1
|
Sriganesh K, Kramer BW, Wadhwa A, Akash VS, Bharadwaj S, Rao GSU, Steinbusch HWM, Konar SK, Gopalakrishna KN, Sathyaprabha TN. Incidence, predictors, and impact of acute post-operative pain after cranial neurosurgery: A prospective cohort study. J Neurosci Rural Pract 2023; 14:637-643. [PMID: 38059224 PMCID: PMC10696338 DOI: 10.25259/jnrp_141_2023] [Citation(s) in RCA: 1] [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] [Received: 03/13/2023] [Accepted: 06/25/2023] [Indexed: 12/06/2023] Open
Abstract
Objectives Pain is common after craniotomy. Its incidence and predictors in developing nations are not adequately studied. We aimed to assess the incidence, predictors, and impact of acute post-operative pain after intracranial neurosurgeries. Materials and Methods This prospective observational study was conducted in adult patients undergoing intracranial neurosurgeries. After patient consent, ethics committee approval, and study registration, we assessed the incidence of post-operative pain using numerical rating scale (NRS) score. Predictors and impact of pain on patient outcomes were also evaluated. Results A total of 497 patients were recruited during 10-month study period. Significant (4-10 NRS score) post-operative pain at any time-point during the first 3 days after intracranial neurosurgery was reported by 65.5% (307/469) of patients. Incidence of significant pain during the 1st post-operative h, on the 1st, 2nd, and 3rd post-operative days was 20% (78/391), 50% (209/418), 38% (152/401), and 24% (86/360), respectively. Higher pre-operative NRS score and pain during the 1st h post-operatively, predicted the occurrence of pain during the first 3 days after surgery, P = 0.003 and P < 0.001, respectively. Pain was significantly associated with poor sleep quality on the first 2 post-operative nights (P < 0.001). Patient satisfaction score was higher in patients with post-operative pain, P = 0.002. Conclusion Every two in three patients undergoing elective intracranial neurosurgery report significant pain at some point during the first 3 postoperative days. Pre-operative pain and pain during 1st post-operative h predict the occurrence of significant post-operative pain.
Collapse
Affiliation(s)
- Kamath Sriganesh
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Boris W Kramer
- School of Women's and Infants' Health, University of Western Australia, Australia
| | - Archisha Wadhwa
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - V S Akash
- Department of Clinical Psychology, All India Institute of Speech and Hearing, Mysuru, Karnataka, India
| | - Suparna Bharadwaj
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - G S Umamaheswara Rao
- Department of Neuroanaesthesia and Neurocritical Care (Retired), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harry W M Steinbusch
- Department of Cellular and Translational Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - T N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
2
|
Chakrabarti D, Bharadwaj S, Akash VS, Wadhwa A, Konar S, Kamath S, Gopalakrishna KN. Postoperative delirium after intracranial neurosurgery: A prospective cohort study from a developing nation. Acta Neurochir (Wien) 2023; 165:1473-1482. [PMID: 37126098 DOI: 10.1007/s00701-023-05610-w] [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: 02/02/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Post-operative delirium (POD) is a major complication after anesthesia and surgery with an incidence varying from 5 to 50%. The incidence of POD after intracranial surgery is likely to be higher due to the pre-existing brain pathology and direct handling of the brain during neurosurgery. The primary objective of this study was to assess the incidence of POD after intracranial neurosurgery and our secondary objective was to identify the potential risk factors for its occurrence. MATERIALS AND METHODS This prospective observational study was conducted after the institutional ethics committee approval between october 2020 and march 2021. We included patients of either gender aged ≥ 18 years and undergoing elective intracranial neurosurgery. Exclusion criteria included patients aged below 18 years, undergoing emergency neurosurgery, patients with impaired consciousness and patients with psychiatric comorbidities or those taking psychotropic medications. We planned to exclude patients from analysis who were transferred to intensive care unit (ICU) or if they were not extubated after surgery. Our study outcome was development of POD as assessed by confusion assessment method (CAM). RESULTS The overall incidence of POD during the three postoperative days was 19.2% (n=60/313). The incidence of POD on days 1, 2, and 3 were 19.2% (n=60/313), 17.2% (n=50/291), and 16.3% (n=39/239). Preoperative delirium and hyperactive Emergence Delirium were found to be the significant predictors of POD. CONCLUSION Every one in five patients undergoing intracranial neurosurgery is vulnerable for the development of POD within first three days after surgery. The incidence of occurrence of POD is time-sensitive and is decremental.
Collapse
Affiliation(s)
- Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India
| | - Suparna Bharadwaj
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India
| | - V S Akash
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India
| | - Archisha Wadhwa
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India
| | - Sriganesh Kamath
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India
| | - Kadarapura Nanjundaiah Gopalakrishna
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560 029, India.
| |
Collapse
|
3
|
Wadhwa A, Akash VS, Bharadwaj S, Kadarapura NG, Konar SK, Naik S, Sriganesh K, Venkataramaiah S. Association between patient characteristics and dissatisfaction after cranial neurosurgery: A prospective observational study. J Neurosci Rural Pract 2023; 14:280-285. [PMID: 37181196 PMCID: PMC10174114 DOI: 10.25259/jnrp_31_2023] [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: 01/15/2023] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives Patient satisfaction is an indicator of the quality of healthcare. It can improve treatment adherence and health outcomes. This study aimed to determine the incidence, predictive factors, and impact of post-operative patient dissatisfaction with perioperative care after cranial neurosurgery. Materials and Methods This was a prospective observational study conducted in a tertiary care academic university hospital. Adult patients undergoing cranial neurosurgery were assessed for satisfaction 24 h after surgery using a five-point scale. The data regarding patient characteristics that may predict dissatisfaction after surgery were collected along with ambulation time and hospital stay. Shapiro-Wilk test was used to assess normality of data. Univariate analysis was performed using Mann-Whitney U-test and significant factors were entered into binary logistic regression model for identifying predictors. The level of significance was set at P < 0.05. Results Four hundred and ninety-six adult patients undergoing cranial neurosurgery were recruited into the study from September 2021 to June 2022. Data of 390 were analyzed. The incidence of patient dissatisfaction was 20.5%. On univariate analysis, literacy, economic status, pre-operative pain, and anxiety were associated with post-operative patient dissatisfaction. On logistic regression analysis, illiteracy, higher economic status, and no pre-operative anxiety were predictors of dissatisfaction. The patient dissatisfaction did not impact ambulation time or duration of hospital stay after the surgery. Conclusion One in five patients reported dissatisfaction after cranial neurosurgery. Illiteracy, higher economic status, and no pre-operative anxiety were predictors of patient dissatisfaction. Dissatisfaction was not associated with delayed ambulation or hospital discharge.
