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Jha N, Balachandran DM, Thabah MM, Jha AK. Diagnosis, management and outcomes of primary hypokalemic periodic paralysis during pregnancy. Obstet Med 2024; 17:119-123. [PMID: 38784184 PMCID: PMC11110751 DOI: 10.1177/1753495x221144670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 09/11/2023] [Imported: 09/11/2023] Open
Abstract
Primary hypokalaemic periodic paralysis during pregnancy has been rarely reported. Four pregnant women with the acute onset of flaccid paralysis presented between January 2018 and December 2021. Focussed history and physical examination helped an appropriate radiological and laboratory investigation plan to be made. All women recovered within 4-7 days of potassium supplementation. Supplemental potassium continued until delivery. A pain management plan with continuous epidural infusion helped in avoiding stress-induced hypokalaemia. None of the women developed an episode of muscle weakness during the intervening period. In conclusion, a focussed history and targeted laboratory investigation are needed to diagnose primary hypokalaemic periodic paralysis. Early administration of oral or intravenous potassium is crucial in improving fetomaternal outcomes.
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Jha N, Jha AK, Mishra SK, Parida S. Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:385-396. [PMID: 37147484 DOI: 10.1007/s00404-023-07065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/01/2023] [Indexed: 05/07/2023] [Imported: 08/29/2023]
Abstract
PURPOSE Pre-conceptual comorbidities, an inherent risk of graft loss, rejection during pregnancy, and the postpartum period in women with thoracic lung transplant may predispose them to increased risk of adverse feto-maternal outcomes. The study aimed to systematically analyze and assess the risk of adverse pregnancy outcomes in women with thoracic organ transplant. METHODS MEDLINE, EMBASE, and Cochrane library were searched for publication between January 1990 and June 2020. Risk of bias was assessed using Joanna Briggs critical appraisal tool for case series. The primary outcomes included maternal mortality and pregnancy loss. The secondary outcomes were maternal complications, neonatal complications, and adverse birth outcomes. The analysis was performed using the DerSimonian-Laird random effects model. RESULTS Eleven studies captured data from 275 parturient with thoracic organ transplant describing 400 pregnancies. The primary outcomes included maternal mortality {pooled incidence (95% confidence interval) 4.2 (2.5-7.1) at 1 year and 19.5 (15.3-24.5) during follow-up}. Pooled estimates yielded 10.1% (5.6-17.5) and 21.8% (10.9-38.8) risk of rejection and graft dysfunction during and after pregnancy, respectively. Although 67% (60.2-73.2) of pregnancies resulted in live birth, total pregnancy loss and neonatal death occurred in 33.5% (26.7-40.9) and 2.8% (1.4-5.6), respectively. Prematurity and low birth weight were reported in 45.1% (38.5-51.9) and 42.7% (32.8-53.2), respectively. CONCLUSIONS Despite pregnancies resulting in nearly 2/3rd of live births, high incidence of pregnancy loss, prematurity and low birth weight remain a cause of concern. Focused pre-conceptual counseling to avoid unplanned pregnancy, especially in women with transplant-related organ dysfunctions and complications, is vital to improve pregnancy outcomes. PROSPERO NUMBER CRD42020164020.
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Jha AK. Phenotypic characterization of heart failure with preserved ejection fraction. Letter regarding the article 'Disproportionate exercise-induced pulmonary hypertension in relation to cardiac output in heart failure with preserved ejection fraction: A non-invasive echocardiographic study'. Eur J Heart Fail 2023; 25:2338-2339. [PMID: 37559567 DOI: 10.1002/ejhf.2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] [Imported: 09/11/2023] Open
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Madhuri MS, Jha N, Pampapati V, Chaturvedula L, Jha AK. Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study. J Perinat Med 2023; 51:1067-1073. [PMID: 37125850 DOI: 10.1515/jpm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] [Imported: 09/11/2023]
Abstract
OBJECTIVES Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus. METHODS This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity. RESULTS A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group. CONCLUSIONS The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.
