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Uppal S, Emani S, Mazzaferri E, Mast D, Satyapriya S, Whitson B, Boudoulas K. Out-of-hospital cardiac arrest due to refractory pulseless ventricular tachycardia and/or ventricular fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0657] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Survival rates for out-of-hospital cardiac arrest (OOHCA) are extremely low and neurologic recovery is poor. Extracorporeal cardiopulmonary resuscitation (ECPR), which combines extracorporeal membrane oxygenation (ECMO) with cardiopulmonary resuscitation (CPR), has emerged as a viable strategy to improve outcomes in OOHCA. A collaborative ECPR program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire Emergency Medical Services (EMS).
Purpose
Outcomes for patients who present as an ECPR alert from the field, but did not meet predefined criteria for placement of extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL) is described.
Methods
Between September 15, 2017 and October 12, 2019, 50 subjects presented as an ECPR alert for OOHCA secondary to pulseless VT/VF refractory to defibrillation. All subjects were placed on an automated CPR device prior to transfer to the CCL. From these 50 individuals, 28 (56%) did not meet prespecified laboratory criteria (lactate ≤15 mg/dL, partial pressure of oxygen (PaO2) ≥50 mm Hg, end-tidal carbon dioxide (ETCO2) of ≥10) and did not have a shockable rhythm in the CCL, thus ECMO was not placed and usual care for cardiac arrest was administered.
Results
Nine (32%) of the 28 patients achieved return of spontaneous circulation (ROSC), while the remaining 19 (68%) where pronounced deceased in the CCL. All 9 patients who achieved ROSC underwent a coronary angiography with 4 (44%) requiring percutaneous coronary intervention and 4 (44%) requiring an acute mechanical circulatory support device (Impella with 1 change out to ECMO). Of the patients that achieved ROSC, 4 (44%) were discharged from the hospital with good neurologic recovery; the remaining 5 (56%) ultimately expired during the hospitalization. From the initial 28 patient cohort, there were 4 (14%) patients discharged alive. Patients who achieved ROSC as compared to no ROSC were found on presentation in the CCL to have a significantly lower lactate (12.3±4.3 vs 16.2±3.6, respectively; p=0.03) and greater PaO2 (145±125 vs 47±9, respectively; p=0.01); there was no significant differences between groups in ETCO2, age or emergency services dispatch to CCL arrival time.
Conclusion
This study demonstrates that an ECPR program for OOHCA due to refractory VT/VF may provide benefit to patients that do not meet the predefined criteria for ECMO. This may be due to minimizing no flow/low flow time by early recognition and ongoing CPR en route to the CCL by a skilled EMS team, high efficiency citywide expedited transport/triage, the provision of high quality uninterrupted chest compressions using the mechanical CPR device during transport, and the care provided by highly trained multidisciplinary team members in the CCL.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Uppal
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - S Emani
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - E Mazzaferri
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - D Mast
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - S Satyapriya
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - B Whitson
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - K.D Boudoulas
- Ohio State University Wexner Medical Center, Columbus, United States of America
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Dey A, Das R, Misra H, Uppal S. Coronavirus disease 2019: scientific overview of the global pandemic. New Microbes New Infect 2020; 38:100800. [PMID: 33133611 PMCID: PMC7591944 DOI: 10.1016/j.nmni.2020.100800] [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: 08/29/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Genome sequencing of the virus revealed that it is a new zoonotic virus that might have evolved by jumping from bats to humans with one or more intermediate hosts. The immediate availability of the sequence information in the public domain has accelerated the development of quantitative RT-PCR-based diagnostics. Numerous clinical trials have been prioritized globally for testing new vaccines and treatments against this disease. This review provides a broad insight into different aspects of COVID-19, an introduction to SARS-CoV-2 mitigation strategies and the present status of diagnostics and therapeutics.
