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Puri S, Sen IM, Bhardwaj N, Yaddanapudi S, Mathew PJ, Bandyopadhyay A, Samujh R, Dogra S, Kumar P. Postoperative outcome of neonatal emergency surgeries in a tertiary care institute-A prospective observational study. Paediatr Anaesth 2023; 33:1075-1082. [PMID: 37483171 DOI: 10.1111/pan.14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
AIMS Neonatal surgical mortality continues to be high in developing countries. A better understanding of perioperative events and optimization of causative factors can help in achieving a favorable outcome. The present study was designed to evaluate the perioperative course of surgical neonates and find out potential factors contributing to postoperative mortality. METHODS This prospective observational study enrolled neonates, undergoing emergency surgical procedures in a tertiary care institute. Primary outcome was 6 weeks postsurgical mortality. The babies were observed till discharge and subsequently followed up telephonically for 6 weeks after surgery. Multivariable logistic regression analysis of various parameters was performed. RESULTS Out of the 324 neonates who met inclusion criteria, 278 could be enrolled. The median age was 4 days. Sixty-two (27.7%) neonates were born before 37 weeks period of gestation (POG), and 94 (41.8%) neonates weighed below 2.5 kg. The most common diagnoses was trachea-esophageal fistula (29.9%) and anorectal malformation (14.3%). The median duration of hospital stay for survivors was 14 days. The in-hospital mortality was 34.8%. Mortality at 6 weeks following surgery was 36.2%. Five independent risk factors identified were POG < 34 weeks, preoperative oxygen therapy, postoperative inotropic support postoperative mechanical ventilation, and postoperative leukopenia. In neonates where invasive ventilation was followed by non-invasive positive pressure ventilation in the postoperative period, risk of postoperative surgical mortality was significantly reduced. CONCLUSION Present study identified preterm birth, preoperative oxygen therapy, postoperative positive pressure ventilation, requirement of inotropes, and postoperative leukopenia as independent predictors of 6-week mortality. The possibility of early switch to noninvasive positive pressure ventilation was associated with a reduction in neonatal mortality.
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Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjishnujit Bandyopadhyay
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivani Dogra
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Department of Neonatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Acharya V, Jain D, Gandhi K, Bhardwaj N, Mathew P. A noninferiority trial on information-based video versus self-selected video distraction technique for preoperative anxiety reduction in school children: Prepare trial. Paediatr Anaesth 2023; 33:955-961. [PMID: 37365954 DOI: 10.1111/pan.14718] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Distraction techniques using smartphones to watch cartoon videos and play videogames have been successfully used to reduce preoperative anxiety in school children. However, the literature about the use of video-based preoperative information technique for anxiety reduction in that age group still remains understudied with conflicting results. We hypothesized that there would be no meaningful difference in anxiety score at induction period between the information-based video versus self-selected video distraction technique. METHODS Eighty-two children between 6 and 12 years undergoing surgery were randomized to self-selected video (n = 41) and information-based video (n = 41) distraction group in this prospective, randomized, noninferiority trial. Children in self-selected video group were shown video of their choice using smart phones, while children in the information-based video group were shown video of operation theater (OT) set up and induction procedure. The children were taken inside operating room along with parents watching the respective videos. Modified Yale Preoperative Anxiety Scale (m-YPAS), just before induction of anesthesia was recorded as the primary outcome. Induction compliance checklist score, anxiety of the parents, and short-term postoperative outcomes in 15 days (telephonically) were recorded as secondary outcomes. RESULTS The mean difference in the baseline mYPAS score (95% CI) between the two groups was -2.7 (-8.2 to 2.8, p = .33) and -6.39 (-12.74 to -0.44, p = .05) just before the induction period. The upper bound of the 95% CI did not cross the value of 8, which was the noninferiority margin decided prior to study commencement. 70.73% cases had perfect induction in the self-selected video distraction group, compared to 68.29% in the information-based video group. After 15 days of postoperative follow-up, participants in the self-selected video group had a larger proportion of negative outcomes (53.7%) compared to information-based video group (31.7%), p = .044. CONCLUSION Information-based technique using smart phone is non inferior to self-selected video-based distraction-based technique in decreasing PA with an additional advantage of decreasing postoperative short-term negative outcomes. TRIAL REGISTRATION CTRI identifier: CTRI/2020/03/023884.
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Affiliation(s)
- Vanitha Acharya
- Department of Anesthesia and intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anesthesia and intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Komal Gandhi
- Department of Anesthesia and intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy Mathew
- Department of Anesthesia and intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jain A, Singh A, Jafra A, Singh S, Bhardwaj N. Anesthesiologist led end-to-end management of pediatric stridor presenting to a NORA setting. J Anaesthesiol Clin Pharmacol 2023; 39:661-662. [PMID: 38269159 PMCID: PMC10805195 DOI: 10.4103/joacp.joacp_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/26/2024] Open
Affiliation(s)
- Aditi Jain
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anudeep Jafra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shephali Singh
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jafra A, Jain D, Bhardwaj N, Yaddanapudi S. Neonatal perioperative resuscitation (NePOR) protocol-An update. Saudi J Anaesth 2023; 17:205-213. [PMID: 37260653 PMCID: PMC10228857 DOI: 10.4103/sja.sja_632_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 03/11/2023] Open
Abstract
Unexpected cardiac arrest in the perioperative period is a devastating complication. Owing to immaturity of organ systems, and presence of congenital malformations, morbidity and mortality are higher in neonates. There is abundant literature about early recognition and management of perioperative adverse events in children, but similar data and guidelines for surgical neonates is lacking. The current neonatal resuscitation guidelines cater to a newborn requiring resuscitation at the time of birth in the delivery room. The concerns in a newborn undergoing transition from intrauterine to extra uterine life is significantly different from a neonate undergoing surgery. This review highlights the causes and factors responsible for peri-arrest situations in neonates in the perioperative period, suggests preoperative surveillance for prevention of these conditions, and finally presents the resuscitation protocol of the surgical neonate. All these are comprehensively proposed as Neonatal Peri-operative Resuscitation (NePOR) protocol.
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Affiliation(s)
- Anudeep Jafra
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Fitzpatrick P, Bhardwaj N, Masalkhi M, Lyons A, Frazer K, McCann A, Syed S, Niranjan V, Kelleher CC, Brennan S, Kavanagh P, Fox P. Provision of smoking cessation support for patients following a diagnosis of cancer in Ireland. Prev Med Rep 2023; 32:102158. [PMID: 36875512 PMCID: PMC9982599 DOI: 10.1016/j.pmedr.2023.102158] [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: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
There is growing evidence that smoking cessation (SC) improves outcomes following diagnosis of cancer. Notwithstanding adverse outcomes, a significant number of those diagnosed with cancer continue to smoke. Our objective was to document the SC services provided for patients with cancer by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. A cross-sectional survey based on recent national clinical guidelines was used to determine SC care delivery across eight adult cancer specialist hospitals, and one specialist radiotherapy centre. Qualtrics was used. The response rate was 88.9% with data reported from seven cancer hospitals and one specialist radiotherapy centre, all indicating they had some SC related provision (100%). Stop smoking medications were provided to cancer inpatients in two hospitals, at outpatients and attending day ward services in one hospital. Smokers with cancer were referred automatically to the SC service in two hospitals at diagnosis. While stop smoking medications were available 24 h a day in five hospitals, most did not stock all three (Nicotine Replacement Therapy, Bupropion, Varenicline). One hospital advised they had data on uptake of SC services for smokers with cancer but were unable to provide detail. There is considerable variation in SC information and services provided to cancer patients across adult cancer specialist centres in Ireland, reflecting the suboptimal practice of smoking cessation for patients with cancer found in the limited international audits. Such audits are essential to demonstrate service gaps and provide a baseline for service improvement.
