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Tewari A. Phase I study of in-situ autologous vaccination for prostate cancer in a neo-adjuvant setting. EUR UROL SUPPL 2023. [DOI: 10.1016/s2666-1683(23)00044-7] [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: 01/31/2023] Open
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2
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Abstract
Transfer learning is one of the most appreciated classification techniques, when a small size of training dataset and limited computer capabilities exist along with the presence of noisy data. Such a scenario is encountered in keystroke dynamics whereby the typing gesticulation composed to form ‘keystroke dynamics’, is used to distinguish a human. Keystroke dynamics is persistently gaining reputation as one of the most promising and cost-effective behavioral biometrics. AlexNet and ResNet are two separate types of pre-trained convolutional neural network models, normally used to apply deep transfer learning concepts within image-based systems. Conversion of keystroke data into image data and then the formation of the artificial image data by extending available data are crucial attraction of this paper. In this paper, the pre-trained models are utilized by applying fine-tuning (of parameters in some layers) and used as an end-to-end learning and classification system by us. On the keystroke dataset, the feature extraction method (support vector machine for classification) is also applied here with pre-trained models. A relative analysis of both approaches is provided and lastly, the better one is employed in the proposed (recognition based) system. Finally, 98.57% accuracy of successful recognition is recorded.
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3
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2021; 45:e40-e42. [PMID: 34717886 PMCID: PMC8549443 DOI: 10.1016/j.medine.2020.06.014] [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] [Accepted: 06/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
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4
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Cotter C, Rudd E, Williamson E, Philippidou M, Tewari A. Anti-Ku-positive juvenile dermatomyositis. Clin Exp Dermatol 2021; 47:425-427. [PMID: 34528293 DOI: 10.1111/ced.14937] [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] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Cotter
- Department of Dermatology, King's College Hospital, London, UK
| | - E Rudd
- Department of Dermatology, King's College Hospital, London, UK
| | - E Williamson
- Department of Dermatology, King's College Hospital, London, UK
| | - M Philippidou
- Department of Dermatology, King's College Hospital, London, UK
| | - A Tewari
- Department of Dermatology, King's College Hospital, London, UK
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5
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Aydin A, Ahmed K, Abe T, Raison N, Van Hemelrijck M, Ahmed H, Al-Jabir A, Brunckhorst O, Shinohara N, Zhu W, Zeng G, Sfakianos J, Tewari A, Gözen A, Rassweiler J, Skolarikos A, Kunit T, Knoll T, Moltzahn F, Thalmann G, Lantz Powers A, Chew B, Sarica K, Khan M, Dasgupta P. Simulation in urological training and Education (SIMULATE): A randomised controlled clinical and educational trial to determine the effect of simulation-based surgical training. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01334-8] [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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6
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Cotter C, Howard E, Williamson E, Tewari A. Relapsing-remitting linear ecchymosis. Clin Exp Dermatol 2021; 46:931-932. [PMID: 33511668 DOI: 10.1111/ced.14582] [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] [Received: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C Cotter
- Department of Paediatric Dermatology, St Johns Institute of Dermatology, London, UK
| | - E Howard
- Department of Paediatric Dermatology, St Johns Institute of Dermatology, London, UK
| | - E Williamson
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - A Tewari
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
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7
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Tewari A, Khan I, Ostlere L. Type I and type IV systemic contact dermatitis to balsam of Peru with a particular reaction to cinnamyl alcohol. Clin Exp Dermatol 2020; 46:342-343. [PMID: 32357255 DOI: 10.1111/ced.14266] [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] [Accepted: 04/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- A Tewari
- Department of Dermatology, St George's Hospital, London, UK
| | - I Khan
- Department of Dermatology, St George's Hospital, London, UK
| | - L Ostlere
- Department of Dermatology, St George's Hospital, London, UK
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Pedregal Trujillo M, Ravi P, Shaw G, Markt S, Hamid A, Tewari A, Van Allen E, Sweeney C. 792P A retrospective review of the survival outcomes of patients with nonseminomatous germ cell tumors (NSGCTs) with and without teratoma in the primary. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.864] [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] Open
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9
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2020; 45:S0210-5691(20)30219-9. [PMID: 32912654 PMCID: PMC7334967 DOI: 10.1016/j.medin.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
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10
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Treacy P, Martini A, Falagario U, Ratnani P, Horowitz A, Wajswol E, Begemann D, Beksac A, Durand M, Wiklund P, Nair S, Kyprianou N, Tewari A. The role of connective tissue in prostate cancer growth and progression. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33007-x] [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] Open
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11
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Tewari A, Mahmoud M, Rose D, Ding L, Tenney J. Intravenous dexmedetomidine sedation for magnetoencephalography: A retrospective study. Paediatr Anaesth 2020; 30:799-805. [PMID: 32436319 DOI: 10.1111/pan.13925] [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: 12/24/2019] [Revised: 04/13/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Magnetoencephalography (MEG) plays a preponderant role in the preoperative assessment of patients with drug-resistant epilepsy (DRE). However, the magnetoencephalography of patients with drug-resistant epilepsy can be difficult without sedation and/or general anesthesia. Our objective is to describe our experience with intravenous dexmedetomidine as sedation for magnetoencephalography and its effect, if any, on the ability to recognize epileptic spikes. METHODS In this retrospective study, we reviewed the records of 89 children who presented for Magnetoencephalography/electroencephalography (EEG) scans between August of 2008 and May of 2015. Data analyzed included demographics and the frequency of epileptic spikes. Sedated magnetoencephalography recordings were compared to nonsedated video-electroencephalography (vEEG) recordings in the same patients to determine the impact of dexmedetomidine. RESULTS Spike frequency between magnetoencephalography with sedation and video-electroencephalography without sedation was compared in 85 patients. Magnetoencephalography and video-electroencephalography were considered clinically concordant in 80 patients (94.1%) and discordant in 5 patients (5.9%), all with less spikes during Magnetoencephalography. The median (range) bolus dose of dexmedetomidine was 2 (1-2) mcg/kg. The median (range) infusion rate of dexmedetomidine was 2 (0.5-4) mcg/kg/h. All patients experienced reductions in heart rate after administration of dexmedetomidine; these reductions were statistically, but not clinically, significant. CONCLUSIONS Our results suggest that dexmedetomidine-based protocol provides reliable sedation in children undergoing MEG scanning because of the high success rate, limited interictal artifacts, and minimal impacts on spike frequency.