Collapse
Affiliation(s)
- Archisha Wadhwa
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - V. S. Akash
- Department of Clinical Psychology, All India Institute of Speech and Hearing, Mysuru, Karnataka, India
| | - Suparna Bharadwaj
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - N. Gopalakrishna Kadarapura
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subhas K. Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shweta Naik
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kamath Sriganesh
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sudhir Venkataramaiah
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
4
|
Noid G, Currey A, Tai A, Kelly T, Jorns J, Bovi J, Kong A, Wadhwa A, Bergom C, Li A. Treatment Response Assessment Using Daily Dual-Energy CT during Pre-Operative Radiation Therapy for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.718] [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]
|
5
|
Wadhwa A, Sareen A, Saade Y. TMS use in Depressive disorder in Youth. Eur Psychiatry 2022. [PMCID: PMC9567586 DOI: 10.1192/j.eurpsy.2022.1908] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Objectives Methods Results Conclusions Disclosure
Collapse
Affiliation(s)
- A. Wadhwa
- University of Alabama at Birmingham, Child And Adolescent Psychiatry, Birmingham, United States of America,Corresponding author
| | - A. Sareen
- Bronx Care Health System-Affiliated with the Icahn School of Medicine at Mount Sinai, Psychiatry,
New York, United States of America
| | - Y. Saade
- Children’s National Hospital, Child And Adolescent Psychiatry,
Washington DC, United States of America
| |
Collapse
|
6
|
Jay J, Sareen A, Hassan N, Dumlao N, Jose K, Haza I, Wadhwa A, Gunturu S. Tolerability of Ziprasidone Use in Children and Adolescents: A Prisma Model: Systematic Review and Meta-Analysis. Eur Psychiatry 2022. [PMCID: PMC9566988 DOI: 10.1192/j.eurpsy.2022.383] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Studies have demonstrated that Ziprasidone use may be beneficial in children. Determining its potential risks and benefits when used in children is therefore important. Objectives To examine the tolerability of Ziprasidone, an atypical antipsychotic, in children and adolescents. Methods We conducted a literature search of open label or randomized control trials that report on Ziprasidone use in children on three databases: Embase, PsychInfo and PubMed using the PRISMA guidelines of Systematic review and Meta-analysis. Out of 1690 articles, 11 studies met inclusion criteria. Outcome measures included adverse effects such as weight gain, increase in BMI, QTc prolongation, changes in metabolic parameters, sedation, and dizziness. We conducted a random effects meta-analysis and meta-regression of potential moderators. Publication bias was assessed with funnel plots. Results Data from Eleven studies was meta-analyzed (Total n= 474, mean age=12.87 years, male= 68..37%) that reported the use of Ziprasidone in children and adolescents with Psychosis, Bipolar, Autism spectrum disorders and Tourettes syndrome. Mean Ziprasidone dose = 84.40 mg and mean study duration = 2.85 months). We found that Ziprasidone was not found to cause any significant weight gain (1.72, p>0.05) or change in BMI (0.58 , p>0.05). QTc prolongation was found to be significant (11.9 , p<0.05). Most common side effects were sedation (42.44%), Nausea(19.32%), Headache (22.92%), fatigue (16.67%) and Dizziness (16.96 %). Conclusions Results demonstrate that Ziprasidone does not cause significant weight gain, however QTc prolongation and sedation were found to be significant side effects of Ziprasidone use. Therefore, baseline EKG and thorough history must be obtained before prescribing Ziprasidone in children and adolescents. Disclosure No significant relationships.
Collapse
|
7
|
Wadhwa A, Sareen A, Soeung C, Penuelas-Calvo I. Efficacy and Tolerability of Ziprasidone Use in Children and Adolescents, a Systemic Review and Meta Analysis. Eur Psychiatry 2022. [PMCID: PMC9565114 DOI: 10.1192/j.eurpsy.2022.1076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Ziprasidone is an atypical antipsychotic that has demonstrated efficacy for the treatment of bipolar disorder and schizophrenia. There is some preliminary evidence for Ziprasidone use in children and adolescents with several open label studies and some randomized control trials, therefore it is advantageous to understand where Ziprasidone lies in the treatment algorithm of children and adolescents. Objectives The aim of our study is to examine the efficacy and tolerability of Ziprasidone in children and adolescents. Methods We conducted a literature search consisting of open label or randomized control trials (RCT) that report on Ziprasidone use in children on the PubMed database. We found 13 studies (11 open label and 2 RCT) that met our inclusion criteria. Our outcome measures included efficacy measures such as BPRS, YMRS, CGI-S and adverse effects such as weight gain, increase in BMI, QTc prolongation, sedation, dizziness and EPS. Results Data from thirteen studies was meta-analyzed (Total n= 560, mean age=13.16 years, male= 70.35% that reported the use of Ziprasidone in children and adolescents. We found that Ziprasidone was efficacious in children and adolescents in measures of BPRS (-13.493, p<0.05), YMRS (-14.225, p<0.05), CGI-S (-1.430, p<0.05). In measures of adverse effects, Ziprasidone was not found to cause any significant weight gain (0.164, p>0.05) or change in BMI (-0.159, p>0.05). QTc prolongation was found to be significant (13.122, p<0.05). Conclusions Ziprasidone is an efficacious in children and adolescent population. It does not cause significant weight gain, however QTc prolongation and sedation were found to be the most significant side effects . Disclosure No significant relationships.