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Affiliation(s)
- P Fitzpatrick
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - M Masalkhi
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland
| | - A Lyons
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - K Frazer
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
| | - A McCann
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland.,UCD Conway Institute of Biomolecular and Biomedical Research and UCD School of Medicine, Ireland
| | - S Syed
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - C C Kelleher
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,College of Health and Agricultural Science (CHAS), University College Dublin, Belfield Dublin 4, Ireland
| | - S Brennan
- St Luke's Hospital, Rathgar Dublin 6, Ireland
| | - P Kavanagh
- Health Service Executive Tobacco Free Ireland Programme, Strategy and Research, 4th Floor, Jervis House, Jervis Street, Dublin 1, D01 W596, Ireland
| | - P Fox
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
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Vardhan H, Sarna R, Sen IM, Bhardwaj N, Yaddanapudi S, Mathew PJ. Evaluation of Size 3.0 Microcuff Endotracheal Tube in Infants Undergoing Major Surgery under General Anesthesia. Indian J Pediatr 2023; 90:204. [PMID: 36513885 DOI: 10.1007/s12098-022-04416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Harsha Vardhan
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, 160012, India
| | - Rashi Sarna
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, 160012, India
| | - Indu Mohini Sen
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, 160012, India.
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, 160012, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, 160012, India
| | - Preethy J Mathew
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, 160012, India
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Makar D, Nazemi A, Gong SG, Bhardwaj N, De Guzman R, Sessle BJ, Cioffi I. Development of a model to investigate the effects of prolonged ischaemia on the muscles of mastication of male Sprague Dawley rats. Arch Oral Biol 2023; 146:105602. [PMID: 36543038 DOI: 10.1016/j.archoralbio.2022.105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study were to develop a novel rodent model of masticatory muscle ischaemia via unilateral ligation of the external carotid artery (ECA), and to undertake a preliminary investigation to characterize its downstream effects on mechanosensitivity and cellular features of the masseter and temporalis muscles. DESIGN The right ECA of 18 male Sprague-Dawley rats was ligated under general anaesthesia. Mechanical detection thresholds (MDTs) at the masseter and temporalis bilaterally were measured immediately before ECA ligation and after euthanasia at 10-, 20-, and 35-days (n = 6 rats/timepoint). Tissue samples from both muscles and sides were harvested for histological analyses and for assessing changes in the expression of markers of hypoxia and muscle degeneration (Hif-1α, VegfA, and Fbxo32) via real time PCR. Data were analyzed using mixed effect models and non-parametric tests. Statistical significance was set at p < 0.05. RESULTS MDTs were higher in the right than left hemiface (p = 0.009) after 20 days. Histological changes indicative of muscle degeneration and fibrosis were observed in the right muscles. Hif-1α, VegfA, and Fbxo32 were more highly expressed in the masseter than temporalis muscles (all p < 0.05). Hif-1α and, VegfA did not change significantly with time in all muscles (all p > 0.05). Fbxo32 expression gradually increased in the right masseter (p = 0.024) and left temporalis (p = 0.05). CONCLUSIONS ECA ligation in rats induced hyposensitivity in the homolateral hemiface after 20 days accompanied by tissue degenerative changes. Our findings support the use of this model to study pathophysiologic mechanisms of masticatory muscle ischaemia in larger investigations.
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Affiliation(s)
- D Makar
- University of Toronto, Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, Toronto, ON, Canada; University of Toronto, Faculty of Dentistry, Graduate Orthodontics, Toronto, ON, Canada
| | - A Nazemi
- University of Toronto, Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, Toronto, ON, Canada
| | - S G Gong
- University of Toronto, Faculty of Dentistry, Graduate Orthodontics, Toronto, ON, Canada
| | - N Bhardwaj
- University of Toronto, Faculty of Medicine, Department of Comparative Medicine, Toronto, ON, Canada; Peter Gilgan Centre for Research and Learning, Sickkids Hospital, Toronto, ON, Canada
| | - R De Guzman
- University of Toronto, Faculty of Medicine, Department of Comparative Medicine, Toronto, ON, Canada
| | - B J Sessle
- University of Toronto, Faculty of Dentistry, Toronto, ON, Canada; University of Toronto, Faculty of Medicine, Department of Physiology, Toronto, ON, Canada
| | - I Cioffi
- University of Toronto, Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, Toronto, ON, Canada; Mount Sinai Hospital, Department of Dentistry, Toronto, ON, Canada; University of Toronto, Faculty of Dentistry, Graduate Orthodontics, Toronto, ON, Canada.
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Fitzpatrick P, Bhardwaj N, Syed S, Fox P, Frazer K, Niranjan V, Lyons A, McCann A, Brennan S, Guerin S. Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions. Eur J Public Health 2022. [PMCID: PMC9594757 DOI: 10.1093/eurpub/ckac131.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs). Methods Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis. Results Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge. (2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels. (3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC. (4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy. Conclusions Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages • Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. • Tailored SC support should be an integral part of comprehensive cancer care.
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Affiliation(s)
- P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - S Syed
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - A McCann
- Biomolecular & Biomedical Research Institute, University College Dublin , Dublin, Ireland
| | - S Brennan
- Department of Radiation Oncology, St. Luke’s Radiation Oncology Network , Dublin, Ireland
| | - S Guerin
- School of Psychology, University College Dublin , Dublin, Ireland
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Frazer K, Bhardwaj N, Fox P, Niranjan V, Quinn S, Kelleher C, Fitzpatrick P. Rapid systematic review of smoking cessation interventions for people who smoke and have cancer. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher rates of cancer are reported in smokers compared to non-smokers, and continued smoking following a cancer diagnosis is associated with reduced health outcomes and survival. Despite international evidence of increased risks, a substantial percentage of people with a cancer diagnosis continue to smoke. Patients may be unaware of the additional risks associated with continued smoking, and health care professionals may not engage with quit supports. As part of a larger feasibility study to develop a smoking cessation pathway in cancer services in Ireland, a rapid review of the evidence was completed.
Methods
Systematic searches of PubMed, Embase, and CINAHL 2015 to December 2020 were conducted; with studies restricted to adults with a cancer diagnosis [lung, breast, cervical, head and neck] and published in English. No restriction was placed on study designs. 6404 studies were identified and uploaded into COVIDENCE platform, Cochrane's systematic review methods were adopted throughout, PRISMA reporting guidelines were used, and narrative data synthesis was completed (CRD 42020214204).