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Affiliation(s)
- Anurag Tewari
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Douglas Rose
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey Tenney
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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12
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Bustamante M, Hernandez‐Ferrer C, Tewari A, Sarria Y, Harrison G, Puigdecanet E, Nonell L, Kang W, Friedländer M, Estivill X, González J, Nieuwenhuijsen M, Young A. A study into how ultraviolet radiation from the sun effects genes in the skin. Br J Dermatol 2020. [DOI: 10.1111/bjd.19071] [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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13
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Bustamante M, Hernandez‐Ferrer C, Tewari A, Sarria Y, Harrison G, Puigdecanet E, Nonell L, Kang W, Friedländer M, Estivill X, González J, Nieuwnhuijsen M, Young A. 太阳紫外线辐射如何影响皮肤基因的研究. Br J Dermatol 2020. [DOI: 10.1111/bjd.19083] [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: 11/27/2022]
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14
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Cotter CL, Rivers E, Salisbury J, Duarte Williamson E, Tewari A. Neonatal erythroderma. Clin Exp Dermatol 2020; 45:646-649. [PMID: 32212273 DOI: 10.1111/ced.14206] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- C L Cotter
- Department of Dermatology, King's College Hospital, London, UK
| | - E Rivers
- Department of Immunology, Great Ormond Street Hospital for Children, London, UK
| | - J Salisbury
- Department of Dermatology, King's College Hospital, London, UK
| | | | - A Tewari
- Department of Dermatology, King's College Hospital, London, UK
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15
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Abstract
The refractory seizures have significant impact on the quality of life and increase long term neurologic and non-neurologic complications. Implantation of Stereotactic Electroencephalography (SEEG) leads is one of the newer surgical techniques intended to localize seizure foci with higher accuracy than the conventional methods. Most of the commonly utilized anesthetic agents depress EEG waveforms affecting intra operative monitoring during these surgeries. Hence, the anesthetic goals include a stable induction and maintenance with agents which have minimal effect on EEG. This article discusses the peri-operative considerations of multiple anti-epileptic medications, recent advances in anesthetic management, and important post-operative concerns.
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Affiliation(s)
- Chakrabarti Rajkalyan
- Department of Anesthesiology, Newham University Hospital, Barts Health NHS Trust, London
| | | | - Shilpa Rao
- Department of Neuro-Anesthesiology, Yale School of Medicine and Yale-New Haven Hospital, CT, USA
| | - Rafi Avitsian
- Department of of Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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16
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Bustamante M, Hernandez-Ferrer C, Tewari A, Sarria Y, Harrison GI, Puigdecanet E, Nonell L, Kang W, Friedländer MR, Estivill X, González JR, Nieuwenhuijsen M, Young AR. Dose and time effects of solar-simulated ultraviolet radiation on the in vivo human skin transcriptome. Br J Dermatol 2019; 182:1458-1468. [PMID: 31529490 PMCID: PMC7318624 DOI: 10.1111/bjd.18527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 12/18/2022]
Abstract
Background Terrestrial ultraviolet (UV) radiation causes erythema, oxidative stress, DNA mutations and skin cancer. Skin can adapt to these adverse effects by DNA repair, apoptosis, keratinization and tanning. Objectives To investigate the transcriptional response to fluorescent solar‐simulated radiation (FSSR) in sun‐sensitive human skin in vivo. Methods Seven healthy male volunteers were exposed to 0, 3 and 6 standard erythemal doses (SED). Skin biopsies were taken at 6 h and 24 h after exposure. Gene and microRNA expression were quantified with next generation sequencing. A set of candidate genes was validated by quantitative polymerase chain reaction (qPCR); and wavelength dependence was examined in other volunteers through microarrays. Results The number of differentially expressed genes increased with FSSR dose and decreased between 6 and 24 h. Six hours after 6 SED, 4071 genes were differentially expressed, but only 16 genes were affected at 24 h after 3 SED. Genes for apoptosis and keratinization were prominent at 6 h, whereas inflammation and immunoregulation genes were predominant at 24 h. Validation by qPCR confirmed the altered expression of nine genes detected under all conditions; genes related to DNA repair and apoptosis; immunity and inflammation; pigmentation; and vitamin D synthesis. In general, candidate genes also responded to UVA1 (340–400 nm) and/or UVB (300 nm), but with variations in wavelength dependence and peak expression time. Only four microRNAs were differentially expressed by FSSR. Conclusions The UV radiation doses of this acute study are readily achieved daily during holidays in the sun, suggesting that the skin transcriptional profile of ‘typical’ holiday makers is markedly deregulated. What's already known about this topic? The skin's transcriptional profile underpins its adverse (i.e. inflammation) and adaptive molecular, cellular and clinical responses (i.e. tanning, hyperkeratosis) to solar ultraviolet radiation. Few studies have assessed microRNA and gene expression in vivo in humans, and there is a lack of information on dose, time and waveband effects.
What does this study add? Acute doses of fluorescent solar‐simulated radiation (FSSR), of similar magnitude to those received daily in holiday situations, markedly altered the skin's transcriptional profiles. The number of differentially expressed genes was FSSR‐dose‐dependent, reached a peak at 6 h and returned to baseline at 24 h. The initial transcriptional response involved apoptosis and keratinization, followed by inflammation and immune modulation. In these conditions, microRNA expression was less affected than gene expression.