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Affiliation(s)
- A. Dey
- Molecular Genetics Section, Molecular Biology Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
| | - R. Das
- Molecular Genetics Section, Molecular Biology Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
- Homi Bhabha National Institute, Anushakti Nagar, Mumbai, India
| | - H.S. Misra
- Molecular Genetics Section, Molecular Biology Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
- Homi Bhabha National Institute, Anushakti Nagar, Mumbai, India
| | - S. Uppal
- Molecular Genetics Section, Molecular Biology Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
- Homi Bhabha National Institute, Anushakti Nagar, Mumbai, India
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Vetter M, Smrz S, Gehrig P, Peng K, Matsuo K, Davidson B, Cisa M, Lees B, Brunette L, Tucker K, Stuart Staley A, Gotlieb W, Holloway R, Essel K, Holman L, Goldfeld E, Olawaiye A, Rose S, Uppal S, Bixel K. Pathologic and clinical tumor size discordance in early-stage cervical cancer: Does it matter? Gynecol Oncol 2020; 159:354-358. [DOI: 10.1016/j.ygyno.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023]
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Schmidt P, Kamdar N, Swenson C, Uppal S, Morgan D. 06: Development of a preoperative prediction tool for postoperative complications after hysterectomy. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.029] [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: 10/24/2022]
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Uppal S, Burns L, Marzano D. 60: Using iPAD based interactive white board app to create annotated surgical videos for training purposes. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uppal S, Tilea A, Morgan D, Pearlman M. 16: Bundled interventions and an institutional focus on infection prevention significantly reduces post-hysterectomy infectious morbidity. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elghadi R, Uppal S, Chotalia M, Grant J. Escalation plans and DNACPR discussions in the unwell oncology patient. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz261.001] [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: 11/13/2022] Open
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Horner W, Pleasant V, Peng K, Brackmann M, Ebott J, Gutfreund R, Reynolds R, Uppal S. Trends in surgical complexity in ovarian cancer surgery in the era of increasing neoadjuvant chemotherapy: A National Cancer Database study. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.457] [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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Brackmann M, Ebott J, Gutfreund R, McLean K, Reynolds R, Uppal S. 'Present on admission': Reducing catheter-associated urinary tract infections in gynecologic oncology patients with universal intraoperative screening. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Michaels B, Hesson A, Argyelan A, Luo T, Uppal S, Liu J. Guided imagery and distress in perioperative gynecologic oncology: A randomized control trial. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.386] [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: 11/26/2022]
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Pleasant V, Spencer R, Bell S, Reynolds R, Rice L, Uppal S. Variation in utilization of end-of-life resources by cancer site. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.381] [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: 11/30/2022]
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Peng K, Pleasant V, Bell S, Horner W, Ebott J, Gutfreund R, Reynolds R, Uppal S. 88: Trends of acute venous thromboembolism during index surgical hospitalization in patients undergoing hysterectomy and risk of readmission. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cun H, Huffman L, Neimi C, Medlin E, Uppal S, Spencer R, Al-Niaimi A. Longitudinal Outcome Study: What are the Factors That Impact Clinically Relevant Post-Operative Complications in Single-Port Laparoscopy. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Singla M, Singh S, Uppal S, Garg S, Singh G. Clinical profile of patients presenting with headache in a tertiary care hospital in North India. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2657] [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: 12/01/2022]
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Spencer R, Hacker K, Rice L, Reynolds R, Griggs J, Uppal S. Ultra-high volume centers result in both reduced 30-day and 90-day risk-adjusted mortality for high-grade serous ovarian cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.149] [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: 10/19/2022]
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Bregar A, Melamed A, Diver E, Clemmer J, Uppal S, Schorge J, Rice L, del Carmen M, Rauh-Hain J. Minimally invasive staging surgery in women with early-stage endometrial cancer: Analysis of the National Cancer Data Base. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Uppal S, Spencer R, del Carmen M, Rice L, Griggs J. Hospital readmission as a quality measure in ovarian cancer surgery. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.033] [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: 10/19/2022]
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Spencer R, Rice L, Uppal S. Using the National Comprehensive Cancer Network guidelines and levels of evidence to prioritize research focus in gynecologic cancer care. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.091] [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: 10/19/2022]
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Till SR, Morgan DM, Pearlman MD, Bazzi AA, Reynolds RK, Uppal S. Role of Metronidazole in Reducing Surgical Site Infections After Hysterectomy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Medlin E, Spencer RJ, Hufman L, Uppal S, Sandeep S, Barroilhet L, Rice LW, Al-Niaimi A. Surgeon's Heart Rate Measurements as a Means of Evaluating Proficiency in Newly Adopted Surgical Technique in Gynecologic Oncology Surgery. J Minim Invasive Gynecol 2016; 22:S90-S91. [PMID: 27679375 DOI: 10.1016/j.jmig.2015.08.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Medlin