Results
The twenty-three-studies report evidence from USA, Canada, England, Lebanon, and Australia. The setting for all interventions was hospitals and cancer clinics. Evidence identifies high dropout rates, inconsistencies in approaches and duration of smoking cessation interventions with varied outcomes. A wide-ranging number of critical components emerged associated with optimal quit support- including the timing of and frequency of quit conversations, use of electronic records, in-person support meetings, provision of nicotine replacement therapy and extended use of Varenicline, smoking cessation services embedded in oncology depts, and engaging with families wanting to quit at the same time.
Conclusions
Developing tailored smoking cessation interventions are needed for smokers diagnosed with cancer to enable engagement.
Key messages
• Continued smoking following a cancer diagnosis is associated with reduced health outcomes.
• Smoking cessation programmes for cancer patient should be tailored to meet needs.
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Affiliation(s)
- K Frazer
- Nursing, Midwifery and Health Systems, University College Dublin , Dublin, Ireland
| | - N Bhardwaj
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - P Fox
- Nursing, Midwifery and Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - S Quinn
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - C Kelleher
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
- Department Preventive Medicine and Health Promotion, St Vincent's University Hospital , Dublin, Ireland
| | - P Fitzpatrick
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
- Department Preventive Medicine and Health Promotion, St Vincent's University Hospital , Dublin, Ireland
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Veluswamy R, Bhalla S, Samstein R, Marron T, Gomez J, Doroshow D, Sabari J, Shum E, Saxena A, Namakydoust A, Chachoua A, Wisnivesky J, Mandeli J, Bhardwaj N, Hirsch F, Merad M, Reddy E. 1018P Phase I/II trial of rigosertib and nivolumab for KRAS mutated non-small cell lung cancer (NSCLC) patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1144] [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: 11/01/2022] Open
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Singhi A, Chen T, Madison R, Bhardwaj N, Jin D, Fleischmann Z, Newberg J, Moore J, Frampton G, Hegde P, Fabrizio D, He J, Schrock A, Ebot E, Sokol E. 1300P Exploration of a novel HRD signature (HRDsig) as a biomarker of first line FOLFIRINOX benefit in metastatic pancreatic cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1432] [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] Open
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Charuvila S, Lloyd A, Bhardwaj N, Lloyd D. 542 Laparoscopic Division of a Congenital Splenogonadal Portosystemic Shunt: A Case Report. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
We describe a rare congenital portosystemic shunt. A 37-year-old woman was found to have a previously unreported congenital shunt following investigations into secondary causes of hypertension. The abnormal venous shunt connected the splenic vein to the left ovarian vein. The patient underwent a laparoscopic procedure to successfully divide the shunt. She made a full recovery without complications. To our knowledge, this is the first presentation of a congenital portosystemic shunt involving the splenic and ovarian veins to be reported. This case demonstrates that such a shunt can be amenable for laparoscopic management. The case report shows preoperative scans and intraoperative images.
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Affiliation(s)
- S Charuvila
- University Hospitals Leicester , Leicester , United Kingdom
| | - A Lloyd
- Hull York Medical School , Hull , United Kingdom
| | - N Bhardwaj
- University Hospitals Leicester , Leicester , United Kingdom
| | - D Lloyd
- University Hospitals Leicester , Leicester , United Kingdom
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Bhardwaj N, Joshi A, Kataria DS, Katariya D. Analysis of Perception of Students and Faculty on Case Based Early Clinical Exposure in First Year Medical Students. Mymensingh Med J 2022; 31:841-847. [PMID: 35780372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Early clinical exposure (ECE) is a novel strategy for medical colleges to bridge the gap between basic and clinical sciences. There are few studies that explain student's and faculty's perspective on ECE. This study compares the ECE models (Case-based and Video-based case) in terms of benefits and challenges. This cross-over comparative study with 120 medical students of MBBS Batch 2019 and 8 facilitators was conducted in Government medical college, Pali, Rajasthan, India from September 2020 to March 2021. Entire batch was divided into two groups. In a hospital environment, one group was taught by an actual case (patient) of a specific topic, while another group was taught in a classroom setting by a video-based case. The students' and faculty's perspectives on Case-Based Early Clinical Exposure (CBECE) were documented using a pre-tested questionnaire and evaluated on a Likert scale. Finally, both groups were given assessment questions and the process was repeated in the following session of case based early clinical exposure, but with switched groups. Majority of the students (98.3%) agreed CBECE as more effective for attentiveness, retention, correlation of clinical knowledge with theoretical knowledge and communication. Most of the students (43.0%) believed that learning is limited due to lack of repeatability as compare with video-based case. Most of the facilitators found CBECE as effective tool for the development of attitude and communication skills of the students. CBECE can be implemented with limited sessions for sensitization of students about health care setup, importance of empathetic behavior, communication skill and better correlation of preclinical subjects in the context of disease.
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Affiliation(s)
- N Bhardwaj
- Dr Nikha Bhardwaj, Associate Professor, Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India; E-mail:
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Sarkar S, Bhardwaj N, Yaddanapudi S, Jain D. Effect of two different levels of positive end-expiratory pressure (PEEP) on oxygenation and ventilation during pneumoperitoneum for laparoscopic surgery in children: A randomized controlled study. Saudi J Anaesth 2022; 16:430-436. [PMID: 36337428 PMCID: PMC9630667 DOI: 10.4103/sja.sja_445_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10–cm H2O of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP. Method: After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2–10 years, undergoing LAP were randomized to receive PEEP of 5- or 10–cm H2O during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO2, and PaCO2 were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O2) were calculated at the above-mentioned time points. Data were analyzed using Student's t-test and repeated measures ANOVA with Bonferroni correction. Results: The oxygenation index and D(A-a)O2 decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant (P = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant (P = 0.001). There were no significant changes in the hemodynamic parameters in the two groups. Conclusion: Use of 10-cm H2O PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.
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Jain A, Singh A, Bhardwaj N, Sen IM. Management of a difficult airway in Hunters syndrome. J Anaesthesiol Clin Pharmacol 2022; 38:503-504. [PMID: 36505189 PMCID: PMC9728441 DOI: 10.4103/joacp.joacp_260_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Aditi Jain
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Aditi Jain, 8H/4; PGIMER, Chandigarh - 160 012, India. E-mail:
| | - Ajay Singh
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu M. Sen
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Bhardwaj N, Fitzpatrick P. Breast self-examination among older women in Ireland: The Irish Longitudinal Study on Ageing -TILDA. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Regular breast self-examination (BSE) is a simple, cost-effective way of early breast cancer detection, particularly for women outside eligible screening age and for interval cancers. Although mammographic screening is the current most effective breast screening tool, the importance of regular BSE and breast awareness may be overlooked. The study aimed to identify socio-demographic, lifestyle and health-related factors associated with BSE practice among women in Ireland.