Linked Comment:Hart. Br J Dermatol 2020; 182:1328–1329. Plain language summary available online Respond to this article
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Affiliation(s)
- M Bustamante
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - C Hernandez-Ferrer
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA, U.S.A
| | - A Tewari
- King's College London, St John's Institute of Dermatology, London, U.K
| | - Y Sarria
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G I Harrison
- King's College London, St John's Institute of Dermatology, London, U.K
| | - E Puigdecanet
- Servei d'Anàlisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - L Nonell
- Servei d'Anàlisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - W Kang
- Science for Life Laboratory, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - M R Friedländer
- Science for Life Laboratory, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - X Estivill
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Genetics Program, Sidra Medical Center, Al Rayyan Municipality, Qatar
| | - J R González
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Nieuwenhuijsen
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - A R Young
- King's College London, St John's Institute of Dermatology, London, U.K
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Treacy P, Pavlova I, Falagario U, Brody R, Epstein J, Cordero Bravo J, Barthe F, Wiklund P, Tewari A, Durand M. Mesure du collagène au sein d’un tissu cancéreux prostatique à l’aide du microscope multiphotonique : résultats préliminaires. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.218] [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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18
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Treacy P, Martini A, Ratnani P, Nair S, Horowitz A, Wiklund P, Durand M, Tewari A. La signature transcriptomique des gènes du tissu conjonctif prédit des caractéristiques péjoratives chez les patients avec un cancer de prostate localisé. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.079] [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]
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19
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Durand M, Bessede T, Treacy P, Bentellis I, Amiel J, Corcuera-solano I, Taouli B, Rastinehad A, Ying Tang C, Wang V, Reddy B, Raffaelli C, Fromont G, Puech P, Haines K, Tewari A, Villers A. Imagerie expérimentale ex vivo de haute résolution à 7 tesla du cancer localisé de la prostate. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.083] [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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20
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Woo J, Santasusagna S, Banks J, Dominguez-Andres A, Yadav K, Pippa R, Carceles-Cordon M, Lallas C, Luyao G, Rodriguez-Bravo V, Tewari A, Pastor-Lopez S, Kelly W, Leiby B, Prats J, Gomella L, Domingo-Domenech J. Urine extracellular vesicle GATA2 mRNA alone and in a multigene test predicts initial prostate biopsy result. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Weinstock TG, Tewari A, Patel H, Kelley K, Tananbaum R, Flores A, Shah AT, Abujaber SY, Khorashadi L, Shortsleeve MJ, Thomson CC. No stone unturned: Nodule Net, an intervention to reduce loss to follow-up of lung nodules. Respir Med 2019; 157:49-51. [PMID: 31518707 DOI: 10.1016/j.rmed.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/25/2019] [Revised: 08/13/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Inadequate lung nodule surveillance leads to diagnostic delays. We implemented a retrospective intervention program, Nodule Net, to improve surveillance in our hospital. METHODS 9,224 Chest computed tomography (CT) scans between January 1, 2015 and December 31, 2016 were manually reviewed for lung nodules. For patients without follow-up, charts were reviewed to assess follow-up. If follow-up appeared indicated, the clinician or patient was contacted, and follow-up was tracked. RESULTS Lung nodules were identified on 5,101 (55%) of 9,224 scans. Follow-up was potentially indicated and not completed in 1,385 (27%). 183 (13%) were excluded after imaging review. 1,202 received outreach. Of the 801 (66%) with a provider in our system, 225 (27%) returned for follow-up. Nodules were stable in 199 (88%), new or growing in 23 (11%), resolved in 3 (1%), and stage 1 lung cancer in 2 (1%). 90 (11%) had follow-up outside our system and 431 (51%) had no follow-up due to a clinical contraindication. 55 (7%) have imaging pending and 14 (2%) are awaiting pulmonary evaluation. Of the 302 (25%) patients with providers outside our system, 121 (40%) had followed-up elsewhere. 146 (48%) had no follow-up due to a clinical reason. 35 (12%) providers did not respond to outreach. CONCLUSIONS We identified 1,202 patients with lung nodules who needed follow-up over a two-year period. Compliance was more successful with providers within our hospital system. We recommend robust surveillance for patients to ensure follow-up is completed and clinical contraindications are well documented.
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Affiliation(s)
- T G Weinstock
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA; Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A Tewari
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
| | - H Patel
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - K Kelley
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA
| | - R Tananbaum
- Washington University, St. Louis, Missouri, USA
| | - A Flores
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA
| | - A T Shah
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - S Y Abujaber
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - L Khorashadi
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| | - M J Shortsleeve
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| | - C C Thomson
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA; Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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22
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Abstract
Foot-and-mouth disease (FMD) is a contagious and important transboundary disease of cloven-hoofed animals and ruminants. In ruminants, an animal is considered as a foot-and-mouth disease virus (FMDV) carrier if a live FMDV/FMDV RNA is obtained from the oro-pharyngeal fluid (OPF) beyond 28 days after infection. These carrier animals may pose a risk for causing outbreaks in healthy animals. Moreover, it is important to conduct serosurveillance to know the virus circulation. In the present study, an ELISA was developed using field samples to detect FMDV specific secretory IgA antibodies. These samples were also tested for the presence of FMDV RNA using quantitative real-time PCR (qRT-PCR). It was found that more carrier animals were detected by IgA ELISA in comparison to qRT-PCR. Thus, IgA ELISA is an important tool to detect FMD carriers. An ELISA based on detection of antibodies against FMDV 2B non-structural protein (NSP) was also used to confirm the results obtained from screening of 3AB3 NSP ELISA. These two new approaches (IgA ELISA and 2B ELISA) form important tools for detection of carriers and virus circulation, respectively, during FMD eradication program. Keywords: foot-and-mouth disease virus; carriers; IgA; 2B non-structural protein; 3AB3 non-structural protein.
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Narbutt J, Philipsen P, Harrison G, Morgan K, Lawrence K, Baczynska K, Grys K, Rogowski‐Tylman M, Olejniczak‐Staruch I, Tewari A, Bell M, O'Connor C, Wulf H, Lesiak A, Young A. Optimal sunscreen use prevents holiday erythema. Br J Dermatol 2019. [DOI: 10.1111/bjd.17556] [Citation(s) in RCA: 2] [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: 12/01/2022]
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Narbutt J, Philipsen P, Harrison G, Morgan K, Lawrence K, Baczynska K, Grys K, Rogowski‐Tylman M, Olejniczak‐Staruch I, Tewari A, Bell M, O'Connor C, Wulf H, Lesiak A, Young A. 优化防晒霜使用以防止假日红斑. Br J Dermatol 2019. [DOI: 10.1111/bjd.17572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tewari A, Alarcon L, Gordon K, Mansour S, Akhras V. Postzygotic mosaicism in a woman with Goltz syndrome mimics segmental angioma serpiginosum. Br J Dermatol 2019; 181:613-614. [PMID: 30801665 DOI: 10.1111/bjd.17823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Tewari
- Department of Dermatology, St George's Hospital, Tooting, London, U.K
| | - L Alarcon
- Department of Histopathology, St George's Hospital, Tooting, London, U.K
| | - K Gordon
- Department of Dermatology, St George's Hospital, Tooting, London, U.K
| | - S Mansour
- Department of Clinical Genetics, St George's Hospital, Tooting, London, U.K
| | - V Akhras
- Department of Dermatology, St George's Hospital, Tooting, London, U.K
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Tewari A. IONM practice guidelines for the IONM supervising professional: some questions. J Clin Monit Comput 2019; 33:347-348. [PMID: 30701420 DOI: 10.1007/s10877-019-00263-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
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Lubotzky FP, Butow P, Hunt C, Costa DSJ, Laidsaar-Powell R, Carroll S, Thompson SR, Jackson M, Tewari A, Nattress K, Juraskova I. A Psychosexual Rehabilitation Booklet Increases Vaginal Dilator Adherence and Knowledge in Women Undergoing Pelvic Radiation Therapy for Gynaecological or Anorectal Cancer: A Randomised Controlled Trial. Clin Oncol (R Coll Radiol) 2018; 31:124-131. [PMID: 30580905 DOI: 10.1016/j.clon.2018.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 05/15/2018] [Revised: 09/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
AIMS Women treated with pelvic radiation therapy (PRT) for gynaecological or anorectal cancer report a high number of sexual problems and unmet post-treatment psychosexual information needs. Currently, there is suboptimal adherence to recommended rehabilitation aids, such as vaginal dilators, and a paucity of resources to facilitate post-radiation rehabilitation and reduce distress in this population. This randomised controlled trial aimed to evaluate the effectiveness of a study-developed psychosexual rehabilitation booklet in this setting. MATERIALS AND METHODS Eighty-two women scheduled for PRT to treat gynaecological/anorectal cancer were randomised to receive the intervention booklet (n = 44) or standard information materials (n = 38). Self-report questionnaires administered at pre-treatment baseline and at 3, 6 and 12 months post-treatment assessed adherence with rehabilitation aids, booklet knowledge, anxiety, depression and sexual functioning/satisfaction. RESULTS Dilator adherence and booklet knowledge were significantly higher in the intervention group than in the control group (averaged over time points), with scores significantly increasing over time. Younger age and gynaecological cancer were significant predictors of greater dilator adherence. No significant group differences were found on psychological and sexual measures. CONCLUSIONS The psychosexual rehabilitation booklet was effective in educating women with gynaecological and anorectal cancers about PRT-related psychosexual side-effects and rehabilitation options, as well as promoting uptake of vaginal dilator use. Future research should elucidate the effectiveness of this booklet in women with greater psychological and sexual functioning needs.
