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Grover T, Dayal V, Fourcin A, Milabo C, Limousin P, Foltynie T. Quantifying Stridor Associated with Parkinsonism and Deep Brain Stimulation-A Case Report. Mov Disord Clin Pract 2022; 9:91-94. [PMID: 35005071 DOI: 10.1002/mdc3.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/01/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Timothy Grover
- Movement Disorders National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Viswas Dayal
- Neurology Department Auckland City Hospital Auckland New Zealand
| | - Adrian Fourcin
- Department of Linguistics, Faculty of Brain Sciences University College London London United Kingdom
| | - Catherine Milabo
- Movement Disorders National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London United Kingdom
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2
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Vijiaratnam N, Girges C, Wirth T, Grover T, Preda F, Tripoliti E, Foley J, Scelzo E, Macerollo A, Akram H, Hyam J, Zrinzo L, Limousin P, Foltynie T. Long-term success of low-frequency subthalamic nucleus stimulation for Parkinson's disease depends on tremor severity and symptom duration. Brain Commun 2021; 3:fcab165. [PMID: 34396114 PMCID: PMC8361419 DOI: 10.1093/braincomms/fcab165] [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] [Accepted: 06/14/2021] [Indexed: 11/15/2022] Open
Abstract
Patients with Parkinson’s disease can develop axial symptoms, including speech, gait and balance difficulties. Chronic high-frequency (>100 Hz) deep brain stimulation can contribute to these impairments while low-frequency stimulation (<100 Hz) may improve symptoms but only in some individuals. Factors predicting which patients benefit from low-frequency stimulation in the long term remain unclear. This study aims to confirm that low-frequency stimulation improves axial symptoms, and to go further to also explore which factors predict the durability of its effects. We recruited patients who developed axial motor symptoms while using high-frequency stimulation and objectively assessed the short-term impact of low-frequency stimulation on axial symptoms, other aspects of motor function and quality of life. A retrospective chart review was then conducted on a larger cohort to identify which patient characteristics were associated with not only the need to trial low-frequency stimulation, but also those which predicted its sustained use. Among 20 prospective patients, low-frequency stimulation objectively improved mean motor and axial symptom severity and quality of life in the short term. Among a retrospective cohort of 168 patients, those with less severe tremor and those in whom axial symptoms had emerged sooner after subthalamic nucleus deep brain stimulation were more likely to be switched to and remain on long-term low-frequency stimulation. These data suggest that low-frequency stimulation results in objective mean improvements in overall motor function and axial symptoms among a group of patients, while individual patient characteristics can predict sustained long-term benefits. Longer follow-up in the context of a larger, controlled, double-blinded study would be required to provide definitive evidence of the role of low-frequency deep brain stimulation.
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Affiliation(s)
- Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Christine Girges
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Wirth
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Timothy Grover
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Francesca Preda
- Unit of Neurology of Ospedale "M. Bufalini" of Cesena, Cesena, Italy
| | - Elina Tripoliti
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Foley
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Emma Scelzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Antonella Macerollo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Jonathan Hyam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Unit of Functional Neurosurgery, the National Hospital for Neurology and Neurosurgery, London, UK
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Dayal V, De Roquemaurel A, Grover T, Ferreira F, Salazar M, Milabo C, Candelario‐McKeown J, Zrinzo L, Akram H, Limousin P, Foltynie T. Novel Programming Features Help Alleviate Subthalamic Nucleus Stimulation‐Induced Side Effects. Mov Disord 2020; 35:2261-2269. [DOI: 10.1002/mds.28252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Viswas Dayal
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Alexis De Roquemaurel
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Timothy Grover
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Francisca Ferreira
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
| | - Maricel Salazar
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Catherine Milabo
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Joseph Candelario‐McKeown
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Harith Akram
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
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4
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Grover T, Georgiev D, Kalliola R, Mahlknecht P, Zacharia A, Candelario J, Hyam J, Zrinzo L, Hariz M, Foltynie T, Limousin P, Jahanshahi M, Tripoliti E. Effect of Low versus High Frequency Subthalamic Deep Brain Stimulation on Speech Intelligibility and Verbal Fluency in Parkinson's Disease: A Double-Blind Study. J Parkinsons Dis 2020; 9:141-151. [PMID: 30594934 DOI: 10.3233/jpd-181368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Subthalamic deep brain stimulation (STN-DBS) is an established treatment for late stage Parkinson's disease (PD). Speech intelligibility (SI) and verbal fluency (VF) have been shown to deteriorate following chronic STN-DBS. It has been suggested that speech might respond favourably to low frequency stimulation (LFS). OBJECTIVE We examined how SI, perceptual speech characteristics, phonemic and semantic VF and processes underlying it (clustering and switching) respond to LFS of 60 and 80 Hz in comparison to high frequency stimulation (HFS) (110, 130 and 200 Hz). METHODS In this double-blind study, 15 STN-DBS PD patients (mean age 65, SD = 5.8, 14 right handed, three females), were assessed at five stimulation frequencies: 60 Hz, 80 Hz, 110 Hz, 130 Hz and 200 Hz. In addition to the clinical neurological assessment of speech, VF and SI were assessed. RESULTS SI and in particular articulation, respiration, phonation and prosody improved with LFS (all p < 0.05). Phonemic VF switching improved with LFS (p = 0.005) but this did not translate to an improved phonemic VF score. A trend for improved semantic VF was found. A negative correlation was found between perceptual characteristics of speech and duration of chronic stimulation (all p < 0.05). CONCLUSIONS These findings highlight the need for meticulous programming of frequency to maximise SI in chronic STN-DBS. The findings further implicate stimulation frequency in changes to specific processes underlying VF, namely phonemic switching and demonstrate the potential to address such deficits through advanced adjustment of stimulation parameters.