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Rakhi Krishna CM, Mishra SK, Jha AK, Senthilnathan M, Parida S. Ultrasound-Guided Radial Arterial Catheterization in Patients With Regurgitant and Stenotic Left-Sided Cardiac Valvular Lesions. Semin Cardiothorac Vasc Anesth 2023; 27:153-161. [PMID: 37269115 DOI: 10.1177/10892532231181481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] [Imported: 09/11/2023]
Abstract
Background. The pulse characteristics of arterial circulation might affect radial artery catheterization's success rate. Therefore, we hypothesized that the success rate of radial artery catheterization would be lower in the left-sided severe stenotic valvular lesion group than severe regurgitant valvular lesion group. Methods. This prospective study was conducted among patients with left-sided cardiac valvular lesions undergoing cardiac and non-cardiac surgery. The patients with left-sided severe valvular stenosis and left-sided severe valvular regurgitation were included in the study. Radial artery cannulation was performed using an ultrasound-guided out-of-plane short-axis approach. The outcome measures were success rate, number of attempts, and cannulation time. Result. One hundred fifty-two patients were recruited for the study, and all were eligible for final analysis. The first attempt success rate was non-significantly higher in the stenotic valvular lesion group than the regurgitant group (69.7% vs 56.6%; P = .09). Furthermore, the number of attempts (median; 95% CI) was significantly higher in the regurgitant group (1; 1.2-1.43 vs 1; 1.38-1.67; P = .04). However, it may not be of clinical relevance. Moreover, the cannulation time and the number of redirections of the cannula were comparable. Heart rate was significantly higher in the regurgitant group (91.8 ± 13.9 vs 82.26 ± 15.92 beats/min; P = .00), while the incidence of atrial fibrillation was significantly higher in the stenotic lesion (P = .00). No failure was reported, and the incidence of periarterial hematoma was comparable. Conclusion. The success rate of ultrasound-guided radial arterial catheterization is comparable in left-sided stenotic valvular and regurgitant lesion groups.
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Jha AK. Understanding the Pathophysiological and Clinical Changes in Lung Injury Models. Am J Respir Crit Care Med 2023; 208:632-633. [PMID: 37315324 PMCID: PMC10492260 DOI: 10.1164/rccm.202305-0826le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 06/16/2023] [Imported: 08/29/2023] Open
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Jha N, Divya MB, Jha AK. Management and outcomes of pulmonary artery hypertension and Eisenmenger syndrome during pregnancy: a prospective observational cohort study. BJOG 2023. [PMID: 37039249 DOI: 10.1111/1471-0528.17474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 04/12/2023] [Imported: 09/11/2023]
Abstract
OBJECTIVES Maternal-fetal morbidity and mortality among pregnant women with pulmonary artery hypertension (PAH) and Eisenmenger syndrome are unacceptable, and management decision-making in these clinical scenarios remains debatable. This study aimed to compare and analyse clinical characteristics, management and pregnancy outcomes in PAH and Eisenmenger syndrome. DESIGN Prospective observational cohort study. SETTINGS A large tertiary care university hospital. PATIENTS Thirty patients with pulmonary artery hypertension and 20 patients with Eisenmenger syndrome. METHODS Data pertaining to clinical characteristics, anaesthetic, medical and obstetric management, and outcomes in pregnancy complicated by PAH and Eisenmenger syndrome were collected between July 2020 and June 2022. Each treating unit followed its management protocol in consultation with the multidisciplinary team. MAIN OUTCOME MEASURES Maternal mortality and morbidity. RESULTS Maternal mortality was lower in the PAH group (6.6% versus 15%; p = 0.33). All mortalities were in the postpartum period. The incidence of new-onset or exacerbation of heart failure (23.3% versus 60%; p = 0.009) and hypoxaemia (13.3% versus 50%; p = 0.005) were significantly lower in the PAH group. In the Eisenmenger syndrome group, a significantly higher number of women received pulmonary hypertension and heart failure medications. Prematurity and neonatal intensive care unit admission were frequently noticed in Eisenmenger syndrome, whereas perinatal mortality, birthweight and APGAR score were comparable. CONCLUSIONS Fetomaternal outcomes are inferior in Eisenmenger syndrome compared with PAH and are either lower or comparable to those reported from contemporary cohorts of developed nations.