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Affiliation(s)
- F P Lubotzky
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - P Butow
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - C Hunt
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - D S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - R Laidsaar-Powell
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - S Carroll
- Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - S R Thompson
- Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - M Jackson
- Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Tewari
- Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - K Nattress
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - I Juraskova
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia.
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Narbutt J, Philipsen PA, Harrison GI, Morgan KA, Lawrence KP, Baczynska KA, Grys K, Rogowski-Tylman M, Olejniczak-Staruch I, Tewari A, Bell M, O'Connor C, Wulf HC, Lesiak A, Young AR. Sunscreen applied at ≥ 2 mg cm -2 during a sunny holiday prevents erythema, a biomarker of ultraviolet radiation-induced DNA damage and suppression of acquired immunity. Br J Dermatol 2018; 180:604-614. [PMID: 30307614 DOI: 10.1111/bjd.17277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sun protection factor (SPF) is assessed with sunscreen applied at 2 mg cm-2 . People typically apply around 0·8 mg cm-2 and use sunscreen daily for holidays. Such use results in erythema, which is a risk factor for skin cancer. OBJECTIVES To determine (i) whether typical sunscreen use resulted in erythema, epidermal DNA damage and photoimmunosuppression during a sunny holiday, (ii) whether optimal sunscreen use inhibited erythema and (iii) whether erythema is a biomarker for photoimmunosuppression in a laboratory study. METHODS Holidaymakers (n = 22) spent a week in Tenerife (very high ultraviolet index) using their own sunscreens without instruction (typical sunscreen use). Others (n = 40) were given SPF 15 sunscreens with instructions on how to achieve the labelled SPF (sunscreen intervention). Personal ultraviolet radiation (UVR) exposure was monitored electronically as the standard erythemal dose (SED) and erythema was quantified. Epidermal cyclobutane pyrimidine dimers (CPDs) were determined by immunostaining, and immunosuppression was assessed by contact hypersensitivity (CHS) response. RESULTS There was no difference between personal UVR exposure in the typical sunscreen use and sunscreen intervention groups (P = 0·08). The former had daily erythema on five UVR-exposed body sites, increased CPDs (P < 0·001) and complete CHS suppression (20 of 22). In comparison, erythema was virtually absent (P < 0·001) when sunscreens were used at ≥ 2 mg cm-2 . A laboratory study showed that 3 SED from three very different spectra suppressed CHS by around ~50%. CONCLUSIONS Optimal sunscreen use prevents erythema during a sunny holiday. Erythema predicts suppression of CHS (implying a shared action spectrum). Given that erythema and CPDs share action spectra, the data strongly suggest that optimal sunscreen use will also reduce CPD formation and UVR-induced immunosuppression.
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Affiliation(s)
- J Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-647, Łódź, Poland
| | - P A Philipsen
- University of Copenhagen, Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - G I Harrison
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Morgan
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K P Lawrence
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Baczynska
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, OX11 0RQ, U.K
| | - K Grys
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | | | - I Olejniczak-Staruch
- Dermoklinika Centrum Medyczne, Łódź, 90-436, Poland.,Department of Dermatology and Venereology, Medical University of Łódź, 90-647, Łódź, Poland
| | - A Tewari
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - M Bell
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - C O'Connor
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - H C Wulf
- University of Copenhagen, Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - A Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-647, Łódź, Poland
| | - A R Young
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
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Abdul Salam M, Praveen D, Patel A, Tewari A, Webster R. PO171 Barriers to the Use of Cardiovascular Polypills In India: A Mixed-Methods Study. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.150] [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] Open
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30
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Ashman BD, Tewari A, Castle J, Hasan SS, Bhatia S. Intraoperative Neuromonitoring for Brachial Plexus Neurolysis During Delayed Fixation of a Clavicular Fracture Presenting as Thoracic Outlet Syndrome: A Case Report. JBJS Case Connect 2018; 8:e85. [PMID: 30601768 DOI: 10.2106/jbjs.cc.18.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/09/2023]
Abstract
CASE Brachial plexopathy is a rare complication of nonoperatively treated clavicular fractures. We describe a 68-year-old man who presented with fracture-callus-induced acute brachial plexopathy and dynamic thoracic outlet syndrome after 9 weeks of nonoperative management for a clavicular fracture. He underwent fracture fixation with brachial plexus decompression via callus excision; intraoperative neuromonitoring was used to evaluate brachial plexus function. Postsurgery, his neurologic function recovered completely. CONCLUSION Intraoperative neuromonitoring is a useful tool for minimizing the risk of additional brachial plexus injury and determining the adequacy of neural decompression during delayed open reduction and internal fixation of clavicular fractures with fracture-callus-induced brachial plexus compression.