Methods
This study was conducted using Wave 4 data from The Irish Longitudinal Study on Ageing (TILDA), which collects health-related information from people aged 50 plus in biennial data collection waves. Those women aged 50-64 (eligible breast screening age in 2016) were selected. Following univariate analysis, logistic regression analysis was performed on selected variables to determine the factors independently associated with BSE practice.
Results
The prevalence of BSE was 70.7%. There was no significant association found between socio-demographic, lifestyle or health related factors and BSE. On logistic regression analysis, family history of cancer was not found to be associated with increased practice of BSE (Adjusted Odds Ratio (OR) 1.02, 95% Confidence Interval (CI) 0.79-1.31, p = 0.86). Having attended for mammogram showed a non-significant reduction in the likelihood of doing BSE (Adjusted OR 0.77, 95% CI 0.58-1.02, p = 0.07).
Conclusions
There are few studies on BSE from developed countries and this is the first from Ireland. BSE prevalence was 61%, 22.6% and 46.8% from Canada, United Kingdom and United States respectively, and was considerably lower from Asian and African countries. Women in this study were more educated than the general population counterparts, this might have overestimated BSE prevalence and obscured true associations. While we did not identify significant associations there is a suggestion that attending for mammography reduces women's interest in BSE.
Key messages
Being ‘Breast Aware’ and BSE are important alongside mammography for early detection of breast cancer. In countries where screening mammography is unavailable, BSE is an important detection tool.
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Affiliation(s)
- N Bhardwaj
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
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Bhardwaj N, Fox P, Frazer K, Lyons A, Doherty K, Fitzpatrick P. Has the national fall in smoking rate in Ireland been replicated in cancer patients? a 5-year report. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Population smoking rates are falling in Ireland, however many cancer patients continue smoking post diagnosis, despite its association with poorer treatment and clinical outcomes. As part of a feasibility study of smoking cessation for cancer patients in Ireland, a review of smoking rates in cancer patients was undertaken.
Methods
The Hospital Inpatient Enquiry system (HIPE), a national database which collects administrative, demographic & clinical data on discharges from public hospitals in Ireland, provided data (2014-2018) on smoking status of adult discharges with a cancer diagnosis (overall, breast, lung, cervical and head & neck (H&N). Smoking trends were compared with Healthy Ireland data (2015-2018), from a national survey for adults on health & wellbeing.
Results
During 2014-18, current smoking rose for all cancers (10.5%-11.4%), cervical cancer (11%-19.8%) and initially (2014-2016) for H&N (3%-12.7%) and lung (24.7%-27.2%), which dropped to 7.6% and 24% respectively in 2018; breast was stable at 6 ± 0.6%. Rates are lower than the general population (23%-20%). During 2014-17, past smoking rates demonstrated an upward trend among all cancers and specific cancers, with the highest prevalence among lung (30.3-39%) and lowest among breast (7.3-11%); comparative general population data was 23-28%. Current smoking rates for all cancers were highest among 50-59-year-olds (14-16%), which contrasts with the general population (24-35 years at 32-28%). Current and past smoking rates for all cancers were consistently higher among males, similar to the general population.
Conclusions
HIPE data is limited by duplicate episodes of care, and it is recognised that smoking documentation may be an underestimate. However, it is useful to analyse trends, as these limitations should be stable over the 5-year study period. Rates remain high; our further research will document barriers and facilitators to smoking cessation among cancer patients.
Key messages
Smoking rates in cancer patients are high despite proven benefits of smoking cessation. Supportive smoking cessation services as part of routine cancer care are indicated.
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Affiliation(s)
- N Bhardwaj
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
| | - K Doherty
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
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Isherwood J, Karki BB, Chung WY, AlSaoudi T, Wolff J, Malde D, Bhardwaj N, Garcea G, Dennison A. 228 Outcomes of Gallstone Complications During the COVID Pandemic. Br J Surg 2021. [PMCID: PMC8524580 DOI: 10.1093/bjs/znab259.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate. Method This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019. Results Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al. Conclusions In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.
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Affiliation(s)
- J Isherwood
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - B B Karki
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - W Y Chung
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - T AlSaoudi
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - J Wolff
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - D Malde
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - N Bhardwaj
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - G Garcea
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - A Dennison
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Ray A, Sen IM, Bhardwaj N, Yaddanapudi S, Mathews P. Videolaryngoscopic versus direct laryngoscopic paraglossal intubation for cleft lip/palate reconstructive surgeries: A randomised controlled trial. Indian J Anaesth 2021; 65:593-599. [PMID: 34584282 PMCID: PMC8445211 DOI: 10.4103/ija.ija_463_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: In the cleft lip and palate, the laryngoscope blade often tends to lodge inside midline clefts, causing reduced manoeuvrability and tissue trauma. The paraglossal technique avoids the midline and offers better Cormack Lehane (CL) grades. We aimed to assess the first-pass intubation rate in performing the left paraglossal laryngoscopy with a curved-blade videolaryngoscope (VLS) versus direct laryngoscope (DLS) in children with cleft palate and evaluate the time taken for successful endotracheal intubation (TTI) and Intubation Difficulty Score (IDS) with both devices. Methods: This randomised controlled trial included 60 patients with cleft palate, between 3 months and 6 years. Patients were randomised into group V (VLS) (n = 30) and group D (DLS) (n = 30). Left paraglossal laryngoscopy was done with VLS or DLS, and the first-pass intubation, TTI, CL grade and IDS were recorded. Results: First-pass intubation (primary outcome) was successful in all cases in group V and in 29 (96%) cases in group D (P = 0.923). Amongst the secondary outcomes, the IDS of the majority in both groups was 1–4 (slight difficulty) (P = 0.98) and the mean TTI In group D was 34.6 s (SD = 19.0) (95% CI: 27.5–41.7) versus 39.8 s (SD = 5.2) (95% CI: 37.8–41.7) in group V (P = 0.151). Conclusions: There was no significant difference in the use of a VLS over a DLS in performing the left paraglossal laryngoscopy in terms of first-pass intubation rate, CL Grade, IDS and TTI. Further studies with different VLS may be done to improve the ease of this technique.