Collapse
|
8
|
Desai N, Jorns J, Kelly T, Johnstone C, Bovi J, Shukla M, Wadhwa A, Kong A, Paulson E, Currey A, Bergom C. Correlation between Tumor-Infiltrating Lymphocytes and 21-Gene Recurrence Score in Patients Undergoing Pre-Operative Accelerated Partial-Breast Irradiation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.663] [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]
|
9
|
Desai N, Liang Y, Paulson E, Fitzgerald J, Jorns J, Bovi J, Kelly T, Wadhwa A, Li A, Kong A, Johnstone C, Shukla M, Bergom C, Currey A. Relationship of Radiomic Features and Tumor Response in Patients Undergoing Pre-Operative Accelerated Partial Breast Irradiation for Breast Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.255] [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]
|
10
|
Komatsu R, Sengupta P, Wadhwa A, Akça O, Sessler DI, Ezri T, Lenhardt R. Ultrasound Quantification of Anterior Soft Tissue Thickness Fails to Predict Difficult Laryngoscopy in Obese Patients. Anaesth Intensive Care 2019; 35:32-7. [PMID: 17323663 DOI: 10.1177/0310057x0703500104] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Morbid obesity is associated with difficult laryngoscopy and intubation. In the general population, bedside indices for predicting difficult intubation (i.e. Mallampati classification, thyromental distance, sternomental distance, mouth-opening and Wilson risk score) have poor-to-moderate sensitivity (20-62%) and moderate-to-fair specificity (82-97%). In the obese population, although the risk of difficult intubation after a positive Mallampati test is 34%, it is still not sufficient to be used as a single predictive test. An abundance of pretracheal soft tissue anterior to the vocal cords, as quantified by ultrasound, was a better predictor of difficult laryngoscopy than body mass index (BMI) in Israeli patients. Obesity is a growing problem in the United States: therefore we sought to confirm this finding in the obese population in the United States. We used ultrasound to quantify the neck soft tissue, from the skin to the anterior aspect of the trachea at the vocal cords, in 64 obese patients (BMI >35). We assessed thyromental distance, mouth-opening, jaw movement, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference, confirmed obstructive sleep apnoea, BMI, age, race and gender as predictors. Twenty patients were classified as difficult laryngoscopy; they were older (47±9 vs 42±1 years; P=0.048; mean±SD) and had less soft pretracheal tissue (20.4±3.0 vs 22.3±3.8 mm; P=0.049) than did easy laryngoscopy patients. Multivariate regression indicated that none of the factors was an independent predictor of difficult laryngoscopy. We conclude that the thickness of pretracheal soft tissue at the level of the vocal cords is not a good predictor of difficult laryngoscopy in obese patients in the United States.
Collapse
Affiliation(s)
- R Komatsu
- Outcomes Research Institute and Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
The efficacy of a dietary intervention programme to control vitamin A deficiency through inexpensive, locally available sources of β-carotene was evaluated in 121 children 7–12 years old. The subjects were randomly divided into experimental and control groups. A three-day food intake was first recorded for each subject using a 24-hour recall method and repeated at the end of the study on a randomly selected subsample. The intervention period lasted one month, during which carrots, papayas, coriander, and mint were offered daily as sources of β-carotene. There was no significant difference in the dietary intakes of the groups before the study. After the intervention period, the serum vitamin A values of the experimental subjects were significantly higher than those of the controls. These results indicate that consumption of small amounts of inexpensive, readily available vegetable sources of β-carotene could help prevent and control vitamin A deficiency. Nutrition education programmes are needed to encourage the use of these foods for home consumption as well as in feeding programmes for schoolchildren.
Collapse
|
12
|
Galling B, Vernon JA, Pagsberg AK, Wadhwa A, Grudnikoff E, Seidman AJ, Tsoy-Podosenin M, Poyurovsky M, Kane JM, Correll CU. Efficacy and safety of antidepressant augmentation of continued antipsychotic treatment in patients with schizophrenia. Acta Psychiatr Scand 2018; 137:187-205. [PMID: 29431197 DOI: 10.1111/acps.12854] [Citation(s) in RCA: 46] [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] [Accepted: 01/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of antidepressant augmentation of antipsychotics in schizophrenia. METHODS Systematic literature search (PubMed/MEDLINE/PsycINFO/Cochrane Library) from database inception until 10/10/2017 for randomized, double-blind, efficacy-focused trials comparing adjunctive antidepressants vs. placebo in schizophrenia. RESULTS In a random-effects meta-analysis (studies = 42, n = 1934, duration = 10.1 ± 8.1 weeks), antidepressant augmentation outperformed placebo regarding total symptom reduction [standardized mean difference (SMD) = -0.37, 95% confidence interval (CI) = -0.57 to -0.17, P < 0.001], driven by negative (SMD = -0.25, 95% CI = -0.44-0.06, P = 0.010), but not positive (P = 0.190) or general (P = 0.089) symptom reduction. Superiority regarding negative symptoms was confirmed in studies augmenting first-generation antipsychotics (FGAs) (SMD = -0.42, 95% CI = -0.77, -0.07, P = 0.019), but not second-generation antipsychotics (P = 0.144). Uniquely, superiority in total symptom reduction by NaSSAs (SMD = -0.71, 95% CI = -1.21, -0.20, P = 0.006) was not driven by negative (P = 0.438), but by positive symptom reduction (SMD = -0.43, 95% CI = -0.77, -0.09, P = 0.012). Antidepressants did not improve depressive symptoms more than placebo (P = 0.185). Except for more dry mouth [risk ratio (RR) = 1.57, 95% CI = 1.04-2.36, P = 0.03], antidepressant augmentation was not associated with more adverse events or all-cause/specific-cause discontinuation. CONCLUSIONS For schizophrenia patients on stable antipsychotic treatment, adjunctive antidepressants are effective for total and particularly negative symptom reduction. However, effects are small-to-medium, differ across antidepressants, and negative symptom improvement seems restricted to the augmentation of FGAs.