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
| | - R J Spencer
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
| | - L Hufman
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
| | - S Uppal
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
| | - S Sandeep
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
| | - L Barroilhet
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
| | - L W Rice
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
| | - A Al-Niaimi
- Ob/Gyn, University of Wisconsin, Madison, Wisconsin
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Mistry H, Uppal S, Nadig S, Coatesworth A, Grace A. Remodeling of the temporal bone after involvement with langerhans' cell histiocytosis. Acta Radiol 2016; 44:355. [PMID: 12752013 DOI: 10.1080/j.1600-0455.2003.00077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chapman C, Uppal S, Prisciandaro J, Maturen K, Jolly S. Vaginal cuff underdosing is observed across different surgical approaches. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.504] [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]
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Szmal P, Bazzi A, Reynolds R, McLean K, Uppal S. Incidence and the timing of thromboembolic events in ovarian cancer patients undergoing neoadjuvant chemotherapy. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stasenko M, Reynolds R, Brackmann M, McLean K, Spencer R, Uppal S, Johnston C. Adherence to hematologic hold parameters in dose-dense chemotherapy for ovarian malignancies: A survey of the National Comprehensive Cancer Network (NCCN) sites. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.279] [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: 12/01/2022]
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Bazzi A, Harris J, Morgan D, Pearlman M, Reynolds R, Campbell D, Uppal S. 15: Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis after abdominal hysterectomy. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Barnes H, Spencer R, Uppal S, Rice L, Al-Niaimi A. The Adoption of Single-Port Laparoscopic Full Staging for Endometrial Cancer: Safety, Learning Curve and Surgical Outcome. J Minim Invasive Gynecol 2015; 22:S49-S50. [DOI: 10.1016/j.jmig.2015.08.136] [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: 10/22/2022]
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Huffman LB, Spencer RJ, Medlin EE, Uppal S, Rice LW, Al-Niaimi AN. Successful Adoption of Single-Port Laparoscopy for Gynecologic Indications: Outcomes From a Large Single Institution’s Experience. J Minim Invasive Gynecol 2015; 22:S98. [DOI: 10.1016/j.jmig.2015.08.263] [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: 10/22/2022]
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Uppal S, Sunmboye K, Moorthy A. AB1207 Audit on the Management of Rheumatology Patients Who Developed Malignancy While on Anti TNF Treatment. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Uppal S, Stasenko M, McLean K, Liu J, Johnston C, Reynolds R. Predictors of 30-day readmission in gynecologic oncology. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.205] [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: 11/30/2022]
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Affiliation(s)
- M Tan
- Department of Otorhinolaryngology, Khoo Teck Puat Hospital, Singapore City, Singapore.
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Igwe E, Hernandez E, Rose S, Uppal S. Resident Participation in Laparoscopic Hysterectomy: Impact of Trainee Involvement on Operative Times and Surgical Outcomes. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Spencer R, Al-Niaimi A, Uppal S, Kushner D. Robotic Radical Parametrectomy with Repair of Previously Undiscovered Ureteral Injury. J Minim Invasive Gynecol 2013. [DOI: 10.1016/j.jmig.2013.08.177] [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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Salib R, Talpallikar S, Uppal S, Nair S. A prospective randomised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products Sterimar™ and Sinus Rinse™ following functional endoscopic sinus surgery. Clin Otolaryngol 2013; 38:297-305. [DOI: 10.1111/coa.12132] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
- R.J. Salib
- Academic unit of Clinical and Experimental Sciences; Department of Otorhinolaryngology - Head and Neck Surgery; University Hospital Southampton NHS Foundation Trust; Southampton; UK
| | - S. Talpallikar
- Department of Otorhinolaryngology - Head and Neck Surgery; Royal Hampshire County Hospital; Winchester; UK
| | - S. Uppal
- Department of Otorhinolaryngology - Head and Neck Surgery; Khoo Teck Puat Hospital; Singapore City; Singapore
| | - S.B. Nair
- Department of Otorhinolaryngology - Head and Neck Surgery; Auckland University Hospitals and Manukau SuperClinic; Auckland; New Zealand
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Albertin C, Uppal S, Al Niami A, Hinshaw J, Seo S, Hartenbach E. Clinical factors predictive of postoperative pulmonary embolism in gynecologic cancer patients. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
A 17-year-old male presented with a 10-day history of symptoms of upper respiratory tract infection, headaches, photophobia and progressive swelling around both eyes. Clinical examination revealed a temperature of 39 °C and bilateral periorbital swelling which was worse on the left side. Initial ophthalmological examination revealed a dilated non-reactive pupil on the left side and a sluggish pupillary reflex on the right side. The patient also had a lateral rectus palsy of the left eye. Fundoscopy showed bilateral papilloedema, and visual acuity on admission was 6/12 in the right and 6/18 in the left eye. Ear, nose and throat examination revealed a rhinitic nasal mucosa with thick mucopus in the left middle meatus. The patient required surgical intervention to drain his sinuses followed by long-term intravenous antibiotic therapy and anticoagulation. After 6 weeks of therapy and close observation, he recovered with minimal sequelae.