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Affiliation(s)
- Timothy Grover
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Dejan Georgiev
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.,Department of Neurology, University Medical Centre Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia.,Faculty of Computer and Information Sciences, University of Ljubljana, Slovenia
| | - Rania Kalliola
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Philipp Mahlknecht
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.,Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - André Zacharia
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Joseph Candelario
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Jonathan Hyam
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Elina Tripoliti
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
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Dayal V, Grover T, Tripoliti E, Milabo C, Salazar M, Candelario‐McKeown J, Athauda D, Zrinzo L, Akram H, Hariz M, Limousin P, Foltynie T. Short Versus Conventional Pulse‐Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison. Mov Disord 2019; 35:101-108. [DOI: 10.1002/mds.27863] [Citation(s) in RCA: 13] [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] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 08/23/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Viswas Dayal
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Timothy Grover
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Elina Tripoliti
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Catherine Milabo
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Maricel Salazar
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Joseph Candelario‐McKeown
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Dilan Athauda
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Harith Akram
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Marwan Hariz
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
- Department of Clinical Neuroscience Umeå University Umeå Sweden
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery London United Kingdom
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Dayal V, Grover T, Limousin P, Akram H, Cappon D, Candelario J, Salazar M, Tripoliti E, Zrinzo L, Hyam J, Jahanshahi M, Hariz M, Foltynie T. The Effect of Short Pulse Width Settings on the Therapeutic Window in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s disease. JPD 2018; 8:273-279. [DOI: 10.3233/jpd-171272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Viswas Dayal
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Timothy Grover
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Harith Akram
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Davide Cappon
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Joseph Candelario
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Maricel Salazar
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Elina Tripoliti
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jonathan Hyam
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Ali N, Sawyer T, Barry J, Grover T, Ades A. Resuscitation practices for infants in the NICU, PICU and CICU: results of a national survey. J Perinatol 2017; 37:172-176. [PMID: 27787506 DOI: 10.1038/jp.2016.193] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Received: 05/23/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Infants requiring resuscitation at birth are resuscitated using neonatal resuscitation guidelines. Sometime after birth, resuscitation practice must transition to pediatric guidelines. There is no evidence on when this transition should occur. The objective of this study was to describe infant resuscitation practices in Neonatal Intensive Care Units (NICUs), Pediatric Intensive Care Units (PICUs) and Cardiac Intensive Care Units (CICUs). STUDY DESIGN An electronic survey was sent to medical directors of NICUs, PICUs and CICUs in the U.S. The survey examined resuscitation practices, and preference for use of neonatal or pediatric guidelines, for different postnatal ages, clinical scenarios and etiologies of arrest. RESULTS A total of 152 responses were received, including 118 NICUs, 19 PICUs and 15 CICUs. The majority of NICU responders used greater than 28 days as the time to change from neonatal to pediatric guidelines. The majority of PICU and CICU transitioned to pediatric guidelines immediately after birth. Pediatric guidelines were preferred in the PICU and CICU regardless of the arrest etiology. NICU responders favored pediatric guidelines only if the arrest was cardiac. CONCLUSIONS Our results suggest that infants are resuscitated using neonatal guidelines in the NICU and pediatric guidelines in the PICU and CICU, even if they are the same age and have the same etiology of arrest. There is no agreement on the time to change from neonatal to pediatric guidelines. Further research comparing the outcomes of infants resuscitated in these different units could inform future guideline refinement.