Collapse
Affiliation(s)
- B Galling
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA
| | - J A Vernon
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | - A K Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Wadhwa
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | | | - A J Seidman
- Department of Psychology, Iowa State University, Ames, IA, USA
| | - M Tsoy-Podosenin
- Department of Psychiatry, St John's Episcopal Hospital, New York, NY, USA
| | - M Poyurovsky
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Tirat Carmel Mental Health Center, tirat Carmel, Israel
| | - J M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - C U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| |
Collapse
|
13
|
Wadhwa A, AlNahhas MF, Dierkhising R, Patel R, Kashyap P, Pardi D, Khanna S, Grover M. High risk of post-infectious irritable bowel syndrome in patients with Clostridium difficile infection. Aliment Pharmacol Ther 2016; 44:576-82. [PMID: 27444134 PMCID: PMC4982831 DOI: 10.1111/apt.13737] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [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: 03/31/2016] [Revised: 04/24/2016] [Accepted: 06/29/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Infectious enteritis is a commonly identified risk factor for irritable bowel syndrome (IBS). The incidence of Clostridium difficile infection (CDI) is on the rise. However, there is limited information on post-infectious IBS (PI-IBS) development following CDI and the host- and infection-related risk factors are not known. AIM To determine the incidence and risk factors for PI-IBS following CDI. METHODS A total of 684 cases of CDI identified from September 2012 to November 2013 were surveyed. Participants completed the Rome III IBS questionnaire and details on the CDI episode. Predictive modelling was done using logistic regression to evaluate risk factors for PI-IBS development. RESULTS A total of 315 CDI cases responded (46% response rate) and 205 were at-risk (no pre-CDI IBS) for PI-IBS development. A total of 52/205 (25%) met the Rome III criteria for IBS ≥6 months following CDI. IBS-mixed was most common followed by IBS-diarrhoea. In comparison to those without subsequent PI-IBS, greater percentage of PI-IBS patients had CDI symptoms >7 days, nausea, vomiting, abdominal pain during CDI, anxiety and a higher BMI. Using logistic regression, CDI symptoms >7 days [Odds ratio (OR): 2.96, P = 0.01], current anxiety (OR: 1.33, P < 0.0001) and a higher BMI (OR: 1.08, P = 0.004) were independently associated with PI-IBS development; blood in the stool during CDI was protective (OR: 0.44, P = 0.06). CONCLUSIONS In this cohort study, new-onset IBS is common after CDI. Longer CDI duration, current anxiety and higher BMI are associated with the diagnosis of C. difficile PI-IBS. This chronic sequela should be considered during active management and follow-up of patients with CDI.
Collapse
Affiliation(s)
- A. Wadhwa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - MF. AlNahhas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - R. Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - R. Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | - P. Kashyap
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - D. Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - S. Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - M. Grover
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
14
|
Wadhwa A, Avasthi R, Ghambhir JK, Dwivedi S. To study the prevalence and profile of metabolic syndrome, levels of hs-CRP, Lp(a) and serum ferritin in young Indian patients (< or = 45 years) with acute myocardial infarction. J Assoc Physicians India 2013; 61:384-386. [PMID: 24640203] [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: 06/03/2023]
Abstract
OBJECTIVE To study the prevalence and profile of metabolic syndrome, levels of hs-CRP, Lp(a) and serum ferritin in young Indian patients (< or = 45 years) with acute MI. METHODS A total of 80 subjects in two groups (40 cases and 40 controls) of age < or = 45 years were studied. Diagnosis of MI was made using the American College of Cardiology and European Society of Cardiology guidelines for acute MI. Patients were assessed for presence of MetS, diagnosed as per modified ATP III criteria. The anthropometric measurements (including height, weight, waist circumference) and sample collection for lipid profile, fasting blood sugar, hs-CRP, Lp(a) and serum ferritin were done after seventy two hours of admission. RESULTS The mean age for cases was 39.23 +/- 4.80 years and for controls it was 38.9 +/- 4.23 years. 19 (47.5%) patients out of 40 in group 1 fulfilled > or = 3/5 criteria for MetS while only 8 (20%) subjects in control group had MetS. Among five components of metabolic syndrome, increased waist circumference was most predominant factor followed by decreased HDL, increased TG, increased blood pressure and impaired fasting glucose. The mean value of serum ferritin was 279.33 +/- 46.69 mg in case group as compared to 245.15 +/- 56.94 in control group. hs-CRP (16.048 +/- 10.27 mg/l vs 1.8 +/- 1.6 mg/l) and Lp(a) (38.74 +/- 26.15 mg/dl vs 20.54 +/- 16.27 mg/dl) levels were significantly raised in cases as compared to control subjects. CONCLUSION The present study revealed high prevalence of metabolic syndrome (47.5%) in young patients with acute MI. Serum hsCRP, a diagnostic and prognostic novel marker of inflammation was also significantly elevated in cases. Its relationship with metabolic syndrome is also well established. Lp(a) and serum ferritin were also raised in cases.