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Affiliation(s)
- Bradley D Ashman
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio
| | | | | | - Samer S Hasan
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio
| | - Sanjeev Bhatia
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio
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31
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Tewari A, Castle J, Frye T, Taylor T, Schaiper L, Mahmoud M. S110. Intraoperative neurophysiological monitoring team’s communiqué with anesthesia professionals. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.470] [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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Chidambaran V, Tewari A, Mahmoud M. Anesthetic and pharmacologic considerations in perioperative care of obese children. J Clin Anesth 2018; 45:39-50. [DOI: 10.1016/j.jclinane.2017.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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33
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Tewari A, Fityan A, Fassihi H, Sarkany R. Solar urticaria developing in patients with erythropoietic protoporphyria: a clue to the pathogenesis of solar urticaria? Br J Dermatol 2017; 178:567-568. [PMID: 28796891 DOI: 10.1111/bjd.15882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Tewari
- Photodermatology Department, St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RH, U.K
| | - A Fityan
- Photodermatology Department, St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RH, U.K.,Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Hampshire, SO16 6YD, U.K
| | - H Fassihi
- Photodermatology Department, St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RH, U.K
| | - R Sarkany
- Photodermatology Department, St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RH, U.K
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34
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Tewari A, Sethi RS, Banga HS, Singh B, Gill J. Concomitant effect of low dose of lindane and intranasal lipopolysaccharide on respiratory system of mice. Hum Exp Toxicol 2017; 36:1201-1211. [PMID: 28177269 DOI: 10.1177/0960327116685889] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lindane is very commonly used organochlorine pesticide and has been reported to cause several toxic effects including respiratory insufficiency. However, effects of low concentration of lindane alone or in combination with microbial molecules on lungs are not fully understood. To understand the effects a preliminary study was designed on Swiss albino mouse. Male mice were divided into treatment and control group (20; each). Treatment mice were given lindane in ground nut oil orally at 0.25 mg kg-1 day-1 for 60 days. After treatment, 10 mice were challenged with intranasal Escherichia coli lipopolysaccharide (LPS; 80 μg per mice) and remaining 10 with normal saline. The mice were euthanized 16 h post-LPS exposure. Control mice (10 each) were given normal saline or the LPS alone. Mice exposed with lindane and in combination with LPS had increase in total cell counts and leukocyte counts in broncho-alveolar lavage. Histological examination showed lung injury in the lindane-treated mice. The histopathological changes were more pronounced in lindane along with LPS-exposed mice. Lindane alone and in combination with LPS showed expression of immunopositive Toll-like receptor (TLR)-4 and tumour necrosis factor-alpha (TNF-α) positive reaction in various cells of lungs. While LPS induced acute inflammation in the lungs, combination of lindane and LPS exacerbated histological signs of the inflammation. The data indicate that lindane alone or in combination with LPS caused changes in lung morphology and altered TLR-4 and TNF-α expression which may have led to altered response to LPS challenge.
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Affiliation(s)
- A Tewari
- 1 School of Public Health and Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India.,2 Department of VPE, College of Veterinary Science & Animal Husbandry, Kuthulia Farm, Rewa, Madhya Pradesh, India
| | - R S Sethi
- 3 School of Animal Biotechnology, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - H S Banga
- 4 Department of Veterinary Pathology, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - B Singh
- 5 Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Jps Gill
- 1 School of Public Health and Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
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Maulik PK, Devarapalli S, Kallakuri S, Tewari A, Chilappagari S, Koschorke M, Thornicroft G. Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach. Psychol Med 2017; 47:565-575. [PMID: 27804895 PMCID: PMC5244444 DOI: 10.1017/s0033291716002804] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/19/2016] [Accepted: 10/06/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Stigma related to mental health is a major barrier to help-seeking resulting in a large treatment gap in low- and middle-income countries (LMIC). This study assessed changes in knowledge, attitude and behaviour, and stigma related to help-seeking among participants exposed to an anti-stigma campaign. METHOD The campaign, using multi-media interventions, was part of the SMART Mental Health Project, conducted for 3 months, across 42 villages in rural Andhra Pradesh, in South India. Mixed-methods evaluation was conducted in two villages using a pre-post design. RESULTS A total of 1576 and 2100 participants were interviewed, at pre- and post-intervention phases of the campaign. Knowledge was not increased. Attitudes and behaviours improved significantly (p < 0.01). Stigma related to help-seeking reduced significantly (p < 0.05). Social contact and drama were the most beneficial interventions identified during qualitative interviews. CONCLUSION The results showed that the campaign was beneficial and led to improvement of attitude and behaviours related to mental health and reduction in stigma related to help-seeking. Social contact was the most effective intervention. The study had implications for future research in LMIC.
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Affiliation(s)
- P. K. Maulik
- Research & Development, George Institute
for Global Health, New Delhi,
India
- George Institute for Global Health, University of
Oxford, Oxford, UK
| | - S. Devarapalli
- Research & Development, George Institute
for Global Health, New Delhi,
India
| | - S. Kallakuri
- Research & Development, George Institute
for Global Health, New Delhi,
India
| | - A. Tewari
- Research & Development, George Institute
for Global Health, New Delhi,
India
| | - S. Chilappagari
- Research & Development, George Institute
for Global Health, New Delhi,
India
| | - M. Koschorke
- Centre for Global Mental Health, Institute of
Psychiatry, Psychology and Neuroscience, King's College,
London, UK
| | - G. Thornicroft
- Centre for Global Mental Health, Institute of
Psychiatry, Psychology and Neuroscience, King's College,
London, UK
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36
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Tewari A, Samy RN, Castle J, Frye TM, Habeych ME, Mohamed M. Intraoperative Neurophysiological Monitoring of the Laryngeal Nerves During Anterior Neck Surgery: A Review. Ann Otol Rhinol Laryngol 2016; 126:67-72. [PMID: 27803238 DOI: 10.1177/0003489416675354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Indexed: 11/15/2022]
Abstract
Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and head and neck surgery have increased over recent years. Organizational support for neural monitoring during surgery is becoming evident and is increasingly recognized as an adjunct to visual nerve identification. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. This review will explore the potential advantages of IONM to improve the outcomes among patients undergoing anterior neck surgery.