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Affiliation(s)
- Ananya Ray
- Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy Mathews
- Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bishnoi S, Gombar S, Ahuja V, Bhardwaj N, Kaur J. Vitamin D levels of anesthesiologists working in tertiary care hospital of South Asian country: An observational study. J Anaesthesiol Clin Pharmacol 2021; 37:237-242. [PMID: 34349373 PMCID: PMC8289653 DOI: 10.4103/joacp.joacp_310_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Vitamin D deficiency is now emerging as a major global health problem. Doctors spend most of their time indoors and hence, have very low sun exposure. With limited studies on vitamin D levels of anesthesiologists and no published study from South Asian countries, we planned to determine vitamin D levels in anesthesiologists. Material and Methods: One hundred twenty anesthesiologists, working in two tertiary care hospitals, were enrolled in this study. The participants were asked to complete the questionnaire and blood samples were drawn at the same sitting for measuring serum 25(OH) D and serum calcium levels. A subgroup analysis of anesthesiologists was done based on vitamin D status levels defined as per Endocrine society clinical practice guidelines 2011 on vitamin D deficiency. Vitamin D deficiency: 25(OH) D <20 ng/ml (<50 nmol/l), Vitamin D insufficiency: 25(OH) D of 21–29 ng/ml (52.5–72.5 nmol/l), Vitamin D sufficiency: 25(OH) D of ≥30 ng/ml (≥75 nmol/l). Results: The mean working hours in a day [mean ± standard deviation (SD)] were 10.70 ± 1.56 hours with a range of 8–15 hours. The mean ± SD level of vitamin D in anesthesiologists was 14.56 ± 9.39 ng/ml with a range of 5.30–58.00 ng/ml. Out of 120 anesthesiologists, 101 (84.2%) anesthesiologists had deficient levels of vitamin D, 10 (8.3%) had insufficient levels, and 9 (7.5%) anesthesiologists had sufficient levels of vitamin D. Majority of the anesthesiologists had normal serum calcium levels. A total of 91.5% of doctors had vitamin D deficiency who were not taking vitamin D supplement groups as compared to 28.6% in doctors who had taken vitamin D supplements in the past. Conclusion: Prevalence of vitamin D deficiency/insufficiency was high among anesthesiologists. However, levels were optimal in professionals taking vitamin D supplements.
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Affiliation(s)
- Sonika Bishnoi
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Hospital, Chandigarh, India
| | - Jasbinder Kaur
- Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
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21
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Bernstein E, Bhardwaj N, Pfoh ER, Yudelevich E. A Nationwide Survey of Educational Resource Utilization and Perception Among Internal Medicine Residents. J Gen Intern Med 2021; 36:1598-1604. [PMID: 33506391 PMCID: PMC7840077 DOI: 10.1007/s11606-020-06441-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND New virtual resources ("novel resources") have been incorporated into medical education. No recent large studies about their use and perception among internal medicine (IM) residents exist. OBJECTIVE Characterize the use and perceived helpfulness of educational resources. DESIGN Nationwide survey from December 2019 to March 2020. PARTICIPANTS IM residents in the USA. MAIN MEASURES Residents were surveyed on their use and their perceived helpfulness of resources for both attaining general medical knowledge and for point-of-care (POC) learning. Traditional resources included board review resources, clinical experience, digital clinical resources (e.g., UpToDate), journal articles, pocket references, professional guidelines, textbooks, and residency curricula. Novel resources included Twitter, video streaming platforms (e.g., YouTube), online blogs, podcasts, and Wikipedia. KEY RESULTS We had 662 respondents from 55 residency programs across 26 states. On average, residents used 9 total resources (7 traditional and 2 novel). Digital clinical resources and clinical experience were used by all residents and found helpful by the highest percentage of residents (96% and 94%, respectively). Journal articles were next (used by 90%), followed by board review resources and residency curricula (both used by 85%). Their perceived helpfulness varied, from 90% for board review resources, to 66% for journal articles and 64% for residency curricula, the lowest perceived helpfulness of any traditional resource. Podcasts and video streaming platforms were used as frequently as textbooks (58-59%), but were rated as helpful more frequently (75% and 82% vs 66%, respectively). CONCLUSIONS Digital clinical resources, video streaming platforms, and podcasts were perceived as helpful, underscoring the importance of ensuring their integration into medical education to complement clinical experience and other traditional resources which remain highly valued by residents. IMPORTANCE Our findings can inform residency programs as they transition to virtual curricula in the wake of the COVID-19 pandemic.
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Affiliation(s)
- E Bernstein
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - N Bhardwaj
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - E R Pfoh
- Center for Value Based Care, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - E Yudelevich
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Layton GR, Chung WY, Isherwood J, Fraser RE, Issa E, Robertson GS, Garcea G, Bhardwaj N, Dennison AR. Endoscopic retrograde cholangiopancreatography in the COVID era: considerations for hepatobiliary and pancreatic surgery units. Br J Surg 2021; 108:e290-e291. [PMID: 34000030 DOI: 10.1093/bjs/znab161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/14/2021] [Indexed: 01/28/2023]
Affiliation(s)
- G R Layton
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R E Fraser
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - E Issa
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G S Robertson
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Alsaoudi T, Slavin D, Khasawneh F, Chung WY, Eltweri A, Sahloul M, Bhardwaj N, Malde D, Dennison AR, Garcea G. Selective impact of COVID-19 in patients presenting with non-specific abdominal pain. Br J Surg 2021; 108:e150-e151. [PMID: 33792638 PMCID: PMC8083566 DOI: 10.1093/bjs/znaa152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
Affiliation(s)
- T Alsaoudi
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - D Slavin
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - F Khasawneh
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - A Eltweri
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - M Sahloul
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - D Malde
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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Isherwood J, Karki B, Chung WY, AlSaoudi T, Wolff J, Malde D, Bhardwaj N, Garcea G, Dennison AR. Outcomes of gallstone complications during the COVID pandemic. Br J Surg 2021; 108:e29-e30. [PMID: 33640947 DOI: 10.1093/bjs/znaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/31/2022]
Abstract
As data and metadata from the SARS-CoV-2 pandemic mature, the true impact on non-cancer, non-emergency surgical practice is becoming apparent. The authors present data on the impact of gallstone disease in their unit during 5 months of the COVID-19 pandemic (March 2020 to August 2020) compared with the equivalent period in 2019. Although the total number of patients presenting with gallstone disease was comparable, there was a decrease in patients with cholecystitis and perforation (although it is possibly too early for these to have presented), and there was a small but worrying increase in patients with gallstone pancreatitis. With the recent increase in alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent national approach is required to mitigate these risks.
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Affiliation(s)
- J Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - B Karki
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - T AlSaoudi
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - J Wolff
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - D Malde
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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NAVEEN V, D'Cruz S, Kashyap J, Bhardwaj N. POS-280 CORRELATION OF AMBULATORY BLOOD PRESSURE MEASUREMENT (ABPM) WITH OFFICE BLOOD PRESSURE MEASUREMENT IN PATIENTS OF CHRONIC KIDNEY DISEASE (CKD). Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.295] [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: 10/21/2022] Open
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Garg K, Bhardwaj N, Yaddanapudi S, Sen IM, Mathew PJ, Kanojia RP. Efficacy of dexmedetomidine as an adjunct to ropivacaine in transversus abdominis plane block for paediatric laparoscopic surgeries: A double-blinded randomised trial. Indian J Anaesth 2021; 65:S27-S33. [PMID: 33814587 PMCID: PMC7993041 DOI: 10.4103/ija.ija_1207_20] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/19/2020] [Accepted: 12/25/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims α2 agonists have been utilised in regional blocks, but very little data is available for their use in transversus abdominis plane (TAP) block in paediatric laparoscopic (LAP) surgeries. This study investigated the analgesic effect of ropivacaine alone versus its combination with dexmedetomidine for TAP block in children undergoing LAP surgery. METHODS A randomised, double-blind trial was conducted in 50 American Society of Anesthesiologists (ASA) 1 and 2 children of 2-8 years undergoing LAP abdominal surgery. Children were randomised to receive a total volume of 0.5 ml/kg of 0.2% ropivacaine (LA group) or 0.2% ropivacaine with 1 μg/kg dexmedetomidine (LAD group) for performing ultrasound-guided bilateral TAP block postoperatively (PO). Patients were monitored PO for vital signs, pain, sedation, time to first rescue analgesic and total analgesic consumption for 24 h. Time to first rescue analgesic was expressed as mean ± standard deviation (SD) and analysed using Kaplan-Meier survival analysis. Pain and sedation scores were expressed as median [interquartile range (IQR)] and analysed using Mann-Whitney U test. Results First rescue analgesic demand was significantly longer (P = 0.001) in LAD (474.8 min) versus LA group (240.9 min) but total analgesics consumption in first 24 h was comparable. Pain scores were significantly lower (P < 0.05) in LAD compared to LA group at all times PO. Each group had comparable but significantly lower sedation scores up to 24 h PO. Conclusion Addition of dexmedetomidine to ropivacaine in TAP block prolongs the time to first analgesic requirement without a difference in the total analgesic consumption.