Collapse
|
15
|
Wadhwa A, Stuckey L, Kaul D, Bartos C, McCullough H, Florn R, Lama V, Lin J, Chan K. Prevention of Resistant CMV Infection Using Persistent Valganciclovir Therapy through Leukopenia and Extending the Duration. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.286] [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: 10/27/2022] Open
|
16
|
Walker N, Badri L, Wadhwa A, Lama V. 225 Local Mesenchymal Origin of Myofibroblasts in the Fibrotic Lesions in Human Lung Allografts. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.232] [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: 11/24/2022] Open
|
17
|
Wadhwa A, Walker N, Badri L, Chan K, Lama V. 562 Fibrotic Differentiation of Resident Mesenchymal Stromal Cells in Bronchiolitis Obliterans Syndrome. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.574] [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] Open
|
18
|
Kaur R, Wadhwa A, Gulati A, Agrawal AK. An unusual phaeoid fungi: Ulocladium, as a cause of chronic allergic fungal sinusitis. Iran J Microbiol 2010; 2:95-7. [PMID: 22347556 PMCID: PMC3279772] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Allergic fungal sinusitis (AFS) has been recognized as an important cause of chronic sinusitis commonly caused by Aspergillus spp. and various dematiaceous fungi like Bipolaris, Alternaria, Curvalaria, and etc. Ulocladium botrytis is a non pathogenic environmental dematiaceous fungi, which has been recently described as a human pathogen. Ulocladium has never been associated with allergic fungal sinusitis but it was identified as an etiological agent of AFS in a 35 year old immunocompetent female patient presenting with chronic nasal obstruction of several months duration to our hospital. The patient underwent FESS and the excised polyps revealed Ulocladium as the causative fungal agent.
Collapse
Affiliation(s)
| | - A Wadhwa
- Department of Microbiology,Corresponding author: Dr. Anupriya Wadhwa. Address: 76, Ground Floor, RPS Flats, Sheikh Sarai Phase-1, Malviya Nagar, New Delhi-110017. Tel: +91-9312350269, +91-1126017626. E-mail:
| | - A Gulati
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| | - AK Agrawal
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
19
|
Griffin L, Painter PE, Wadhwa A, Spirduso WW. Motor unit firing variability and synchronization during short-term light-load training in older adults. Exp Brain Res 2009; 197:337-45. [PMID: 19578838 DOI: 10.1007/s00221-009-1920-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 06/19/2009] [Indexed: 11/28/2022]
Abstract
We compared motor unit synchronization and firing rate variability within and across synergistic hand muscles during a pinching task following short-term light-load training to improve force steadiness in older adults. A total of 183 motor unit pairs before training and 158 motor unit pairs after training were recorded with intramuscular fine-wire electrodes within and across the first dorsal interosseous (FDI) and adductor pollicis (AdP) muscles during a pinch task performed by ten older adults before and after a 4-week short-term light-load training program. Nine younger adults performed the same experimental sessions 4 weeks apart with no training intervention. Two-minute sustained contractions of 2, 4, 8, and 12% maximal voluntary contraction (MVC) were performed with the non-dominant hand. The coefficient of variation (CV) of force was greater in older than in younger adults and was lower at the 2 and 4% MVC levels in both the finger (0.12 +/- 0.01 vs. 0.08 +/- 0.01, and 0.08 +/- 0.01 vs. 0.05 +/- 0.01, respectively) and thumb (0.11 +/- 0.01 vs. 0.08 +/- 0.01, and 0.09 +/- 0.01 vs. 0.05 +/- 0.01, respectively) compared to higher force levels following training in the older adults. There were no changes in CIS or k'-1 values following training. Motor unit firing rate variability significantly decreased at low force levels in the FDI muscle and also tended to decrease with training in the AdP muscle (p = 0.06). No changes occurred in the younger control group. These findings are the first to show that motor unit synchronization does not change during light-load training. Thus, it is likely that force steadiness in older adults improves by reducing motor unit firing variability rather than by changing motor unit synchronization.
Collapse
Affiliation(s)
- L Griffin
- Department of Kinesiology and Health Education, University of Texas at Austin, Bellmont 222, 1 University Station, D3700, Austin, TX 78712, USA.
| | | | | | | |
Collapse
|
20
|
Mahant S, Jovcevska V, Wadhwa A. Clinical Excellence in the Academic Health Science Centre: What Makes an Excellent Clinician? Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.41aa] [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: 11/14/2022] Open
|
21
|
Sahni V, Agarwal SK, Singh NP, Sikdar S, Yadav A, Wadhwa A, Aggarwal G. Successful pregnancy in untreated limited Wegener's granulomatosis. Med J Malaysia 2005; 60:492-4. [PMID: 16570714] [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: 05/08/2023]
Abstract
A thirty four year old female presented with upper and lower respiratory symptoms in the third trimester of pregnancy. After the delivery of a healthy baby, the symptoms progressed to involve multiple organ systems and eventually a diagnosis of limited Wegener's Granulomatosis (Carrington-Liebow syndrome) was made. The extremely rare combination of WG and pregnancy, especially the onset of disease in late pregnancy is discussed. The successful outcome of pregnancy even without treatment of WG is the highlight of the case.
