
- Kliniken Essen Mitte, Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | | | - B Ataseven
- Kliniken Essen Mitte, Essen, Deutschland
| | | | - S Schneider
- Kliniken Essen Mitte, Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | | | - S Prader
- Kliniken Essen Mitte, Essen, Deutschland
| | - R Menon
- NEO New Oncology, Köln, Deutschland
| | | | | | - I Braicu
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | | | - A du Bois
- Kliniken Essen Mitte, Essen, Deutschland
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Talwar A, Willaime J, Pickup L, Enescu M, Boukerroui D, Hickes W, Rahman N, Gooding M, Kadir T, Gleeson F. Pulmonary nodules: Assessing the imaging biomarkers of malignancy in a “coffee-break”. Eur J Radiol 2018; 101:82-86. [DOI: 10.1016/j.ejrad.2018.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/03/2018] [Accepted: 02/06/2018] [Indexed: 11/16/2022]
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20
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Talwar A, Jenko N, Willaime J, Ather S, Hickes W, Pickup L, Rahman N, Kadir T, Gleeson F. P1.05-008 A Comparison of the Imaging Features of Early Stage Primary Lung Cancer in Patients Treated with Surgery, SABR and Microwave Ablation. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.880] [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: 10/18/2022]
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Hallifax RJ, Talwar A, Wrightson JM, Edey A, Gleeson FV. State-of-the-art: Radiological investigation of pleural disease. Respir Med 2017; 124:88-99. [PMID: 28233652 DOI: 10.1016/j.rmed.2017.02.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 12/17/2022]
Abstract
Pleural disease is common. Radiological investigation of pleural effusion, thickening, masses, and pneumothorax is key in diagnosing and determining management. Conventional chest radiograph (CXR) remains as the initial investigation of choice for patients with suspected pleural disease. When abnormalities are detected, thoracic ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) can each play important roles in further investigation, but appropriate modality selection is critical. US adds significant value in the identification of pleural fluid and pleural nodularity, guiding pleural procedures and, increasingly, as "point of care" assessment for pneumothorax, but is highly operator dependent. CT scan is the modality of choice for further assessment of pleural disease: Characterising pleural thickening, some pleural effusions and demonstration of homogeneity of pleural masses and areas of fatty attenuation or calcification. MRI has specific utility for soft tissue abnormalities and may have a role for younger patients requiring follow-up serial imaging. MRI and PET/CT may provide additional information in malignant pleural disease regarding prognosis and response to therapy. This article summarises existing techniques, highlighting the benefits and applications of these different imaging modalities and provides an up to date review of the evidence.
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Affiliation(s)
- R J Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK.
| | - A Talwar
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK
| | - J M Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK
| | - A Edey
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - F V Gleeson
- Department of Radiology, Churchill Hospital, Old Road, Oxford, UK
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Talwar A, Willaime JMY, Pickup LC, Enescu M, Boukerroui D, Hickes W, Gooding MJ, Rahman NM, Kadir T, Gleeson FV. P21 Pulmonary nodules: assessing the repeatability of imaging biomarkers of malignancy. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.164] [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]
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Psallidas I, Kanellakis N, Thezenas ML, Charles P, Corcoran JP, Hallifax R, Talwar A, Pascuall CC, Kessler B, Rahman NM. S94 Biological markers of favourable prognosis and successful pleurodesis for malignant pleural effusion. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.100] [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]
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Ratnakumar R, Corcoran JP, Talwar A, Hallifax RJ, Psallidas I, Wrightson JM, Gleeson FV, Rahman NM. P50 Changing use of CT pulmonary angiography in a uk tertiary hospital over a 6-year period. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Talwar A, Rahman NM, Kadir T, Pickup LC, Gleeson F. A retrospective validation study of three models to estimate the probability of malignancy in patients with small pulmonary nodules from a tertiary oncology follow-up centre. Clin Radiol 2016; 72:177.e1-177.e8. [PMID: 27908443 DOI: 10.1016/j.crad.2016.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
AIM To estimate the probability of malignancy in small pulmonary nodules (PNs) based on clinical and radiological characteristics in a non-screening population that includes patients with a prior history of malignancy using three validated models. MATERIALS AND METHODS Retrospective data on clinical and radiological characteristics was collected from the medical records of 702 patients (379 men, 323 women; range 19-94 years) with PNs ≤12 mm in diameter at a single centre. The final diagnosis was compared to the probability of malignancy calculated by one of three models (Mayo, VA, and McWilliams). Model accuracy was assessed by receiver operating characteristics (ROC). The models were calibrated by comparing predicted and observed rates of malignancy. RESULTS The area under the ROC curve (AUC) was highest for the McWilliams model (0.82; 95% confidence interval [CI]: 0.78-0.91) and lowest for the Mayo model (0.58; 95% CI: 0.55-0.59). The VA model had an AUC of (0.62; 95% CI: 0.47-0.64). Performance of the models was significantly lower than that in the published literature. CONCLUSIONS The accuracy of the three models is lower in a non-screening population with a high prevalence of prior malignancy compared to the papers that describe their development. To the authors' knowledge, this is the largest study to validate predictive models for PNs in a non-screening clinically referred patient population, and has potential implications for the implementation of predictive models.