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Affiliation(s)
- Anurag Tewari
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Ravi N Samy
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | | | - Miguel E Habeych
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Mahmoud Mohamed
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Ohio, USA
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Kandil A, Subramanyam R, Hossain MM, Ishman S, Shott S, Tewari A, Mahmoud M. Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children. Paediatr Anaesth 2016; 26:742-51. [PMID: 27212000 DOI: 10.1111/pan.12931] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
AIM Examination of dynamic airway collapse in patients with obstructive sleep apnea (OSA) during drug-induced sleep endoscopy (DISE) can help identify the anatomic causes of airway obstruction. We hypothesized that a combination of dexmedetomidine and ketamine (Group DK) would result in fewer oxygen desaturations and a higher successful completion rate during DISE in children with OSA when compared to propofol (Group P) or sevoflurane/propofol (Group SP). METHODS In this retrospective study, we reviewed the records of 59 children who presented for DISE between October 2013 and March 2015. Data analyzed included demographics, OSA severity, and hemodynamics (heart rate and blood pressure). The primary outcomes were airway desaturation during DISE to <85% and successful completion of DISE; these were compared between the three groups: DK, P, and SP. RESULTS Preoperative polysomnography was available for 49 patients. There were significantly more patients with severe OSA in Group P as compared to the other two groups. The mean (±sd) bolus dose for ketamine, dexmedetomidine, and propofol were 2.0 ± 0.6 mg·kg(-1) , 1.9 ± 0.9 mcg·kg(-1) , and 1.8 ± 1.1 mg·kg(-1) , respectively. The mean (±sd) infusion rate for dexmedetomidine was 1.6 ± 0.7 mcg·kg(-1) ·h(-1) and for propofol was 248 ± 68 mcg·kg(-1) ·min(-1) in Group P and 192 ± 48 mcg·kg(-1) ·min(-1) in Group SP. Patients in Group DK had significantly fewer desaturations to <85% during DISE compared to Group P. Patients in Group DK had significantly more successful completion of DISE (100% Group DK, 92% Group P, and 79% Group SP) as compared to Group SP. CONCLUSIONS These results suggest that the described dose regimen of propofol used alone or in combination with sevoflurane appears to be associated with more oxygen desaturations and a lower rate of successful completion than a combination of dexmedetomidine and ketamine during DISE in children with OSA.
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Affiliation(s)
- Ali Kandil
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mohamed Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stacey Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology -Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sally Shott
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology -Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anurag Tewari
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Dhawan I, Tewari A, Sehgal S, Sinha AC. Medication errors in anesthesia: unacceptable or unavoidable? Braz J Anesthesiol 2016; 67:184-192. [PMID: 28236867 DOI: 10.1016/j.bjane.2015.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/23/2015] [Accepted: 09/28/2015] [Indexed: 11/16/2022] Open
Abstract
Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to 'treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and 'just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors.
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Affiliation(s)
- Ira Dhawan
- Department of Anesthesia, PGIMER, Chandigarh, India.
| | - Anurag Tewari
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Sankalp Sehgal
- Drexel University College of Medicine, Hahnemann University Hospital, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA, USA
| | - Ashish Chandra Sinha
- Drexel University College of Medicine, Anesthesiology and Perioperative Medicine, Philadelphia, PA, USA
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Singh R, Kundra S, Gupta S, Grewal A, Tewari A. Effect of clonidine and/or fentanyl in combination with intrathecal bupivacaine for lower limb surgery. J Anaesthesiol Clin Pharmacol 2015; 31:485-90. [PMID: 26702205 PMCID: PMC4676237 DOI: 10.4103/0970-9185.169069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 12/03/2022] Open
Abstract
Background and Aims: Various adjuncts to local anesthetics have been used with the purpose of improving the quality of subarachnoid block. This randomized double-blind study was conducted to evaluate the efficacy of adding clonidine to bupivacaine and bupivacaine-fentanyl combination. Material and Methods: A total of 100 patients scheduled for surgery under spinal anesthesia were randomly allocated into four groups (n = 25 each) to receive intrathecal bupivacaine 7.5 mg plus normal saline 0.5 ml (group BS), intrathecal bupivacaine 7.5 mg, and fentanyl 25 μg (group BF), intrathecal bupivacaine 7.5 mg and clonidine 75 μg (group BC), intrathecal bupivacaine 7.5 mg, clonidine 37.5 μg, and fentanyl 12.5 μg (group BCF). The time of onset and duration of sensory block, highest dermatome level of sensory block, time of onset of motor block, time to complete motor block recovery and duration of spinal anesthesia, intraoperative and postoperative hemodynamics and side effects if any were recorded. VAS, total number of patients who were administered supplemental analgesic in each group and the total amount of supplemental analgesic administered in the next 24 h was quantified and documented in all the groups. Results: The time of onset of sensory block (min) in groups BS, BC, BCF, and BF was 10.80 ± 2.26, 10.20 ± 1.00, 10.00 ± 0.00, and 13.80 ± 2.61 respectively, thus onset of sensory block was significantly earlier in groups BC and BCF. Similarly, onset of motor block was also quicker in groups BC and BCF. Time of requirement of supplemental analgesia was 135.20 ± 12.70 min, 199.2 ± 21.92 min, 209.80 ± 26.32 min, and 208.00 ± 26.58 min in groups BS, BF, BC, and BCF respectively. Intraoperative and postoperative changes in heart rate, mean arterial blood pressure, oxygen saturation, and respiratory rate were comparable. Sedation scores were significantly higher in group BC. Pruritus was only observed in groups BF and BCF. Mean nausea vomiting scores were comparable in all groups. Conclusion: We conclude that the addition of clonidine in doses of 75 μg and 37.5 μg to low-dose bupivacaine and bupivacaine-fentanyl prolongs the sensory and motor block while increasing the duration of postoperative analgesia without significant side-effects.
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Affiliation(s)
- Ravanjit Singh
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Kundra
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Shikha Gupta
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Anju Grewal
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Anurag Tewari
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Abstract
Background and Aims: Perioperative beta blockers are also being advocated for modulation of acute pain and reduction of intraoperative anesthetic requirements. This study evaluated the effect of perioperative use of esmolol, an ultra short acting beta blocker, on anesthesia and modulation of post operative pain in patients of laproscopic cholecystectomy. Material and Methods: Sixty adult ASA I & II grade patients of either sex, scheduled for laparoscopic cholecystectomy under general anesthesia, were enrolled in the study. The patients were randomly allocated to one of the two groups E or C according to computer generated numbers. Group E- Patients who received loading dose of injection esmolol 0.5 mg/kg in 30 ml isotonic saline, before induction of anesthesia, followed by an IV infusion of esmolol 0.05 μg/kg/min till the completion of surgery and Group C- Patients who received 30 ml of isotonic saline as loading dose and continuous infusion of isotonic saline at the same rate as the esmolol group till the completion of surgery. Results: The baseline MAP at 0 minute was almost similar in both the groups. At 8th minute (time of intubation), MAP increased significantly in group C as compared to group E and remained higher than group E till the end of procedure. Intraoperatively, 16.67% of patients in group C showed somatic signs as compared to none in group E. The difference was statistically significant. 73.33% of patients in group C required additional doses of Inj. Fentanyl as compared to 6.67% in group E. Conclusions: We conclude that intravenous esmolol influences the analgesic requirements both intraoperatively as well as postoperatively by modulation of the sympathetic component of the pain i.e. heart rate and blood pressure.