Collapse
Affiliation(s)
- V Sahni
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi-110002, India
| | | | | | | | | | | | | |
Collapse
|
22
|
Sahni V, Agarwal SK, Singh NP, Anuradha S, Sikdar S, Wadhwa A, Kaur R. Candidemia--an under-recognized nosocomial infection in Indian hospitals. J Assoc Physicians India 2005; 53:607-11. [PMID: 16190129] [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: 05/04/2023]
Abstract
OBJECTIVE To study the occurrence of candidemia as a nosocomial infection in a large Indian teaching hospital and to evaluate the predisposing factors for development of such infections. METHODS One hundred and one hospitalized patients that developed signs and symptoms of nosocomial bloodstream infections were screened for candidemia and were analyzed for the various predisposing factors like the age of the patient, the duration of hospitalization before the development of fever, neutropenia, use of chemotherapeutic agents, central venous catheters, broad spectrum antibiotics, infection with HIV, diabetes mellitus, use of corticosteroids, administration of total parenteral nutrition, haemodialysis, use of mechanical ventilation, hematological or other malignancies, underlying disease, and any surgical procedure performed on the patient. Candidemic patients were followed up for outcome and the effect of nosocomial candidemia on mortality was assessed and analyzed statistically. RESULTS Out of the 101 patients, seven patients had candidemia, an incidence in study population of 6.9%. Three (42.8%) were infected with albicans and the rest with non-albicans candidemia. All the patients with candidemia were admitted in the Intensive Care Units. Amongst the risk factors, the length of hospitalization (p = 0.018), broad-spectrum antibiotics (p = 0.045), central venous catheters (p = 0.005), mechanical ventilation (p = 0.0139) and total parenteral nutrition (p = 0.001) were found to be significantly related to acquisition of nosocomial candidemia. Mortality in the candidemic patients was influenced only by the age of the patients (p = 0.001). Although the mortality amongst the candidemic patients was twice as much as that of the patients not having this infection, still the difference did not reach significance (p = 0.117). CONCLUSION Candidemia is an important problem in Indian hospitals. Diagnostic delays could be shortened by more active screening for candidemia especially in the intensive care settings. The rising incidence of non-albicans candidemia in the United States probably is true here as well. There should be a concerted effort to control known risk factors especially in intensive care units.
Collapse
Affiliation(s)
- V Sahni
- Department of Medicine, Maulana Azad Medical College, New Delhi-110002
| | | | | | | | | | | | | |
Collapse
|
23
|
Doufas AG, Wadhwa A, Shah YM, Lin CM, Haugh GS, Sessler DI. Block-dependent sedation during epidural anaesthesia is associated with delayed brainstem conduction. Br J Anaesth 2004; 93:228-34. [PMID: 15220178 PMCID: PMC1361808 DOI: 10.1093/bja/aeh192] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neuraxial anaesthesia produces a sedative and anaesthetic-sparing effect. Recent evidence suggests that spinal cord anaesthesia modifies reticulo-thalamo-cortical arousal by decreasing afferent sensory transmission. We hypothesized that epidural anaesthesia produces sensory deafferentation-dependent sedation that is associated with impairment of brainstem transmission. We used brainstem auditory evoked potentials (BAEP) to evaluate reticular function in 11 volunteers. METHODS Epidural anaesthesia was induced with 2-chloroprocaine 2%. Haemodynamic and respiratory responses, sensory block level, sedation depth and BAEP were assessed throughout induction and resolution of epidural anaesthesia. Sedation was evaluated using verbal rating score (VRS), observer's assessment alertness/sedation (OAA/S) score, and bispectral index score (BIS). Prediction probability (PK) was used to associate sensory block with sedation, as well as BIS with other sedation measures. Spearman's rank order correlation was used to associate block level and sedation with the absolute and interpeak BAEP latencies. RESULTS Sensory block level significantly predicted VRS (PK=0.747), OAA/S score (PK=0.748) and BIS. BIS predicted VRS and OAA/S score (PK=0.728). The latency of wave III of BAEP significantly correlated with sedation level (rho=0.335, P<0.01) and sensory block (rho=0.394, P<0.01). The other BAEP parameters did not change during epidural anaesthesia. Haemodynamic and respiratory responses remained stable throughout the study. CONCLUSIONS Sedation during epidural anaesthesia depends on sensory block level and is associated with detectable block-dependent alterations in the brainstem auditory evoked responses. Sensory deafferentation may reduce CNS alertness through mechanisms related to brainstem neural activity.
Collapse
Affiliation(s)
- A G Doufas
- Outcomes Research Institute and Department of Anesthesiology, University of Louisville, KY 40202, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Wadhwa A. Covalent linking of bone morphogeneic protein-2 to resorbable plates. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-5998(03)01015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Richards N, Schaner P, Diaz A, Stuckey J, Shelden E, Wadhwa A, Gumucio DL. Interaction between pyrin and the apoptotic speck protein (ASC) modulates ASC-induced apoptosis. J Biol Chem 2001; 276:39320-9. [PMID: 11498534 DOI: 10.1074/jbc.m104730200] [Citation(s) in RCA: 210] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Patients with familial Mediterranean fever suffer sporadic inflammatory attacks characterized by fever and intense pain (in joints, abdomen, or chest). Pyrin, the product of the MEFV locus, is a cytosolic protein whose function is unknown. Using pyrin as a "bait" to probe a yeast two-hybrid library made from neutrophil cDNA, we isolated apoptotic speck protein containing a caspase recruitment domain (CARD) (ASC), a proapoptotic protein that induces the formation of large cytosolic "specks" in transfected cells. We found that when HeLa cells are transfected with ASC, specks are formed. After co-transfection of cells with ASC plus wild type pyrin, an increase in speck-positive cells is found, and speck-positive cells show increased survival. Immunofluorescence studies show that pyrin co-localizes with ASC in specks. Speck localization requires exon 1 of pyrin, but exon 1 alone of pyrin does not result in an increase in the number of specks. Exon 1 of pyrin and exon 1 of ASC show 42% sequence similarity and resemble death domain-related structures in modeling studies. These findings link pyrin to apoptosis pathways and suggest that the modulation of cell survival may be a component of the pathophysiology of familial Mediterranean fever.