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Affiliation(s)
- A Talwar
- Departments of Respiratory Medicine and Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK.
| | - N M Rahman
- Departments of Respiratory Medicine and Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - T Kadir
- Mirada Medical Ltd, New Road, Oxford OX1 1BY, UK
| | - L C Pickup
- Mirada Medical Ltd, New Road, Oxford OX1 1BY, UK
| | - F Gleeson
- Departments of Respiratory Medicine and Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
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Talwar A, Corcoran JP, Hallifax RJ, Wrightson J, Psallidas I, Rahman NM. P4 A prospective assessment of the clinical utility of intercostal artery identification in pleural intervention. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Corcoran JP, Talwar A, Hallifax RJ, Psallidas I, Wrightson JM, Rahman NM. P2 Incorporation of an in-depth thoracic ultrasound assessment into routine pre-procedural evaluation of patients with pleural effusions. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khare P, Talwar A, Chandran D, Guleria R, Jaryal AK, Kumar G, Trivedi A, Deepak KK. Impaired systemic vascular reactivity & raised high-sensitivity C reactive protein levels in chronic obstructive pulmonary disease. Indian J Med Res 2016; 143:205-12. [PMID: 27121518 PMCID: PMC4859129 DOI: 10.4103/0971-5916.180209] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Chronic obstructive pulmonary disease (COPD) is characterized by slowly progressive airflow limitaion, chronic lung inflammation and associated systemic manifestations. The objective of this preliminary study was to investigate the levels of high sensitivity C reactive protein (hs CRP) and tumour necrosis factor-α (TNF-α) as markers of systemic inflammation and assessment of systemic vascular reactivity that may play an important role in development of cardiovascular disease in COPD patients. METHODS Systemic vascular reactivity was assessed non-invasively by measuring peripheral pulse waveform changes during reactive hyperemia (RH) in 16 COPD patients and 14 controls by photoplethysmography technique (PPG). Parameters measured were pulse wave amplitude (PWA), slope and pulse transit time (PTT). Tumour necrosis factor-α (TNF-α) and hs CRP were measured as markers of inflammation. RESULTS PWA during the 1 st , 2 nd and 3 rd minutes post release of occlusion were significantly higher than the baseline means in controls, whereas in the patient group there was no significant change in the PWA during any of the observed time periods following release of occlusion, in comparison to the baseline means. Similar results were observed in slope values for patients and controls. Maximum percentage change in PWA during RH with reference to baseline was significantly lower in patients as compared to controls (26.78±20.19 vs 57.20±19.80%, p<0.001). Maximum percentage change in slope during RH with reference to baseline was significantly lower in patients as compared to controls (19.77±10.73 vs 39.25±13.49%, P<0.001). A vascular tone response as represented by PTT was also impaired in the 3 rd minute of RH as compared to baseline mean values in COPD patients only. INTERPRETATION & CONCLUSIONS Our findings showed raised hs CRP levels and impaired systemic vascular reactivity in COPD patients. Whether these may increase the risk of cardiovascular disease in COPD patients need to be confirmed in future studies with large sample size and appropriate study design.