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Affiliation(s)
- Ritima Dhir
- Department of Anaesthesiology, Fortis Hospital, Gurgaon, India
| | | | - Tej Kishan Kaul
- Department of Dayanand Medical College and Hospital, Ludhiana, India
| | - Anurag Tewari
- Department of Cincinnati Children's Hospital, Cincinnati, USA
| | - Ripul Oberoi
- Department of Anaesthesiology, Fortis Hospital, Gurgaon, India
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Bilotta F, Lauretta MP, Tewari A, Haque M, Hara N, Uchino H, Rosa G. Insulin and the Brain: A Sweet Relationship With Intensive Care. J Intensive Care Med 2015; 32:48-58. [PMID: 26168800 DOI: 10.1177/0885066615594341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/28/2015] [Accepted: 05/15/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insulin receptors (IRs) in the brain have unique molecular features and a characteristic pattern of distribution. Their possible functions extend beyond glucose utilization. In this systematic review, we explore the interactions between insulin and the brain and its implications for anesthesiologists, critical care physicians, and other medical disciplines. METHODS A literature search of published preclinical and clinical studies between 1978 and 2014 was conducted, yielding 5996 articles. After applying inclusion and exclusion criteria, 92 studies were selected for this systematic review. RESULTS The IRs have unique molecular features, pattern of distribution, and mechanism of action. It has effects on neuronal function, metabolism, and neurotransmission. The IRs are involved in neuronal apoptosis and neurodegenerative processes. CONCLUSION In this systematic review, we present a close relationship between insulin and the brain, with discernible effects on memory, learning abilities, and motor functions. The potential therapeutic effects extend from acute brain insults such as traumatic brain injury, brain ischemia, and hemorrhage, to chronic neurodegenerative diseases such as Alzheimer and Parkinson disease. An understanding of the wider effects of insulin conveyed in this review will prompt anaesthesiologists and critical care physicians to consider its therapeutic potential and guide future studies.
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Affiliation(s)
- F Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
| | - M P Lauretta
- Anesthesia and Intensive Care Department, "La Sapienza" University of Rome, Rome, Italy .,Critical Care Department, University College London Hospital, London, United Kingdom
| | - A Tewari
- Department of Pediatric Neuroanesthesia and IONM, Cincinnati Children Hospital & Medical Center, Cincinnati, OH, USA
| | - M Haque
- Anesthesia and Critical Care Department, University College London Hospital, London, United Kingdom
| | - N Hara
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - H Uchino
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - G Rosa
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
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Abstract
Neurosurgery in awake patients incorporates newer technologies that require the anesthesiologists to update their skills and evolve their methodologies. They need effective communication skills and knowledge of selecting the right anesthetic drugs to ensure adequate analgesia, akinesia, along with patient satisfaction with the anesthetic conduct throughout the procedure. The challenge of providing adequate anesthetic care to an awake patient for intracranial surgery requires more than routine vigilance about anesthetic management.
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Affiliation(s)
- Mahmood Ghazanwy
- Department of Anesthesiology, Cleveland Clinic Foundation, Ohio, USA
| | - Rajkalyan Chakrabarti
- Department of Neurosurgical Anesthesiology and Spine Surgery, Cleveland Clinic Foundation, Ohio, USA
| | - Anurag Tewari
- Department of Neurosurgical Anesthesiology and Spine Surgery, Cleveland Clinic Foundation, Ohio, USA
| | - Ashish Sinha
- Professor and Vice Chair (Research) Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, USA
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Abstract
Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013.
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Affiliation(s)
| | - Mahmood Ghazanwy
- Department of Neuroanaesthesia, Cleveland Clinic Foundation, Ohio, USA
| | - Anurag Tewari
- Department of Neuroanaesthesia, Cleveland Clinic Foundation, Ohio, USA
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Tewari A, Dhawan I, Mahendru V, Katyal S, Singh A, Narula N. A comparative study evaluating the prophylactic efficacy of oral clonidine and tramadol for perioperative shivering in geriatric patients undergoing transurethral resection of prostate. J Anaesthesiol Clin Pharmacol 2014; 30:340-4. [PMID: 25190940 PMCID: PMC4152672 DOI: 10.4103/0970-9185.137264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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] [Indexed: 11/11/2022] Open
Abstract
Background and Aims: Perioperative shivering, in geriatric patients undergoing urological surgery under central neuraxial blockade is a common complication. Prophylactic measures to reduce shivering are quintessential to decrease the morbidity and mortality. Believing that oral formulation will bring down the cost of treatment, we decided to compare the efficacy of oral clonidine and tramadol, as premedication, in prevention of shivering in patients undergoing transurethral resection of prostate (TURP) under spinal anesthesia in a prospective and double-blind manner. Materials and Methods: The patients were randomly allocated into three groups (40 patients each). Group I received oral clonidine 150 μg, Group II received oral tramadol 50 mg, while Group III received a placebo. Number of patients having shivering, their grades and duration, hemodynamic changes, and side-effects in the form of sedation were recorded. Data were analyzed using analysis of variance, Student's t-test, Z test as and when appropriate. Results: In group I and II, 38 patients (95%) and 37 patients (92.5%) did not shiver, respectively. Although in the group III, 24 patients (60%) exhibited no grade of shivering, the shivering was of significantly severe intensity and lasted for a longer duration. No, clinically significant collateral effects were observed in patients who were administered clonidine or tramadol. Conclusions: Oral clonidine and tramadol were comparable in respect to their effect in decreasing the incidence, intensity, and duration of shivering when used prophylactically in patients who underwent TURP under subarachnoid blockade.