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Uppal S, Potti S, Chatwani A, Hernandez E, Dandolu V. Novasure as a Mechanical Endometrial Preparation Agent Compared to GnRH Analogs Prior to Roller Ball Ablation. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.578] [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: 10/19/2022]
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Gomez N, Uppal S, Hernandez E, Dandolu V. Patient Perception of Laparoendoscopic Single-Site (LESS) Gynecologic Surgery and Preference of Surgical Scar. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.138] [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: 10/19/2022]
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Gomez N, Uppal S, Milicia A, Hernandez E, Quintero-Arias C. Comparison of Abdominal Entry Techniques Using Specialized Ports in Laparo-Endoscopic Single-Site (LESS) Gynecologic Surgery: Our Experience. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.417] [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: 10/19/2022]
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Uppal S, Frumovitz M, Escobar P, Ramirez P. Laparo-Endoscopic Single-Site Surgery in Gynecology – A Review of the Literature and Available Technology. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.088] [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: 11/30/2022]
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Abstract
The surgical management for otosclerosis has evolved from stapes mobilisation to total extraction of the footplate, the so called 'stapedectomy', to a small hole in the stapes footplate, the 'stapedotomy'. The aim of stapes surgery is to restore the vibration of fluids within the cochlear canal. Revision stapedectomy should be approached with caution. Stapedectomy can lead to some minor and other more serious complications.
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Affiliation(s)
- Y Bajaj
- Department of ENT, York Hospital, York, UK.
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Abstract
The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. There is some increase in the incidence of stapedial otospongiosis in a low-fluoride area compared with a high-fluoride area. Sodium fluoride treatment has a role to play in preventing the onset and progression of hearing loss in patients suffering from otosclerosis. Sodium fluoride therapy has been shown to have some beneficial effect on dizziness associated with otosclerosis. In view of the possibility of systemic side effects of sodium fluoride therapy, a regular follow up of patients is warranted. Biphosphonates can be used as an alternative treatment to sodium fluoride in cases where the patient is intolerant to sodium fluoride therapy. Hearing aid is also a treatment option, but it does not halt the disease process.
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Affiliation(s)
- S Uppal
- Department of ENT, York Hospital, York, UK.
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Abstract
Otosclerosis is a bone dystrophy localised to the inner ear and the stapes footplate. Otosclerosis is a frequent cause of deafness in adults. The patient with otosclerosis typically presents with a history of slowly progressive conductive or mixed hearing loss that is usually bilateral and often asymmetric, usually between the ages of 15 and 45 years. The disease is characterised by alternating phases of bone resorption and formation. The majority of studies on families with otosclerosis suggest an autosomal dominant mode of inheritance with incomplete penetrance.
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Affiliation(s)
- S Uppal
- Department of ENT, York Hospital, York, UK
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45
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Abstract
Cowden disease is a genetically inherited disorder presenting with multiple hamartomatous and neoplastic lesions in various organs and tissues. We present a review of the diagnostic criteria, clinical presentation, genetics, and management of this condition.
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Affiliation(s)
- S Uppal
- Molecular Medicine Unit, University of Leeds, St. James's University Hospital, Leeds, UK.