Collapse
Affiliation(s)
- N Richards
- Department of Cell and Developmental Biology, The University of Michigan Medical School, Ann Arbor, Michigan, 48109-0616, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Schaner P, Richards N, Wadhwa A, Aksentijevich I, Kastner D, Tucker P, Gumucio D. Episodic evolution of pyrin in primates: human mutations recapitulate ancestral amino acid states. Nat Genet 2001; 27:318-21. [PMID: 11242116 DOI: 10.1038/85893] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Familial Mediterranean fever (FMF; MIM 249100) is an autosomal recessive disease characterized by recurrent attacks of fever with synovial, pleural or peritoneal inflammation. The disease is caused by mutations in the gene encoding the pyrin protein. Human population studies have revealed extremely high allele frequencies for several different pyrin mutations, leading to the conclusion that the mutant alleles confer a selective advantage. Here we examine the ret finger protein (rfp) domain (which contains most of the disease-causing mutations) of pyrin during primate evolution. Amino acids that cause human disease are often present as wild type in other species. This is true at positions 653 (a novel mutation), 680, 681, 726, 744 and 761. For several of these human mutations, the mutant represents the reappearance of an ancestral amino acid state. Examination of lineage-specific dN/dS ratios revealed a pattern consistent with the signature of episodic positive selection. Our data, together with previous human population studies, indicate that selective pressures may have caused functional evolution of pyrin in humans and other primates.
Collapse
Affiliation(s)
- P Schaner
- Cellular and Molecular Biology Program, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
Dextromethorphan is a weak N-methyl-d-aspartate (NMDA) receptor antagonist that inhibits spinal cord sensitization in animal models of pain and also inhibits the development of cutaneous secondary hyperalgesia after tissue trauma. Perhaps coadministration of an NMDA antagonist with an opioid would lead to better pain relief, particularly with movement and an opioid-sparing effect. This has been shown for ketamine, but previous studies with dextromethorphan that have used small doses have shown only a modest reduction in morphine requirements with no or minimal changes in the postoperative pain experience. We sought to determine whether a large dose of this drug, just below the maximum tolerated dose, could potentiate morphine analgesia while simultaneously causing a significant improvement in the management of the postoperative pain experience. Sixty-six patients undergoing knee surgery were enrolled in the study. The study design was a prospective, randomized double-blinded comparison with placebo of 200 mg of dextromethorphan given eight hourly. Postoperative pain experiences were assessed by postoperative morphine usage. Visual analog and verbal rating scales were used to assess pain with movement as well as side effects. Dextromethorphan treatment led to a significant but modest reduction in morphine requirements (29.3% P < 0.05) but no reduction in postoperative pain levels. We conclude that increasing orally administered dextromethorphan to near maximum tolerated doses does not provide greater morphine sparing than 20-40 mg given 6-8 hourly as in previous studies. Furthermore we conclude that dextromethorphan does not improve pain scores in a manner expected of a drug with NMDA antagonist properties.
Collapse
Affiliation(s)
- A Wadhwa
- Monash University Department of Anaesthesia, Clayton, Victoria, Australia
| | | | | | | |
Collapse
|
28
|
Wadhwa A, Sabharwal M, Sharma S. Nutritional status of the elderly. Indian J Med Res 1997; 106:340-8. [PMID: 9361467] [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: 02/05/2023] Open
Abstract
Elderly become vulnerable to malnutrition owing to inappropriate dietary intake, poor economic status and social deprivation. Elderly are known to be easily subjected to inanition and avitaminosis resulting in multiple nutritional deficiencies. Urban slum dwellers, rural poor and those living alone appear to be at a higher risk of poor dietary intake. Though food consumption patterns of rural and urban elderly show a distinct difference, these are greatly influenced by regional dietary patterns. The diets of institutionalised and free living elderly reveal adequate nutrient intakes except iron and vitamin A. The nutrients least adequately supplied in the diets of Indian elderly are calcium, Iron, vitamin A, riboflavin and niacin along with energy deficits. Changes in body composition which mark the onset of the ageing process, include decline in lean body mass and increase in adipose tissue. A high prevalence of iron deficiency anaemia has also been reported among Indian elderly.
Collapse
Affiliation(s)
- A Wadhwa
- Department of Foods & Nutrition, Lady Irwin College, New Delhi
| | | | | |
Collapse
|
29
|
Gabelt BT, Robinson JC, Hubbard WC, Peterson CM, Debink N, Wadhwa A, Kaufman PL. Apraclonidine and brimonidine effects on anterior ocular and cardiovascular physiology in normal and sympathectomized monkeys. Exp Eye Res 1994; 59:633-44. [PMID: 7698258 DOI: 10.1006/exer.1994.1149] [Citation(s) in RCA: 36] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Apraclonidine and brimonidine administered topically to one eye of ketamine-anesthetized normal cynomolgus monkeys each produced a dose-related bilateral reduction in intraocular pressure which was not dependent on intact sympathetic innervation. Brimonidine was more potent and efficacious (10-12 mmHg maximum intraocular pressure reduction 2 hr after 200 micrograms) but produced a shorter-lasting effect than apraclonidine (4 mmHg maximum intraocular pressure reduction 1-6 hr after 600-1000 micrograms). Apraclonidine had little effect on pupil diameter, but brimonidine produced a dose-related bilateral miosis which was dependent on intact sympathetic innervation. Neither drug significantly affected refractive error. Topical brimonidine, but not apraclonidine, produced a dose-dependent reduction in mean arterial blood pressure, while both drugs lowered heart rate. A dose-dependent bilateral reduction in aqueous humor flow rate calculated over a 6-hr period following drug administration was produced by both topical apraclonidine (maximum 30-35% reduction with 600 micrograms) and brimonidine (maximum 30-45% reduction with 50-250 micrograms), which was not dependent on intact sympathetic innervation. Maintenance of blood pressure by intravenous infusion of angiotensin II had no effect on the aqueous humor flow suppression produced by 100 micrograms of topical brimonidine, but pentobarbital anesthesia abolished it. Intracameral injection of 10 micrograms brimonidine in rhesus monkeys produced an ipsilateral approximately 15% reduction in aqueous humor flow calculated for the 1-3 hr post-injection period. The cardiovascular and contralateral ocular effects observed with both drugs are presumably related to the monkeys' small body weight, and the magnitude of IOP reduction for a given degree of flow suppression would be greater in hypertensive than in normotensive eyes. Caution must therefore be exercised in extrapolating from our data in ocular normotensive monkeys to the glaucomatous human.