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Affiliation(s)
- Anurag Tewari
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ira Dhawan
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vidhi Mahendru
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sunil Katyal
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Avtar Singh
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Navneet Narula
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Affiliation(s)
- Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA 52242, USA
| | - Anurag Tewari
- Deparment of Anaesthesiology, Dayanand Medical College, Ludhiana, Punjab, India
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Tewari A, Fassihi H, McGibbon D, Robson A, Sarkany R. A case of extensive hyaline deposition in facial skin caused by erythropoietic protoporphyria. Br J Dermatol 2014; 171:412-4. [DOI: 10.1111/bjd.13034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Tewari
- Department of Dermatology; St John's Institute of Dermatology; Guy's Hospital; 9th Floor Tower Wing London SE1 9RH U.K
| | - H. Fassihi
- Photodermatology Unit; St John's Institute of Dermatology; Guy's Hospital; 9th Floor Tower Wing London SE1 9RH U.K
| | - D. McGibbon
- Photodermatology Unit; St John's Institute of Dermatology; Guy's Hospital; 9th Floor Tower Wing London SE1 9RH U.K
| | - A. Robson
- Department of Histopathology; St John's Institute of Dermatology; Guy's Hospital; 9th Floor Tower Wing London SE1 9RH U.K
| | - R. Sarkany
- Photodermatology Unit; St John's Institute of Dermatology; Guy's Hospital; 9th Floor Tower Wing London SE1 9RH U.K
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Abstract
It is important for the anesthesiologist to understand the etiology of free radical damage and how free-radical scavengers attenuate this, so that this knowledge can be applied to diverse neuro-pathological conditions. This review will concentrate on the role of reactive species of oxygen in the pathophysiology of organ dysfunction, specifically sub arachnoid hemorrhage (SAH), traumatic brain injury (TBI) as well as global central nervous system (CNS) hypoxic, ischemic and reperfusion states. We enumerate potential therapeutic modalities that are been currently investigated and of interest for future trials. Antioxidants are perhaps the next frontier of translational research, especially in neuro-anesthesiology.
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Affiliation(s)
- Anurag Tewari
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vidhi Mahendru
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Sinha
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
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Abstract
Erroneous intravenous drug administration has a high probability of causing substantial financial consequences along with patient morbidity or mortality. Anesthesiologists and hospital administrators need to be cognizant of the problem. National and international anesthesiology bodies should be involved with the medical device manufacturing industry to alleviate this long standing enigma. We propose our concept Vassopressors, Emergency drugs, Induction agents, Reversal agents, Opioids and Miscellaneous (VEINROM) as a conceivable solution to this paradox.
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Affiliation(s)
- Anurag Tewari
- Department of Anesthesiology, Dayanand Medical College, India
| | - Brady Palm
- Department of Bioengineering and Biomedical Engineering, University of Iowa, IA, USA
| | - Taylor Hines
- Department of Bioengineering and Biomedical Engineering, University of Iowa, IA, USA
| | - Trace Royer
- Department of Bioengineering and Biomedical Engineering, University of Iowa, IA, USA
| | - Eric Alexander
- Department of Bioengineering and Biomedical Engineering, University of Iowa, IA, USA
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Tewari A, Dhawan I, Mahendru V, Katyal S, Singh A, Garg S. Use of oral tramadol to prevent perianesthetic shivering in patients undergoing transurethral resection of prostate under subarachnoid blockade. Saudi J Anaesth 2014; 8:11-6. [PMID: 24665233 PMCID: PMC3950433 DOI: 10.4103/1658-354x.125898] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Under regional anesthesia, geriatric patients are prone to shivering induced perioperative complications that Anesthesiologists should prevent rather than treat. Aim: We investigated the prophylactic efficacy of oral tramadol 50 mg to prevent the perioperative shivering after transurethral resection of prostate (TURP) surgery under subarachnoid blockade (SAB). Shivering is usually overlooked in patients undergoing urological surgery under spinal anesthesia and may result in morbidity, prolonged hospital stay and increased financial burden. Use of prophylactic measures to reduce shivering in geriatric patients who undergo urological procedures could circumvent this. Oral formulation of tramadol is a universally available cost-effective drug with the minimal side-effects. Settings and Design: Prospective, randomized, double-blinded, placebo-controlled study. Patients and Methods: A total of 80 patients who were scheduled for TURP surgery under subarachnoid block were randomly selected. Group I and II (n = 40 each) received oral tramadol 50 mg and placebo tablet respectively. After achieving subarachnoid block, the shivering, body temperature (tympanic membrane, axillary and forehead), hemodynamic parameters and arterial saturation were recorded at regular intervals. Statistical Analysis Used: T-test, analysis of variance test, Z-test and Fisher exact test were utilized while Statistical Product and Service Solutions, IBM, Chicago (SPSS statistics (version 16.0)), software was used for analysis. Results: Incidence of shivering was significantly less in patients who received tramadol (7.5% vs. 40%; P < 0.01). The use of tramadol was associated with clinically inconsequential side-effects. Conclusion: We conclude that the use of oral tramadol 50 mg is effective as a prophylactic agent to reduce the incidence, severity and duration of perioperative shivering in patients undergoing TURP surgery under SAB.
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Affiliation(s)
- Anurag Tewari
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, India
| | - Ira Dhawan
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, India
| | - Vidhi Mahendru
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, India
| | - Sunil Katyal
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, India
| | - Avtar Singh
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, India
| | - Shuchita Garg
- Department of Anesthesiology, Dayanand Medical College, Ludhiana, India
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Pannu P, Chawla HS, Tewari A, Gauba K, Sujlana A, Gambhir RS. Correlation between mutans Streptococci counts of parents and their children residing in Chandigarh, India. J Clin Exp Dent 2014; 6:e250-4. [PMID: 25136425 PMCID: PMC4134853 DOI: 10.4317/jced.51372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/19/2014] [Indexed: 11/05/2022] Open
Abstract
Objectives: To determine the prevalence of Mutans Streptococci (MS) in children and to evaluate the relationship between the salivary levels of MS in children and their parents.
Material and Methods: 100 children aged 3-6 years along with their parents (100 mothers and fathers each) were included in the study. The children were segregated depending upon their age and level of caries experience. The children were examined clinically on an ordinary chair in natural daylight using the Møller’s index criteria. Assays for Mutans Streptococci (MS) were done for both the children and their parents using the Dentocult SM strip mutans test. Collected data was assessed using SPSS software.
Results: The overall prevalence of MS in the children was 83%. A statistically significant correlation (p<0.05) was observed between salivary MS counts of children and their mothers. No significant correlation was seen with the fathers.
Conclusions: The findings conclude that if primary caregivers harbour high levels of MS in their saliva, it is likely that their children will have the same.
Key words:Mutans streptococci, parents, children, dentocult SM kits.
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