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Affiliation(s)
- N Ali
- University of Colorado School of Medicine and Children's Hospital Colorado, Division of Neonatology, Aurora, CO, USA
| | - T Sawyer
- University of Washington School of Medicine, Division of Neonatology, WA, USA
| | - J Barry
- University of Colorado School of Medicine and Children's Hospital Colorado, Division of Neonatology, Aurora, CO, USA
| | - T Grover
- University of Colorado School of Medicine and Children's Hospital Colorado, Division of Neonatology, Aurora, CO, USA
| | - A Ades
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
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9
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Prasad A, Grover T, Basu S. Coarse – grained molecular dynamics simulation of cross – linking of DGEBA epoxy resin and estimation of the adhesive strength. ACTA ACUST UNITED AC 2010. [DOI: 10.4314/ijest.v2i4.59196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Parakh R, Kapadia S, Agarwal S, Grover T, Bukhari S, Yadav A, Sen I, Pankaj P. Assessment of total thrombus load in symptomatic patients with venous thromboembolism. Clin Appl Thromb Hemost 2006; 12:369-72. [PMID: 16959693 DOI: 10.1177/1076029606291408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/15/2022] Open
Abstract
Pulmonary embolism (PE) and Deep vein thrombosis (DVT) are separate but related aspects of the same dynamic process termed as venous thrombembolism (VTE). The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from the Indian subcontinent. Between January 2001 and July 2004, 1,552 patients with clinically suspected lower limb DVT underwent a combined ascending radionuclide venogram and lung perfusion scan for assessment of the total thrombus burden. Of 744 patients with radionuclide venography proven DVT, 294 (40%) had a high probability lung scan. Nearly half of these patients were asymptomatic for pulmonary embolism. The high prevalence of PE in patients with DVT suggests the need for evaluation of thrombus load in the venous as well as pulmonary circulation. A combination radionuclide ascending venography with lung perfusion scan is a useful and reliable single test for this purpose.
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Affiliation(s)
- R Parakh
- Department of Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, New Delhi, India.
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11
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Escalante CP, Oh JH, Baum DD, Mante M, Zalpour A, Spivey S, Stewart C, Ensor J, Grover T, Freedman R. Immediate adverse reactions to chemotherapy: Experience of a large ambulatory treatment center. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8558 Background: In recent years there has been a proliferation of Ambulatory Chemotherapy Treatment Centers (ATC). The incidence of hypersensitivity and other immediate adverse drug reactions (IADR) in these ATC units have not been well studied. We aim to describe our experience with IADR in our ATC. Methods: Retrospective chart review was conducted for all patients in the Adverse Drug Reaction Report database (Maxsys II) for the year 2004. Data was abstracted for demographics, risk factors, clinical characteristics, and outcomes of IADR. Overall frequency of different chemotherapeutic and monoclonal agents infused was obtained for the same period through the pharmacy database. Results: In 2004, 81,580 chemotherapy infusions were given and 256 IADR (0.31%) were reported. The mean age was 55 years and 45% were males. The most common drugs used were fluorouracil (12.9%), paclitaxel (9.4%), docetaxel (6.1%), carboplatin (5.9%), and gemcitabine (5.8%). The table shows the most prevalent agents that led to IADR. Common symptoms included flushing (52.3%), dyspnea (27.3%), chest discomfort (27%), pruritus (22.7%), and hypertension (18.4%). Diphenhydramine (85.5%), hydrocortisone (37.1%), and dexamethasone (17.2%) were the most common drugs used for treatment of IADR. Common risk factors included previous allergy to medications (43.4%), previous IADR (19.5%), previous reactions to iodide (7.8%), allergies to seafood (1.6%), allergic rhinitis (1.2%), urticaria (1.2%), and asthma (0.8%). Most patients had their chemotherapy resumed and completed (87.9%) on the same day. Discussion: IADR were rare. Most cases were easily treated and chemotherapy was restarted and completed in the same day. However, they still pose a significant burden to cancer patients. Prospective studies are needed to further evaluate the identified risk factors and most common offending agents in outpatient settings. This will help develop pathways for more effective prevention and treatment of these IADR. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
| | - J. H. Oh
- UT M. D. Anderson Cancer Center, Houston, TX
| | - D. D. Baum
- UT M. D. Anderson Cancer Center, Houston, TX
| | - M. Mante
- UT M. D. Anderson Cancer Center, Houston, TX
| | - A. Zalpour
- UT M. D. Anderson Cancer Center, Houston, TX
| | - S. Spivey
- UT M. D. Anderson Cancer Center, Houston, TX
| | - C. Stewart
- UT M. D. Anderson Cancer Center, Houston, TX
| | - J. Ensor
- UT M. D. Anderson Cancer Center, Houston, TX
| | - T. Grover
- UT M. D. Anderson Cancer Center, Houston, TX
| | - R. Freedman
- UT M. D. Anderson Cancer Center, Houston, TX
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Kunig A, Balasubramaniam V, Markham N, Morgan D, Montgomery G, Grover T, Abman S. 171 RECOMBINANT HUMAN VEGF TREATMENT ENHANCES ALVEOLARIZATION AFTER HYPEROXIC LUNG INJURY IN NEONATAL RATS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.170] [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: 11/18/2022]
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Abstract
Cancer-related fatigue is now the most prevalent symptom of cancer, occurring in 60-90% of patients. Fatigue has been identified by cancer patients as a factor influencing functionality and quality of life. Our objectives in developing a fatigue specialty clinic at The University of Texas M. D. Anderson Cancer Center were to improve our patients' quality of life by decreasing fatigue; educate health care providers, patients, and patients' families about cancer-related fatigue; develop an appropriate clinical and diagnostic evaluation for this symptom; correlate objective measures of fatigue with its clinical evaluation; and develop innovative treatment plans for cancer-related fatigue. This article describes the general clinic design and operations and the preliminary analysis of the first 40 patients evaluated in the fatigue clinic.