Collapse
Affiliation(s)
- B T Gabelt
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, U.S.A
| | | | | | | | | | | | | |
Collapse
|
30
|
Srivastava VK, Wadhwa A, Chatterjee PP, Laisram N. Unusual presentation of poliomyelitis. Indian Pediatr 1992; 29:775-7. [PMID: 1500144] [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: 12/27/2022]
Affiliation(s)
- V K Srivastava
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | | | |
Collapse
|
31
|
Chatterjee PP, Wadhwa A, Mongia A, Srivastava VK. Acute carbamazepine poisoning. Indian Pediatr 1992; 29:368-70. [PMID: 1612686] [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: 12/27/2022]
Affiliation(s)
- P P Chatterjee
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | | | |
Collapse
|
32
|
Anand NK, Chellani HK, Wadhwa A, Prasanna SB, Mohan M. Congenital syphilitic hepatitis. Indian Pediatr 1991; 28:157-9. [PMID: 2055630] [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: 12/30/2022]
Abstract
Hepatitis is a known manifestation of congenital syphilis, however hepatitis developing during penicillin therapy is unknown. Ten patients of congenital syphilis were studied and serial liver enzymes were done before and after starting penicillin therapy. Eight of the ten patients developed hepatitis after initiating penicillin therapy. Whether hepatitis in these cases was secondary to toxic reaction to the products of treponemal lysis or an autoimmune reaction needs to be investigated.
Collapse
Affiliation(s)
- N K Anand
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | | | | | |
Collapse
|
33
|
Sehgal SK, Puri S, Wadhwa A, Pathak OP, Mohan M, Anand NK. Campomelic syndrome. Indian Pediatr 1990; 27:619-22. [PMID: 2253999] [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: 12/31/2022]
Affiliation(s)
- S K Sehgal
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | | | | | | | |
Collapse
|
34
|
Gupta AK, Wadhwa A, Anand NK. Ceftriaxone. Indian Pediatr 1990; 27:381-4. [PMID: 2210825] [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: 12/30/2022]
Affiliation(s)
- A K Gupta
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | |
Collapse
|
35
|
Prakash O, Chellani HK, Wadhwa A, Mohan M, Anand NK. Autoimmune thrombocytopenia in newborn. Indian Pediatr 1990; 27:397-400. [PMID: 2210829] [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: 12/30/2022]
Affiliation(s)
- O Prakash
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | | | | | |
Collapse
|
36
|
Sehgal SK, Wadhwa A, Srivastava VK. Bilateral sixth nerve palsy with staphylococcal septicemia. Indian Pediatr 1990; 27:185-7. [PMID: 2361762] [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: 12/31/2022]
Affiliation(s)
- S K Sehgal
- Department of Pediatrics, Safdarjang Hospital, New Delhi
| | | | | |
Collapse
|
37
|
Ramesh V, Mukherjee A, Chandra M, Sehgal SK, Saxena U, Jain AK, Wadhwa A. Clinical, histopathologic & immunologic features of cutaneous lesions in acute meningococcaemia. Indian J Med Res 1990; 91:27-32. [PMID: 2111800] [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: 12/30/2022] Open
Abstract
Fifty children with culture proven acute meningococcaemia were studied during the winter outbreak of the disease in 1986-87. Purpuric lesions were seen in 60 per cent, erythematous papules in 32 per cent, faint pink macules in 28 per cent, conjunctival petechiae in 10 per cent and herpes labialis in 20 per cent. Histopathology of skin lesions showed that the primary damage was to the dermal vessels, the extent of damage depending on the type of skin involvement. Diplococci in Gram's stained sections were seen frequently in purpuric as compared to the other skin lesions. They were located in degenerating neutrophils, endothelial cells, fibrin clots or freely in the vascular lumen. Electron microscopic study showed vascular changes accompanied by a perivascular phagocytic response. Both light and electronmicroscopy indicated the involvement of the coagulative mechanism in the pathogenesis of meningococcaemia. However, clinical parameters of clotting were often within normal limits. In the case of a child (who died eventually), a low platelet count and prolonged coagulation indices were observed. Sera from some of the children were tested for the presence of antibodies against meningococci by indirect immunofluorescence. Antibodies were detected in the sera and they may have a role in regulating the severity and course of the illness. The significance of immunoglobulin deposits in the skin lesions is not clear.
Collapse
Affiliation(s)
- V Ramesh
- Department of Dermatology, Safdarjang Hospital, New Delhi
| | | | | | | | | | | | | |
Collapse
|
38
|
Sehgal SK, Prasad SR, Wadhwa A. Hypertrophic osteoarthropathy in pulmonary tuberculosis. Indian Pediatr 1987; 24:1161. [PMID: 3450674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
39
|
Chatterji JC, Ohri VC, Chadha KS, Das BK, Akhtar M, Tewari SC, Bhattacharji P, Wadhwa A. Serum and urinary cation changes on acute induction to high altitude (3200 and 3771 metres). Aviat Space Environ Med 1982; 53:576-9. [PMID: 7115242] [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: 01/23/2023]
Abstract
Twenty subjects each were rapidly inducted by road to 3200 ad 3771 m. Serum and urinary sodium, potassium, calcium, and magnesium were measured during 10 d at high altitude. At 3200 m, only serum potassium increased significantly on the 10th day. At 3771 m, serum potassium did not increase. Serum sodium generally remained low, serum magnesium increased, while calcium decreased significantly. Urinary volume over 24 h decreased more and for longer duration at 3771 m than at 3200 m. Urinary cations did not change significantly at 3200 m. At 3771 m, sodium and potassium excretion decreased on days 1 and 3 later returned towards preinduction levels. Magnesium and calcium decreased throughout the high-altitude stay. Significant changes were noticed in serum and urinary cations on exposure to high altitude when adequate caloric intakes were not ensured.
Collapse
|