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Jha AK. Postextubation ventilation strategy in preventing reintubation in patients at very high risk for extubation failure. Intensive Care Med 2023; 49:374-375. [PMID: 36645447 DOI: 10.1007/s00134-023-06979-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/17/2023] [Imported: 08/29/2023]
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Rajan S, Jha N, Jha AK. Clinical characteristics, predictors and pregnancy outcomes in Indian women with peripartum cardiomyopathy. Obstet Med 2023; 16:23-28. [PMID: 37139501 PMCID: PMC10150308 DOI: 10.1177/1753495x211051253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] [Imported: 09/11/2023] Open
Abstract
Background Predictors, pregnancy and subsequent pregnancy outcomes in women with peripartum cardiomyopathy (PPCM) are poorly understood in our geographical region. Methods We retrospectively analysed 58 women with PPCM diagnosed using criteria by the European Society of Cardiology during 2015 to 2019. The main outcome measures were predictors of left ventricular (LV) recovery. LV recovery was defined as return of LV ejection fraction to over 50%. Results Nearly 80% of women had LV recovery during 6 months follow up. Univariate logistic regression revealed LV end diastolic diameter (adjusted odds ratio (OR); 0.87; 95% CI, 0.78-0.98; p = 0.02), LV end systolic diameter (OR; 0.89; 95% CI, 0.8-0.98; p = 0.02) and inotrope use (OR; 0.2, 95% CI, 0.05-0.7; p = 0.01) as predictors of LV recovery. Relapse was not seen in any of the nine women who had a subsequent pregnancy. Conclusion LV recovery was higher than those reported in contemporary PPCM cohorts from other parts of the world.
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Jha AK, Jha N, Malik V. Perioperative Decision-Making in Pulmonary Hypertension. Heart Lung Circ 2023; 32:454-466. [PMID: 36841637 DOI: 10.1016/j.hlc.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 02/27/2023] [Imported: 08/29/2023]
Abstract
Pulmonary hypertension (PH) is a haemodynamic manifestation of cardiorespiratory and non-cardiorespiratory pathologies. Cardiorespiratory pathologies account for nearly three-fourths of patients with PH. It is now increasingly being recognised due to routine requests for transthoracic echocardiographic examination in the perioperative setting in patients undergoing intermediate- to high-risk non-cardiac surgery. The increased risks of perioperative morbidity and mortality attributed to PH have been widely acknowledged in the literature. The importance of PH in perioperative decision-making and postoperative outcomes has had little mention in all the guidelines. Understanding the complexity of the pathophysiology of PH may help in anaesthetic and surgical decision-making. Preoperative evaluation and risk assessment are guided by the nature, extent, invasiveness, and duration of surgery. Surgical decision-making and anaesthetic management involve preoperative risk stratification, understanding the interactions between surgical procedures and PH, and understanding the interactions between anaesthetic procedures, PH, and cardiopulmonary interactions. Intraoperative and postoperative monitoring is crucial for maintaining the haemodynamic parameters and helps titrate anaesthetic agents and medication. This narrative review focusses on all issues related to anaesthetic and surgical challenges in patients with PH. This review aimed to suggest a preoperative evaluation plan, surgical decision-making, anaesthetic plan, and anaesthetic management based on the evidence available in the literature.