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Affiliation(s)
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Kumar A, Bade G, Trivedi A, Jyotsna VP, Talwar A. Postural variation of pulmonary diffusing capacity as a marker of lung microangiopathy in Indian patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2016; 20:238-244. [PMID: 27042422 PMCID: PMC4792027 DOI: 10.4103/2230-8210.176343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is characterized by the presence of chronic hyperglycemia and formation of advanced glycation end products (AGEs). Interaction between AGE and its receptor leads to endothelial damage and microangiopathy. This study was undertaken to investigate the possibility of using a postural variation of diffusing capacity as an early marker of lung microangiopathy and its correlation with the level of adhesion molecules, HbA1c, duration of diabetes, and insulin resistance in type 2 DM (T2DM) patients with and without microangiopathy. MATERIALS AND METHODS Forty patients having T2DM without any microangiopathy (n = 20) as well as with microangiopathy (n = 20), and 22 age and sex matched healthy controls were enrolled in this cross-sectional study. Measurement of lung volumes and capacities were done. DLco was measured in sitting and supine position. Levels of vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fasting glucose, and insulin were estimated in plasma of the patients and compared with controls. RESULTS Restrictive type of ventilatory change was observed in DM patients. Diffusing capacity (% predicted) in the supine position (P < 0.0001), postural change in DLco (P < 0.0001), and coefficient of diffusion were significantly less in DM patients as compared to controls. Plasma levels of VCAM-1 were significantly higher in DM patients without microangiopathy and negatively correlated (r = -0.4054, P = 0.0094) with Δ DLco in all diabetic subjects. All patients had significantly higher insulin resistance. CONCLUSION Lack of postural increase in diffusing capacity in type 2 diabetic patients along with increased VCAM-1 levels could reflect the presence of an early microangiopathy of the small pulmonary vessels.
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Affiliation(s)
- Avinash Kumar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetanjali Bade
- Department of Physiology, Dr. Babasaheb Ambedkar Medical College, Rohini, New Delhi, India
| | - Anjali Trivedi
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P. Jyotsna
- epartment of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Anstey RM, Corcoran JP, Culver EL, Talwar A, Hallifax RJ, Psallidas I, Cargill TN, Manganis CD, Barnes E, Rahman NM. P207 Thoracic involvement in IgG4-related disease. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.343] [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]
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31
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Talwar A, Pickup LC, Willaime JMY, Gooding M, Kadir T, Rahman NM, Gleeson F. S75 A Clinical Model to Estimate the Probability of Pulmonary Nodule Malignancy in a Population of Oncology Follow-up Patients. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gastaldi AC, Paredi P, Talwar A, Meah S, Barnes PJ, Usmani OS. Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion: A Randomized Clinical Trial. Medicine (Baltimore) 2015; 94:e1845. [PMID: 26496331 PMCID: PMC4620777 DOI: 10.1097/md.0000000000001845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD).Randomized crossover study: 15 COPD outpatients from Asthma Lab-Royal Brompton Hospital underwent spirometry, impulse oscillometry (IOS) for respiratory resistance (R) and reactance (X), and fraction exhaled nitric oxide (FeNO) measures.Thirty minutes of flutter exercises: a "flutter-sham" procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed.Respiratory system resistance (R): in COPD patients an increase in X5insp (-0.21 to -0.33 kPa/L/s) and Fres (24.95 to 26.16 Hz) occurred immediately after flutter exercises without bronchodilator. Following 20 min of rest, a decrease in the R5, ΔR5, R20, X5, and Ax was observed, with R5, R20, and X5 values lower than baseline, with a moderate effect size; there were no changes in FeNO levels or spirometry.The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions.