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Affiliation(s)
- Kashish Garg
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Indu M Sen
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Preethy J Mathew
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
| | - Ravi P Kanojia
- Paediatric Surgery, Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh, India, Chandigarh, India
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Sen I, Dave N, Bhardwaj N, Juwarkar C, Beegum S. Specialised training in paediatric anaesthesia: Need of the hour. Indian J Anaesth 2021; 65:17-22. [PMID: 33767498 PMCID: PMC7980246 DOI: 10.4103/ija.ija_1445_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
Paediatric anaesthesia is an upcoming speciality which is gaining wide interest and can be a career choice for the new trainees. The need to develop paediatric anaesthesia as a speciality was realised with the progress in the field of paediatric surgery. The profile of the 'patient' encountered by a paediatric anaesthesiologist spans from an extremely premature neonate on the fringes of survival, to a full-grown adolescent equivalent to an adult. Perioperative morbidity and mortality are 2-3 times higher in infants and neonates compared to adults particularly in middle and low-income countries. The anatomical, physiological, pharmacological variations and presence of congenital cardiac, pulmonary and metabolic diseases in young children make perioperative management challenging. Special expertise and training are required for anaesthetic management of these preverbal children. In India, 3-years DM and 1-year Fellowship courses in paediatric anaesthesia are now available for specialisation. An ideal paediatric anaesthesia training centre should have substantial paediatric and neonatal patient load with exclusive intensive care facility. Paediatric anaesthesiologists, having knowledge of several facets of paediatrics and anaesthesia are capable of coordinating with health care professionals performing procedures outside the operating room. Paediatric anaesthesia, as a career thus offers a great opportunity to enhance quality and safety of anaesthesia in this high-risk surgical population. Persistent coordinated team efforts improve patient outcomes, reduce stress at work and increase job satisfaction.
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Affiliation(s)
- Indu Sen
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandini Dave
- Department of Anaesthesia, NH SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chitra Juwarkar
- Department of Anaesthesiology, Goa Medical College, Bambolim, Goa, India
| | - Shamshad Beegum
- Department of Anaesthesiology and Critical Care, Government Medical College, Thrissur, Kerala, India
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Alsaoudi T, Chung WY, Isherwood J, Bhardwaj N, Malde D, Dennison AR, Garcea G. HPB surgery in the time of COVID. Br J Surg 2020; 107:e588-e589. [PMID: 32936449 DOI: 10.1002/bjs.12030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Affiliation(s)
- T Alsaoudi
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - J Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - D Malde
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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D A, Jafra A, Bhardwaj N, Jain D, Luthra A, Malik MA. Evaluation of various anthropometric airway parameters as predictors of difficult airway in neonates: A prospective observational study. Int J Pediatr Otorhinolaryngol 2020; 138:110387. [PMID: 33152978 DOI: 10.1016/j.ijporl.2020.110387] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the relationship between various anthropometric parameters (age, weight, neck circumference, head circumference, thyromental distance, sternomental distance, frontal plane to chin distance, and frontal plane to chin distance by weight ratio) in neonates with difficult laryngoscopy and difficult intubation. DESIGN A Prospective, double-blind, observational study. SETTING Conducted in a Tertiary care Hospital in India. The study was conducted over a period of one year. PATIENTS Participants included 100 neonates undergoing either elective or emergency non-cardiac surgery under general anesthesia. INTERVENTIONS The various anthropometric parameters were correlated with Difficult laryngoscopy (Cormack Lehane grading III, IV) and Difficult intubation (Intubation Difficulty score>5). MEASUREMENTS Difficult laryngoscopy (Cormack lehane grade III, IV) and Difficult intubation (Intubation Difficulty score >5). MAIN RESULTS We found a statistically significant difference between weight (2.5 (2.2-2.8) kg vs 1.9 (1.55-2.35) kg), (p = 0.006), TMD (3.03 (2.74-3.46) cm vs 2.70 (2.45-3.13) cm), (p = 0.029), SMD (5.18 (5.06-5.76) cm vs 5.02 (4.84-5.29) cm), (p = 0.020) and FPCD/Wt ratio (0.31 (0.27-0.36) vs 0.44 (0.37-0.44)) with p = 0.001 in neonates with Easy and Difficult laryngoscopy. Using ROC curve analysis we calculated AUC, optimal cut off value, sensitivity, specificity, PPV and NPV for weight, TMD, SMD and FPCD/Wt ratio and found FPCD/Wt ratio to be best predictor for difficult laryngoscopy with highest AUC (0.844), high sensitivity (77.78%) and NPV (97.44%). CONCLUSIONS No single parameter can provide a high index of sensitivity and specificity to predict difficult airway in neonates. Therefore, a combination of tests, including Weight, TMD, SMD, and FPCD/Wt ratio, should be used. To the best of our knowledge, this is the first prospective study to assess predictors to the difficult airway in neonates.
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Affiliation(s)
- Aparna D
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
| | - Anudeep Jafra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
| | - Divya Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
| | - Ankur Luthra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
| | - Muneer Abas Malik
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
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Jain A, Bhardwaj N, Yaddanapudi S. What a pediatric anesthesiologist should know about COVID-19. J Anaesthesiol Clin Pharmacol 2020; 36:S85-S91. [PMID: 33100654 PMCID: PMC7573993 DOI: 10.4103/joacp.joacp_237_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic has posed unprecedented challenges and has unique implications for pediatric anesthesiologists. While children have a less severe clinical course compared to adults, they might be an important component in the transmission link by being asymptomatic carriers. Thus, it is essential to have practice guidelines for pediatric health care providers to limit transmission while providing safe and optimum care to our patients. Here we provide a brief review of the unique epidemiology and clinical characteristics of COVID-19 inflicted children. We have also reviewed various pediatric anesthesia guidelines and summarized the same to provide insight into the goals of management. We share the protocols that have been formulated and adopted in the pediatric anesthesia wing of our tertiary care hospital. This article lays special emphasis on the preparation of specialized protocols, designated areas, and training of personnel expected to be involved in patient care. The operating room should be well equipped with weight and age-appropriate equipment and drugs. Special attention should be paid to minimize aerosol generation via premedication and physical barriers. Induction and airway handling should be performed rapidly and securely with minimum personnel present. Disconnections should be avoided during maintenance. Extubation and transfer of children should be smooth. These protocols and guidelines are being constantly reviewed and updated as new evidence emerges. Our goal as pediatric anesthesiologists is to provide anesthesia that is safe for the child while preventing and minimizing the risk of infection to health care workers.