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Jha AK. Effect of COVID-19 in Pulmonary Hypertension. Am J Respir Crit Care Med 2023; 207:492-493. [PMID: 36252237 PMCID: PMC9940140 DOI: 10.1164/rccm.202209-1790le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] [Imported: 08/29/2023] Open
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Pathophysiology of pulmonary and myocardial edema in preeclampsia. Am J Obstet Gynecol 2023; 228:118. [PMID: 36029834 DOI: 10.1016/j.ajog.2022.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 01/26/2023] [Imported: 09/11/2023]
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Nagabhushanam Padala SA, Seema, Jha A. Left subclavian artery obstruction mimicking non-pulsatile flow during minimally invasive cardiac surgery. Indian J Anaesth 2023; 67:S143-S144. [PMID: 37122933 PMCID: PMC10132678 DOI: 10.4103/ija.ija_298_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/21/2022] [Accepted: 11/18/2022] [Indexed: 02/23/2023] [Imported: 09/11/2023] Open
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Rudingwa P, Gopalakrishnan S, Kuberan A, Mishra S, Panneerselvam S, Jha A. Comparison of retrograde transillumination and conventional technique for flexible videoscopy by novice anaesthesia residents: A randomised controlled trial. Indian J Anaesth 2023; 67:161-166. [PMID: 37091437 PMCID: PMC10121094 DOI: 10.4103/ija.ija_633_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023] [Imported: 09/11/2023] Open
Abstract
Background and Aims Retrograde transillumination technique has been found helpful for performing direct and video laryngoscopy by better identification of glottis. The usefulness of this technique during flexible videoscopy by novices has not been evaluated. So, we aimed to compare the retrograde transillumination and conventional technique of flexible videoscopy by novices. The primary outcomes were the time required to visualise the glottis from the point of insertion of the scope into the nostril (T1) and the time needed to see tracheal rings after glottis visualisation (T2). The secondary outcomes were incidence of desaturation with peripheral oxygen saturation (SpO2) <92% and the ease of performance of flexible videoscopy using retrograde transillumination. Methods A total of 92 surgical patients who are undergoing general anaesthesia with normal airway parameters were randomised into two groups, Group C (Conventional flexible videoscopy- Ambu® aScope™ 3 Broncho Slim) and Group R (Flexible videoscopy aided by retrograde transillumination through the cricothyroid space using an OTICA LED vein finder). Results The time to visualise glottis from scope insertion into the nose (T1) (median [interquartile range]) in group C and group R was (19.23 [13.6-30.5] versus 22.50 [17.8-25.5] seconds; P value = 0.417) and time to visualise the tracheal rings (T2) was (13.07 [9.1-20.00] versus 12.13 [9.0-19.1] seconds; P value = 0.714) were comparable in both the groups. 61% of residents found the retrograde transillumination to be very helpful. No incidence of desaturation was noted in either group. Conclusion Retrograde transillumination-aided flexible videoscopy does not shorten the time but facilitates glottis and tracheal rings visualisation among novice anaesthesia residents.