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46
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Nadig SK, Uppal S, Back GW, Coatesworth AP, Grace ARH. Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review. J Laryngol Otol 2006; 120:608-9. [PMID: 16681864 DOI: 10.1017/s0022215106001125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2005] [Indexed: 11/05/2022]
Abstract
The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent.We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms.Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.
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Affiliation(s)
- S K Nadig
- Department of ENT, York District Hospital, York, UK.
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47
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Uppal S, Jose J, Banks P, Mackay E, Coatesworth AP. Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. J Laryngol Otol 2006; 118:189-92. [PMID: 15068514 DOI: 10.1258/002221504322927946] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The need to reduce costs while providing a first-class service has led to the expansion in the role of nurses in recent years. We present results of a comparison of the cost-effectiveness of conventional and nurse-led out-patient ear clinics. Our results indicate that cost-effective health care is a distinct competitive advantage for nurses taking up some roles conventionally performed by doctors. The difference in mean cost of out-patient visit per patient between the two groups is £75.28. This is equivalent to a reduction in cost to the hospital of more than £47000 for the 626 patients seen in a nurse-led ear clinic in a year. The nurse-led service is thus more cost-effective and presents an opportunity by freeing up otolaryngologists’ time to see more complex patients and has the potential for reducing out-patient access time in the NHS.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
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48
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Abstract
Otolaryngologic symptoms are common and patients presenting to the otolaryngologist will often be taking drugs for the treatment of unrelated diseases. As a doctor, one must not forget the potential of these drugs to cause otologic side effects and, in some cases, to be the cause of the presenting symptom. We performed a comprehensive search of the British National Formulary and Electronic Medical Compendium websites to classify the otologic side effects caused by drugs. Not all the data were found at both websites. We have compiled all the data together, subclassified them and produced a review of the otologic side effects of drugs, in table form.
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Affiliation(s)
- C A Lee
- Department of Otolaryngology, York Hospital, York, UK.
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49
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Abstract
From ancient times up to the present day many different functions and conditions have been attributed to the uvula, many speculative and some with a more scientific basis. The uvula has been shown to have the ability to produce and secrete large quantities of thin saliva. A common complication of surgery involving removal of the uvula is pharyngeal dryness. We have observed that on phonation and swallowing the uvula swings back and forth in the oropharynx. We present a review of the literature on the uvula and propose a theory that the uvula bastes the throat and thereby helps keep it moist and well lubricated.
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Affiliation(s)
- G W Back
- Department of Otolaryngology/Head and Neck Surgery, York District Hospital, Wigginton Road, York, UK.
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50
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Uppal S, Sharma R, Nadig SK, Back G, England RJA, Coatesworth AP. A blindedin-vitrostudy to compare the efficacy of five topical ear drops in clearing grommets blocked with thick middle ear effusion fluid. Clin Otolaryngol 2005; 30:29-34. [PMID: 15748186 DOI: 10.1111/j.1365-2273.2004.00920.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the efficacy of 5% NaHCO3, 3% H2O2, Sofradex (dexamethasone sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%), 0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with harvested thick middle ear effusion fluid. STUDY DESIGN A blinded in-vitro study. SETTING District general hospital. PARTICIPANTS A total of 473 grommets were blocked with freshly harvested unpooled thick middle ear effusion fluid obtained from 68 patients. MAIN OUTCOME MEASURES Patency of the grommets before and 7 days after intervention was ascertained by tympanometry and close visual inspection. RESULTS Instillation of eardrops leads to a statistically significant increase in the clearance of grommets as compared with not using any drops (chi2 = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8 for NaHCO3, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and 9.5 for H2O2 eardrops. Pair-wise comparison was only significant for comparison between 5% NaHCO3 and 3% H2O2 eardrops (Bonferroni corrected P = 0.01, odds ratio = 4.3, CI = 1.9-9.9). CONCLUSIONS Use of eardrops leads to a clinically and statistically significant increase in the clearance of blocked grommets. Of the five drops used, 5% NaHCO3 was the most efficacious and 3% H2O2 the least efficacious. Limitations of this in-vitro study are recognized and a prospective in-vivo double blind randomized controlled trial is planned.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
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