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Affiliation(s)
- Ada Clarice Gastaldi
- From the Physiotherapy Course, School of Medicine of Ribeirão Preto, São Paulo University, Brazil (ACG); Airway Disease Section, National Heart and Lung Institute, Imperial College London& Royal Brompton Hospital, United Kingdom (PP, SM, PJB, OSU); and Department of Physiology, All India Institute of Medical Sciences, India (AT)
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Sampath S, Mahapatra SC, Padhi MM, Sharma R, Talwar A. Holy basil (Ocimum sanctum Linn.) leaf extract enhances specific cognitive parameters in healthy adult volunteers: A placebo controlled study. Indian J Physiol Pharmacol 2015; 59:69-77. [PMID: 26571987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Ocimum sanctum (OS), known as Holy basil, has been documented to possess neuroprotective, cognition-enhancing and stress relieving effects in animal models. However there is paucity of clinical studies to document these effects. MATERIALS AND METHODS Effect of OS on parameters related to cognition and stress in humans was evaluated with administration of 300 milligram capsules of ethanolic leaf extracts of Ocimum sanctum (EtOS) or placebo per day, over 30 days. RESULTS Intra-group comparison of Sternberg and Stroop test showed improvement in both the placebo and EtOS groups, however, the improvement stabilized after day 15 in the placebo group. Intergroup comparison revealed a significant improvement of the following cognitive parameters in the EtOS as compared to the placebo: reaction time (RT) and error rate (ER) of Sternberg test, RT of neutral task of Stroop, RT and ER of interference task of Stroop. The intra-group comparison of P300 latency, salivary cortisol, and State-Trait Anxiety Inventory showed improvement over time in the EtOS group alone, though the inter-group difference was significant in the P300 latency alone. There were no changes in heart rate (HR), AHR, or galvanic skin response (GSR) or AGSR. CONCLUSION Ocimum sanctum leaf extract seems to have potential cognition-enhancing properties in humans.
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Corcoran J, Hallifax R, Talwar A, Psallidas I, Sykes A, Rahman N. P111 Procedural Experience, Training Opportunities And Attitudes Towards Intercostal Chest Drain Insertion: Variations Between Consultants, Trainees And Medical Sub-specialties. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.252] [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]
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Corcoran J, Hallifax R, Psallidas I, Talwar A, Sykes A, Rahman N. S40 Improving The Patient Journey: Thoracic Ultrasonography As An Adjunct To Decision Making And Diagnostic Pathways In Pleural Disease. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.46] [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]
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Psallidas I, Corcoran J, Hallifax R, Talwar A, Sykes A, Rahman N. P178 Clinician And Patient Experience In The Delivery Of A Day-case Local Anaesthetic Thoracoscopy Service At A Specialist Pleural Unit. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bade G, Khan MA, Srivastava AK, Khare P, Solaiappan KK, Guleria R, Palaniyar N, Talwar A. Serum cytokine profiling and enrichment analysis reveal the involvement of immunological and inflammatory pathways in stable patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:759-73. [PMID: 25125975 PMCID: PMC4130715 DOI: 10.2147/copd.s61347] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major global health problem. It results from chronic inflammation and causes irreversible airway damage. Levels of different serum cytokines could be surrogate biomarkers for inflammation and lung function in COPD. We aimed to determine the serum levels of different biomarkers in COPD patients, the association between cytokine levels and various prognostic parameters, and the key pathways/networks involved in stable COPD. In this study, serum levels of 48 cytokines were examined by multiplex assays in 30 subjects (control, n=9; COPD, n=21). Relationships between serum biomarkers and forced expiratory volume in 1 second, peak oxygen uptake, body mass index, dyspnea score, and smoking were assessed. Enrichment pathways and network analyses were implemented, using a list of cytokines showing differential expression between healthy controls and patients with COPD by Cytoscape and GeneGo Metacore™ software (Thomson-Reuters Corporation, New York, NY, USA). Concentrations of cutaneous T-cell attracting chemokine, eotaxin, hepatocyte growth factor, interleukin 6 (IL-6), IL-16, and stem cell factor are significantly higher in COPD patients compared with in control patients. Notably, this study identifies stem cell factor as a biomarker for COPD. Multiple regression analysis predicts that cutaneous T-cell-attracting chemokine, eotaxin, IL-6, and stem cell factor are inversely associated with forced expiratory volume in 1 second and peak oxygen uptake change, whereas smoking is related to eotaxin and hepatocyte growth factor changes. Enrichment pathways and network analyses reveal the potential involvement of specific inflammatory and immune process pathways in COPD. Identified network interaction and regulation of different cytokines would pave the way for deeper insight into mechanisms of the disease process.