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Jha AK, Jha N. Ketamine Compared With Fentanyl for Surgical Abortion: A Randomized Controlled Trial. Obstet Gynecol 2023; 141:226. [PMID: 36701624 DOI: 10.1097/aog.0000000000005039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] [Imported: 09/11/2023]
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Khan S, Mishra SK, Parida S, Jha AK, Nagabhushanam Padala SRA. Carotid doppler indices do not predict fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting surgery. J Card Surg 2022; 37:4418-4424. [PMID: 36251251 DOI: 10.1111/jocs.17035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 09/06/2022] [Indexed: 01/06/2023] [Imported: 09/11/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY This study aimed to determine the predictive value of carotid artery blood flow (CABF), corrected carotid flow time (CFT), and respiratory variation in carotid peak systolic velocity (DVPeakCA) for fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting (CABG) surgery. It also aimed to correlate each of these indices with changes in stroke volume index (SVI) after a fluid bolus. METHODS This prospective, interventional, before-after study recruited 45 adult patients undergoing CABG. Following induction of anesthesia, a fluid challenge of 6 ml/kg of a crystalloid solution was delivered over 10 min. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), CABF, CFT, and DVPeakCA were recorded before and following the intervention. Patients with an increase in SVI of >15% from baseline were considered responders. RESULTS We had 22 responders and 23 nonresponders. Areas under the receiver operating characteristic (AUROC) curves for the studied indices (CABF, 0.516, CFT, 0.502, and DVPeakCA, 0.671) did not suggest any strong predictive value to detect fluid responsiveness. Similarly, the r values for correlation of these carotid doppler-derived indices, both baseline and as % change from baseline with the % alteration of SVI were all <0.2, which demonstrates a very weak correlation between these variables. CONCLUSIONS Carotid doppler indices are unreliable to assess fluid responsiveness, and cannot replace invasive methods of analyzing preload optimization. There was no significant correlation between carotid doppler-derived indices and alterations in SVI before and after the fluid bolus.
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Jha AK. Hepatitis of unknown origin in children: Updated evidence and concise review. J Viral Hepat 2022; 29:942-947. [PMID: 36062362 DOI: 10.1111/jvh.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 12/09/2022] [Imported: 09/11/2023]
Abstract
The rapid emergence of severe acute hepatitis across several European countries and several geographical regions in the United States has created panic among health institutions, local authorities, governmental organizations and regulatory bodies. Early reporting, stringent surveillance and supportive care can temporarily help tackle this crisis. However, definitive containment measures and management require characterization of the clinical spectrum, epidemiological assessment and extensive investigations. Furthermore, a sound management strategy requires randomized trials to explore the treatment options.
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Jha AK. Letter by Jha Regarding Article, "Latent Pulmonary Vascular Disease and Therapeutic Atrial Shunt". Circulation 2022; 146:e242-e243. [PMID: 36315606 DOI: 10.1161/circulationaha.122.061558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] [Imported: 09/11/2023]
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Jha AK. Transvenous Phrenic Nerve Stimulation in Patients Who Are Difficult to Wean. Am J Respir Crit Care Med 2022; 206:1047. [PMID: 35772121 PMCID: PMC9801992 DOI: 10.1164/rccm.202206-1024le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] [Imported: 08/29/2023] Open
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Jha AK, Padala SRAN, Parida S, Mishra SK. Diphtheritic Myocarditis Patient with an Impending Upper Airway Compromise. Indian J Crit Care Med 2022; 26:1153-1154. [PMID: 36876208 PMCID: PMC9983671 DOI: 10.5005/jp-journals-10071-24333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] [Imported: 09/11/2023] Open
Abstract
How to cite this article: Jha AK, Padala SRAN, Parida S, Mishra SK. Diphtheritic Myocarditis Patient with an Impending Upper Airway Compromise. Indian J Crit Care Med 2022;26(10):1153-1154.