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Affiliation(s)
- Aditi Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta A, Sen I, Bhardwaj N, Yaddanapudi S, Mathew PJ, Sahni N, Bhatia A. Prospective audit of sedation/anesthesia practices for children undergoing computerized tomography in a tertiary care institute. J Anaesthesiol Clin Pharmacol 2020; 36:156-161. [PMID: 33013027 PMCID: PMC7480298 DOI: 10.4103/joacp.joacp_16_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/25/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: The aim of the study was to enumerate the sedative drugs used, assess the efficacy of sedative drugs, and determine the incidence of adverse events. Material and Methods: A prospective audit of children sedated for computerized tomography (CT) by anesthesiology team was conducted for a period of 4 months. The data included patient demographic variables, fasting period, medications administered, adequacy of sedation, imaging characteristics, adverse events, and requirement for escalated care. Results: A total of 331 children were enrolled for sedation by the anesthesia team. The drugs used for sedation were propofol, ketamine, and midazolam. Twenty-two percent children received one sedative drug, 60% children were administered two drugs, and 5% children required a combination of all three drugs for successful sedation. Sedation was effective for successful conduct of CT scan in 95.8% patients without the requirement of a repeat scan. Twelve (5%) children experienced adverse events during the study period. However, none of the adverse events necessitated prolonged postprocedural hospitalization or resulted in permanent neurologic injury or death. Conclusions: The current practice of sedation with propofol, ketamine, and midazolam, either single or in combination was efficacious in a high percentage of patients. The incidence of adverse events during the study period was low.
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Affiliation(s)
- Aakriti Gupta
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Sen
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kumar S, Singh A, Bhardwaj N. Macrostomia with tracheoesophageal fistula in a neonate: Airway challenge. Paediatr Anaesth 2020; 30:723-724. [PMID: 33210427 DOI: 10.1111/pan.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sumit Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jain D, Ray S, Yaddanapudi S, Bhardwaj N. Effect of different fraction of inspired oxygen on development of atelectasis in mechanically ventilated children: A randomized controlled trial-A Comment. Paediatr Anaesth 2020; 30:628. [PMID: 32500964 DOI: 10.1111/pan.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Divya Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swarup Ray
- Department of Pediatric Anaesthesia, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Moharana S, Jain D, Bhardwaj N, Gandhi K, Yaddanapudi S, Parikh B. Pressure support ventilation-pro decreases propofol consumption and improves postoperative oxygenation index compared with pressure-controlled ventilation in children undergoing ambulatory surgery: a randomized controlled trial. Can J Anaesth 2020; 67:445-451. [PMID: 31898776 PMCID: PMC7222075 DOI: 10.1007/s12630-019-01556-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/09/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The PSVPro mode is increasingly being used for surgeries under laryngeal mask airway owing to improved ventilator-patient synchrony and decreased work of breathing. We hypothesized that PSVPro ventilation mode would reduce consumption of anesthetic agents compared with pressure control ventilation (PCV). METHODS Seventy children between three and eight years of age undergoing elective lower abdominal and urological surgery were randomized into PCV group (n = 35) or PSVPro group (n = 35). General anesthesia was induced with sevoflurane and a Proseal LMA™ was inserted. Anesthesia was maintained with propofol infusion to maintain the entropy values between 40 and 60. In the PCV mode, the inspiratory pressure was adjusted to obtain an expiratory tidal volume of 8 mL·kg-1 and a respiratory rate of 12-20/min. In the PSVPRO group, the flow trigger was set at 0.4 L·min-1 and pressure support was adjusted to obtain expiratory tidal volume of 8 mL·kg-1. Consumption of anesthetic agent was recorded as the primary outcome. Emergence time and discharge time were recorded as secondary outcomes. RESULTS The PSVPro group showed significant reduction in propofol consumption compared with the PCV group (mean difference, 33.3 µg-1·kg-1·min-1; 95% confidence interval [CI], 24.2 to 42.2). There was decrease in the emergence time in the PSVPro group compared with the PCV group (mean difference, 3.5 min; 95% CI, 2.8 to 4.2) and in time to achieve modified Aldrete score > 9 (mean difference, 3.6 min; 95% CI, 1.9 to 5.2). CONCLUSION The PSVPro mode decreases propofol consumption and emergence time, and improves oxygenation index in children undergoing ambulatory surgery. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2017/12/010942); registered 21 December, 2017.
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Affiliation(s)
- Swapnabharati Moharana
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Divya Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Komal Gandhi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Badal Parikh
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
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Bajpai V, Singh P, Chakraborty R, Bhardwaj N, Mathur P. Anti-microbial-resistance and profile of exotoxins of invasive beta-haemolytic-streptococci infections in trauma patients. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.140] [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: 10/25/2022] Open
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Jain A, Bhardwaj N. Need to replace codeine for management of paediatric post operative pain. Indian J Anaesth 2020; 64:83. [PMID: 32001920 PMCID: PMC6967372 DOI: 10.4103/ija.ija_696_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Aditi Jain
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Niyogi SG, Sen IM, Jayant A, Mandal B, Bhardwaj N, Yaddanapudi S, Mathew P. Surrogate indices of aortic peak systolic velocity variation to monitor fluid responsiveness in pediatric non-cardiac surgery: a prospective observational study. J Clin Monit Comput 2019; 34:1159-1166. [PMID: 31811550 DOI: 10.1007/s10877-019-00431-8] [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: 06/01/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Aortic peak systolic velocity variation (ΔVpeakAo) is a reliable dynamic indicator of preload in mechanically ventilated children. However, easily measurable alternative parameters like carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakSs) are not well evaluated in children. The aim of the study was to find correlation between ΔVpeakCa and ΔVpeakSs to ΔVpeakAo, as potential surrogate markers of fluid responsiveness. 52 children, 1-12 years old, undergoing major non-cardiac surgeries under general endotracheal anaesthesia were recruited for this single-centre prospective observational study. ΔVpeakAo, ΔVpeakCa and ΔVpeakSs were measured by pulsed wave Doppler in appropriate windows, measuring maximum and minimum peak flow velocity over a single respiratory cycle. Calculated parameters were compared by a repeated measures study design. Correlation coefficients were 0.82 between ΔVpeakAo and ΔVpeakSs and 0.73 between ΔVpeakAo and ΔVpeakCa. Bland-Altman analysis showed minimal bias of 1.86 percentage points with limits of agreement of 11.21 to - 7.49 (ΔVpeakAo and ΔVpeakSs) and 3.93 percentage points with limits of agreement of 14.04 to - 6.18 (ΔVpeakAo and ΔVpeakCa). ΔVpeakSs and ΔVpeakCa also showed good discrimination to predict ΔVpeakAo (lying in previously validated fluid responsive zones) with sensitivities and specificities of 82.25% and 85% with cut-off of 11% for ΔVpeakSs, and 88.52% and 70% with cut-off of 8.6% for ΔVpeakCa. Carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakCa) can be potential surrogate markers for Aortic peak systolic velocity variation (ΔVpeakAo) in assessing fluid responsiveness in mechanically ventilated children.Study registration: Clinicaltrials.gov ID NCT03155555.