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Affiliation(s)
- Geetanjali Bade
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Meraj Alam Khan
- Program in Physiology and Experimental Medicine, The Hospital for Sick Children, Department of Laboratory Medicine and Pathobiology, and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Parul Khare
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Nades Palaniyar
- Program in Physiology and Experimental Medicine, The Hospital for Sick Children, Department of Laboratory Medicine and Pathobiology, and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Talwar S, Desai M, Talwar A, Choudhary SK, Sreenivas V, Saxena A, Deepak KK, Airan B. Cardiopulmonary exercise performance after total cavopulmonary connection with or without prior superior cavopulmonary connection. J Card Surg 2014; 29:244-50. [PMID: 24734287 DOI: 10.1111/jocs.12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare cardiopulmonary exercise capacity of patients undergoing primary total cavopulmonary connection (TCPC) with those undergoing TCPC after a prior bidirectional Glenn (BDG). METHODS Out of 42 patients in this study, 24 had undergone primary TCPC while 18 had undergone staged TCPC. The peak oxygen consumption (O(2) peak), O(2) pulse, chronotropic index, and other exercise parameters were studied. RESULTS There were no significant differences in O(2) peak (940 ± 538 vs. 1010 ± 417 mL/min, p=0.42) and O(2) pulse (5.76 ± 3.52 vs. 6.85 ± 2.95) of patients undergoing staged TCPC versus primary TCPC, respectively; however, chronotropic index (0.43 ± 0.23 vs. 0.30 ± 017, p=0.047) was significantly different. Exercise tolerance was the same in fenestrated versus nonfenestrated TCPC groups and age at TCPC less than or more than 7 years. However, O(2) peak and O(2) pulse of patients with extracardiac TCPC was better than patients with lateral tunnel TCPC (p values 0.05, 0.04 and respectively). Some parameters of exercise tolerance of patients with antegrade pulmonary blood flow (APBF) interrupted at the time of BDG were better than those with APBF open. CONCLUSION There were no differences in the exercise parameters of patients undergoing a staged versus a primary TCPC, fenestrated versus nonfenestrated TCPC, and age at surgery less than or more than 7 years. Exercise parameters were better in the extracardiac conduit group versus lateral tunnel TCPC groups. Patients who had a TCPC after prior interruption of APBF had better exercise parameters.
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Singh Y, Sharma R, Talwar A. Immediate and long-term effects of meditation on acute stress reactivity, cognitive functions, and intelligence. Altern Ther Health Med 2012; 18:46-53. [PMID: 23251943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT With the current globalization of the world's economy and demands for enhanced performance, stress is present universally. Life's stressful events and daily stresses cause both deleterious and cumulative effects on the human body. The practice of meditation might offer a way to relieve that stress. OBJECTIVE The research team intended to study the effects of meditation on stress-induced changes in physiological parameters, cognitive functions, intelligence, and emotional quotients. METHODS The research team conducted the study in two phases, with a month between them. Each participant served as his own control, and the first phase served as the control for the second phase. In phase 1, the research team studied the effects of a stressor (10 minutes playing a computer game) on participants' stress levels. In phase 2, the research team examined the effects of meditation on stress levels. SETTING The research team conducted the study in a lab setting at the All India Institute of Medical Sciences (AIIMS), New Delhi, India. PARTICIPANTS The participants were 34 healthy, male volunteers who were students. INTERVENTION To study the effects of long-term meditation on stress levels, intelligence, emotional quotients, and cognitive functions participants meditated daily for 1 month, between phases 1 and 2. To study the immediate effects of meditation on stress levels, participants meditated for 15 minutes after playing a computer game to induce stress. OUTCOME MEASURES The research team measured galvanic skin response (GSR), heart rate (HR), and salivary cortisol and administered tests for the intelligence and emotional quotients (IQ and EQ), acute and perceived stress (AS and PS), and cognitive functions (ie, the Sternberg memory test [short-term memory] and the Stroop test [cognitive flexibility]). Using a pre-post study design, the team performed this testing (1) prior to the start of the study (baseline); (2) in phase 1, after induced stress; (3) in part 1 of phase 2, after 1 month of daily meditation, and (4) in part 2 of phase 2, after induced stress, both before and after 15 minutes of meditation. RESULTS Induced stress from the computer game resulted in a significant increase in physiological markers of stress such as GSR and HR. In the short term, meditation was associated with a physiological relaxation response (significant decrease in GSR) and an improvement in scores on the Stroop test of reaction times. In the long-term, meditation brought significant improvements in IQ and scores for cognitive functions, whereas participants' stress levels (GSR and AS) decreased. EQ, salivary cortisol, and HR showed no significant changes. CONCLUSIONS The practice of meditation reduced psychological stress responses and improved cognitive functions, and the effects were pronounced with practice of meditation for a longer duration (1 month).