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Jha L, Lata S, Jha AK, Prasad SKS. Effect of positive end expiratory pressure on central venous pressure in closed and open thorax. Physiol Meas 2022; 43. [PMID: 35882221 DOI: 10.1088/1361-6579/ac8468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022] [Imported: 09/11/2023]
Abstract
OBJECTIVE The magnitude and mechanism of the rise of central venous pressure (CVP) after positive end-expiratory pressure (PEEP) among patients with cardiac disease is poorly understood. Therefore, the study aimed to compare the magnitude of change in CVP after PEEP in patients with TR (tricuspid regurgitation), high CVP and high PCWP (pulmonary capillary wedge pressure) with no TR, low CVP and low PCWP. Additionally, we hypothesized that PEEP in the open thorax would also lead to a rise in CVP. APPROACH This prospective, quasi-experimental study was conducted in patients undergoing cardiac surgery. Three consecutive readings of variables were obtained at 1-minute intervals after PEEP (5 and 10 cm H2O) application in the closed and open thorax. Patients were stratified a priori into low CVP (<10 cm H2O) and high CVP (≥10 cm H2O), no TR and TR and low PCWP (<15 mm Hg) and high PCWP (≥15 mm Hg) in the closed and open thorax. MAIN RESULTS Sixty-two patients were eligible for final analysis. The mean difference (MD) in ∆CVP (CVP10 cm H2O of PEEP - CVP zero end-expiratory pressure) was 2.33±1.13 (95% CI, 2.04-2.62, P=0.000) and 1.02±0.77 (95% CI, 0.82-1.22, P=0.000) in the closed and open thorax, respectively. The increase in CVP was higher among patients who had a lower CVP (2.64 ± 0.9 mm Hg vs 1.45± 1.17 mm Hg; p=0.000), without TR (2.64 ± 0.97 mm Hg vs 2.14 ± 1.2 mm Hg, p=0.09) and lower PCWP (2.4 ± 0.9 mm Hg vs 2.3 ± 1.4 mm Hg, p=0.67) at 10 cm H2O PEEP in the closed thorax. SIGNIFICANCE The rise in CVP was higher among patients without TR, low CVP and low PCWP. Zero intrathoracic pressure in the open thorax did not abolish the effect of PEEP on CVP rise altogether.
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Jha AK. The Relation Between Cardiac Index and Mean Arterial Pressure During Anesthesia and Surgery. Anesth Analg 2022; 135:e4-e5. [PMID: 35709457 DOI: 10.1213/ane.0000000000006021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] [Imported: 09/11/2023]
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Jha N, Madhuri MS, Jha AK, Kubera NS. Subsequent Pregnancy Outcome in Women with Prior Complete Uterine Rupture: A Single Tertiary Care Centre Experience. Reprod Sci 2022; 29:1506-1512. [PMID: 35246823 DOI: 10.1007/s43032-022-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022] [Imported: 09/11/2023]
Abstract
Limited data is available to assess the burden of maternal morbidity, mortality, and perinatal outcome after subsequent pregnancy in women with prior uterine rupture. Therefore, this retrospective descriptive study was conducted to determine subsequent pregnancy outcomes in a larger series of women with prior complete uterine rupture. All pregnant women who had complete uterine rupture were managed according to the standard Institute protocol. The women who conceived following a uterine repair from July 2011 to June 2020 were recruited into the study. Outcome measures included severe maternal morbidities and perinatal outcomes. Fifty-three women with prior complete uterine rupture were conceived subsequently. Two women had an abortion in the first and second trimester, respectively. None of the women developed recurrence of uterine rupture. However, three women developed uterine dehiscence in a total of 16 women who went into spontaneous labour before elective cesarean delivery at 32, 36, and 37 weeks, respectively. None of the women had placenta previa, placenta accreta, bowel injury, bladder injury and none required a hysterectomy. However, 16.7% of women needed a blood transfusion. None of the women required mechanical ventilation, inotropic support, and intensive care unit stay. Seventeen babies required neonatal intensive care admission, and prematurity (90%) was the most common reason, followed by low APGAR scores. In conclusion, subsequent pregnancy outcomes in women with prior uterine rupture appear acceptable in institutionalized care. Timing of cesarean delivery may have to be weighed against the risk of prematurity-associated neonatal morbidity and mortality.
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Jha N, Jha AK. Two physiological phenotypes in preeclampsia: do they really exist? Am J Obstet Gynecol 2022; 226:159-160. [PMID: 34534505 DOI: 10.1016/j.ajog.2021.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] [Imported: 08/29/2023]
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Phenotypic Characterization of Right Ventricular Dysfunction and Prognostication in Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome. Crit Care Med 2021; 50:e393-e394. [PMID: 34923554 PMCID: PMC8923270 DOI: 10.1097/ccm.0000000000005416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] [Imported: 09/11/2023]
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