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Affiliation(s)
- C P Escalante
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Limm WM, Ishikawa SN, Grover T, McNamara JJ, Piette LH. The use of oxygen free radical scavengers in the rat peritonitis model. Basic Life Sci 1988; 49:721-4. [PMID: 3150670 DOI: 10.1007/978-1-4684-5568-7_115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- W M Limm
- Cardiovascular Research Laboratory, Queen's Medical Center, Honolulu, Hawaii 96813
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Adhikari N, Avila ML, Kache S, Grover T, Ansari I, Basnet S. Establishment of Paediatric and Neonatal Intensive Care Units at Patan Hospital, Kathmandu: Critical Determinants and Future Challenges. J Nepal Paedtr Soc 1970. [DOI: 10.3126/jnps.v31i1.4161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Although preventive medicine and primary care are priorities in developing countries, they must be supported by appropriate care of sick and extremely sick children in the medical facilities. Lack of resources and absence of skilled physicians and nurses may lead to poor outcomes in critically ill patients. Intensive care of newborns and children is thought to be very expensive with a low cost-benefit ratio. This presentation discusses the critical factors that facilitated the establishment of PICU and NICU in an urban public hospital in Nepal, where a good standard of Level 2 care was already provided. Aims and objectives: A cooperative model of creation and transfer of technology from the West to a resource-poor country was envisaged. PICU and NICU with six beds each were established. Design and setting: The Nick Simons Foundation, USA provided financial support for design, building and furnishing of a new Mother and Child Wing at Patan Hospital. A generous grant of $300,000 again by the Nick Simons Foundation helped equip the units. Donated equipments also included procedures, medication and storage carts. Methodology: A total of 22 volunteers, 21 from USA and one from Netherlands, were recruited to complete the three months of training. An extensive curriculum was prepared. The trainer team had monthly teleconferences and regular communications with the Chief of Paediatric Services and Nursing Director of Patan Hospital via e-mails and telephone. Responsibilities of volunteers and the host hospital were identified. Results: After 3 years of preparation, the project started in June 2009. All day lectures on topics in critical care, mock case scenarios, practical equipment training and simulated procedures led to the graduation of 60 nurses. Twenty five physicians were trained for three months. The expert team worked with the locals in preparing the units, arranging furniture and equipment, stocking carts, making inventory and preparing protocols. A protocol handbook was developed on topics such as mechanical ventilation, sedation, admission/discharge criteria, procedures and management of different disease states. Various charts such as nurse observation charts, notes by residents, procedure hand offs at change of shifts were designed and printed. Infection control practices and methods of sterilizing non disposable articles were identified and protocols written. At the end of three months the units were functioning with trained local manpower and reasonable modern equipment. Conclusion: Developing nations may not have enough resources to establish much needed critical care facilities. Developed countries can help by funding basic infrastructure and providing expertise in order to transfer knowledge and technology. Involvement in planning from the beginning and training at the host site is a preferred model of transfer of technology. Key words: Paediatric Intensive Care Unit (PICU); Neonatal Intensive Care Unit (NICU); Patan Hospital DOI: 10.3126/jnps.v31i1.4161J Nep Paedtr Soc 2010;31(1):49-56
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Andreoli AJ, Grover T, Gholson RK, Matney TS. Evidence for a functional pyridine nucleotide cycle in Escherichia coli. Biochim Biophys Acta 1969; 192:539-41. [PMID: 4312778 DOI: 10.1016/0304-4165(69)90408-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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