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Affiliation(s)
- Yogesh Singh
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Ocimum sanctum leaves have been traditionally used in treatment of diabetes mellitus. Dietary supplementation of fresh tulsi leaves in a dose of 2 gm/kg BW for 30 days led to significant lowering of blood glucose levels in test group. Intake ofOcimum sanctum also led to significant increase in levels of superoxide dismutase, reduced glutathione and total thiols, but marked reduction in peroxiodised lipid levels as compared to untreated control group. The leaves were found to possess both superoxide and hydroxyl free radical scavenging action. The present observations establish the efficacy ofOcimum sanctum leaves in lowering blood glucose levels and antioxidant property appears to be predominantly responsible for hypoglycemic effect.
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Affiliation(s)
- Jyoti Sethi
- Department of Physiology B. D. Sharma, PGIMS, Rohtak
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Kumar SK, Khare P, Jaryal AK, Talwar A. Validity of heart rate based nomogram fors estimation of maximum oxygen uptake in Indian population. Indian J Physiol Pharmacol 2012; 56:279-283. [PMID: 23734444] [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: 06/02/2023]
Abstract
Maximal oxygen uptake (VO2max) during a graded maximal exercise test is the objective method to assess cardiorespiratory fitness. Maximal oxygen uptake testing is limited to only a few laboratories as it requires trained personnel and strenuous effort by the subject. At the population level, submaximal tests have been developed to derive VO2max indirectly based on heart rate based nomograms or it can be calculated using anthropometric measures. These heart rate based predicted standards have been developed for western population and are used routinely to predict VO2max in Indian population. In the present study VO2max was directly measured by maximal exercise test using a bicycle ergometer and was compared with VO2max derived by recovery heart rate in Queen's College step test (QCST) (PVO2max I) and with VO2max derived from Wasserman equation based on anthropometric parameters and age (PVO2max II) in a well defined age group of healthy male adults from New Delhi. The values of directly measured VO2max showed no significant correlation either with the estimated VO2max with QCST or with VO2max predicted by Wasserman equation. Bland and Altman method of approach for limit of agreement between VO2max and PVO2max I or PVO2max II revealed that the limits of agreement between directly measured VO2max and PVO2max I or PVO2max II was large indicating inapplicability of prediction equations of western population in the population under study. Thus it is evident that there is an urgent need to develop nomogram for Indian population, may be even for different ethnic sub-population in the country.
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Affiliation(s)
- S Krishna Kumar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi
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Abstract
The Buschke-Löwenstein tumour is an extremely rare, slow-growing, locally destructive, cauliflower-like mass, also known as giant condyloma acuminatum. We report a case of a 42-year-old man who presented to the department of surgery with a two-year history of a perineal tumour. The mass was painless initially but had become painful more recently. After histopathological confirmation, the tumour was removed surgically, as it was resistant to medical treatment. There has been considerable debate regarding the exact nature, aetiology and treatment of these lesions.