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Affiliation(s)
- Subhrashis Guha Niyogi
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India.
| | - Aveek Jayant
- Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of Medical Sciences and Research Centre, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682041, India
| | - Banashree Mandal
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Preethy Mathew
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
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Marron T, Wolf A, Flores R, Veluswamy R, Gomez J, Beasley M, Yankelevitz D, Leader A, Lowy I, Miller E, Thurston G, Jankovic V, Deering R, Brown B, Rahman A, Gnjatic S, Hirsch F, Bhardwaj N, Merad M. EP1.04-15 NSCLC Response Determinants to Chemoimmunotherapy: Deep Profiling of Tumors Following Neoadjuvant Cemiplimab and Chemotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2143] [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: 11/17/2022]
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Abstract
Fluid and blood administration are required during surgery in children. The type, amount and tonicity of the intravenous fluids is an important aspect to be considered during anaesthesia management. The physiological differences between adults and children regarding the body water and blood volume needs to be understood. We performed a PUBMED search for English language articles using keywords including 'children', 'intravenous fluid therapy', 'crystalloids', 'colloids', 'fluid homeostasis', 'Starling equation', 'Donnan effect', 'blood loss', 'estimation of blood loss', 'blood management program'. This review discusses the physiological basis, historical background, risk of hyponatraemia, need of glucose in the intravenous fluids as well as the recent concepts in blood transfusion as related to children.
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Affiliation(s)
- Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mathew P, Banoth R, Bhardwaj N, Yaddanappudi S, Sharma R. Evaluation of upper airway obstruction and ultrasonographic posterior tongue thickness in children scheduled for cleft lip/palate repair. Br J Anaesth 2019. [DOI: 10.1016/j.bja.2019.05.009] [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] Open
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Orfanelli T, Roudko V, Bozkus CC, Greenbaum B, Blank S, Bhardwaj N. Shared tumor antigens in uterine cancers with microsatellite instability: Putative targets for immunotherapeutic approaches. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.214] [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: 11/25/2022]
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Bhardwaj N. Enhanced recovery after surgery. J Anaesthesiol Clin Pharmacol 2019; 35:S3-S4. [PMID: 31142952 PMCID: PMC6515718 DOI: 10.4103/joacp.joacp_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta A, Bhardwaj N, Sarkar S, Kanojia RP. Endoscopic excision of hydatid cyst: A case of delayed anaphylaxis in postoperative period - “The risk is not over until it is over”. J Clin Anesth 2019; 52:63-64. [DOI: 10.1016/j.jclinane.2018.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 08/28/2018] [Accepted: 09/08/2018] [Indexed: 11/29/2022]
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Abstract
The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol TV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P<0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P<0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.
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Affiliation(s)
- I Bala
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Goel N, Bhardwaj N, Gupta A, Gowtham K. Giant vallecular cyst excision in infant: Should we proceed without a definite airway? Saudi J Anaesth 2018; 12:647-649. [PMID: 30429754 PMCID: PMC6180690 DOI: 10.4103/sja.sja_149_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nitika Goel
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gowtham
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma J, Sango C, Kaur P, Bhardwaj N. Crude cellulase treatment for reactivity enhancement of pre-hydrolysed kraft dissolving pulp for viscose. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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48
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Ott P, Govindan R, Naing A, Friedlander T, Margolin K, Lin J, Bhardwaj N, Hellman M, Srinivasan L, Greshock J, Moles M, Gaynor R, Goldstein M, Hu-Lieskovan S. A personal neoantigen vaccine, NEO-PV-01, with anti-PD1 induces broad de novo anti-tumor immunity in patients with metastatic melanoma, NSCLC, and bladder cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhardwaj N, Ragonnet-Cronin M, Murrell B, Chodavarapu K, Martin R, Chang S, Miller MD, Feld JJ, Sulkowski M, Mangia A, Wertheim JO, Osinusi A, McNally J, Brainard D, Mo H, Svarovskaia ES. Intrapatient viral diversity and treatment outcome in patients with genotype 3a hepatitis C virus infection on sofosbuvir-containing regimens. J Viral Hepat 2018; 25:344-353. [PMID: 29112331 DOI: 10.1111/jvh.12825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022]
Abstract
Treatment with the direct-acting antiviral agent (DAA) sofosbuvir (SOF), an NS5B inhibitor, and velpatasvir (VEL), an NS5A inhibitor, demonstrates viral cure rates of ≥95% in hepatitis C virus (HCV) genotypes (GT) 1-6. Here, we investigated intrapatient HCV diversity in NS5A and NS5B using Shannon entropy to examine the relationship between viral diversity and treatment outcome. At baseline, HCV diversity was lowest in patients infected with HCV GT3 as compared to the other GTs, and viral diversity was greater in NS5A than NS5B (P < .0001). Treatment outcome with SOF/VEL or the comparator regimen of SOF with ribavirin (RBV) was not correlated with baseline diversity. However, among persons treated with SOF/VEL, a decrease in diversity from baseline was observed at relapse in the majority virologic failures, consistent with a viral bottleneck event at relapse. In contrast, an increase in diversity was observed in 27% of SOF+RBV virologic failures. We investigated whether the increase in diversity was due to an increase in the transition rate, one mode of potential RBV-mediated mutagenesis; however, we found no evidence of this mechanism. Overall, we did not observe that viral diversity at baseline influenced treatment outcome, but the diversity changes observed at relapse can improve our understanding of RBV viral suppression in vivo.
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Affiliation(s)
- N Bhardwaj
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | | | - B Murrell
- University of California San Diego, San Diego, CA, USA
| | - K Chodavarapu
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - R Martin
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - S Chang
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - M D Miller
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - J J Feld
- Toronto Centre for Liver Disease, University of Toronto, Toronto, ON, Canada
| | - M Sulkowski
- Johns Hopkins University, Baltimore, MD, USA
| | - A Mangia
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - J O Wertheim
- University of California San Diego, San Diego, CA, USA
| | - A Osinusi
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - J McNally
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - D Brainard
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - H Mo
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
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Ahuja P, Jain D, Bhardwaj N, Jain K, Gainder S, Kang M. Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study. Int J Obstet Anesth 2018; 33:17-22. [DOI: 10.1016/j.ijoa.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
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