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Affiliation(s)
- A Talwar
- Department of Surgery and Dermatology, G.G.S. Medical College & Hospital, Punjab, India
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Agius M, Talwar A, Murphy S, Zaman R. Issues regarding the delivery of early intervention psychiatric services to the South Asian population in England. Psychiatr Danub 2010; 22:266-269. [PMID: 20562759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Little research has been done to ascertain how patients and families of South Asian origin access and use early intervention mental health services today. The aim of this retrospective study is to gain a better understanding of how well South Asian patients engage with standard psycho-social interventions. SUBJECTS AND METHODS In June 2003 an audit was conducted amongst 75 patients from different ethnic groups in Luton. Measures of engagement with mental health services included; number of missed outpatient appointments over one year and compliance with medication regimes. RESULTS The results of this audit showed that South Asian patients are more likely to miss appointments and refuse to take medication in comparison to their Caucasian or Afro- Caribbean counter-parts. Further analysis revealed that the Bangladeshi subgroup had missed more appointments and had a greater proportion of medication refusal in comparison to the other Asian subgroups. CONCLUSIONS These results support the pioneering work by Dr Robin Pinto in the 1970s he observed that Asian patients perceive and utilise mental health services in a different way compared to the Caucasian population. The observations from our study depict the difficulties in engaging ethnic minority patients into existing services. Hence we argue that future interventions should be adapted and tailored to overcome cultural and language barriers with patients and their families.
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Affiliation(s)
- Mark Agius
- South Essex Partnership University Foundation Trust, Bedfordshire Centre for Mental Health Research in association with the University of Cambridge, UK.
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Nair R, Dutta PK, Talwar A. An overview of National AIDS Control Program (NACP) with special reference to targeted intervention: issues & challenges. J Commun Dis 2010; 42:81-90. [PMID: 22471167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Human Immune Deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) has posed different set of challenges towards the country's growth and has also changed the strategic approach of Public Health for containing the further growth of the disease. HIV/AIDS is considered as more of a social problem than a medical problem alone. National AIDS Control Program (NACP) though its three phases have tried to design & implement evidence based strategies including Targeted Interventions (TI) based on the lessons learnt in the past. It has been a long journey for more than a decade which has brought innovations & effectiveness into the program and is showing some preliminary results in positive direction in limiting the HIV infection among HRGs. In the present communication few of the salient features of the entire approach and possible impacts in the future have been discussed.
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Abstract
Acquired lymphoedema of the vulva is induced by impaired lymph flow. We present the case of a 35-year-old woman having lymphoedema of the vulva following pulmonary tuberculosis, which she had developed four years back for which she had taken a full course of antitubercular treatment for nine months from the Chest and Tuberculosis department. The biopsy taken from the perianal swellings showed hyperkeratosis and acanthosis with multiple dilated lymph specs.
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Affiliation(s)
- A Talwar
- Department of Surgery & Dermatology, GGS Medical College & Hospital, Faridkot 151203, Punjab, India.
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Talwar A, Agius M, Zaman R. Issues regarding the delivery of early intervention for psychosis services to the South Asian population in England. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Talwar A, Dare C, Pain J. Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial. Surg Endosc 2005; 19:902-4. [PMID: 15868252 DOI: 10.1007/s00464-004-9166-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 11/03/2004] [Indexed: 01/22/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangio pancreatography (ERCP) is a technically challenging procedure. Glyceryl trinitrate (GTN) has been shown to reduce tone in the sphincter of Oddi (SO), cannulation of which is a rate-limiting factor. A double-blind randomized control trial was performed to assess whether topical GTN on the SO would facilitate cholangiography and/or bile duct cannulation. METHODS 104 patients requiring ERCP for biliary symptoms were randomized into two groups, 52 controls pretreated with 5 ml 0.9% normal saline (NS) and 52 pretreated with 5 ml GTN (concentration 1 mg/ml). RESULTS There was no significant between the control group and the GTN group in primary cannulation rate (p = 0.76), time taken to cholangiography (p = 0.58), or time to cannulation (p = 0.43). CONCLUSION Topically administered GTN to the SO does not aid in obtaining a cholangiogram or cannulation during an ERCP.
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Affiliation(s)
- A Talwar
- Department of General Surgery, Poole General Hospital, Longfleet Road, Dorset, BH15 2JB, United Kingdom.
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Sethi J, Sood S, Seth S, Talwar A. Protective effect of Tulsi (Ocimum Sanctum) on lipid peroxidation in stress induced by anemic hypoxia in rabbits. Indian J Physiol Pharmacol 2003; 47:115-9. [PMID: 12708134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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