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Pancholy S.B.,The Wright Center for Graduate Medical Education | Shah S.,Apex Heart Institute | Shah S.,Smt NHL Municipal Medical College | Patel T.M.,Apex Heart Institute | Patel T.M.,Smt NHL Municipal Medical College
Interventional Cardiology Clinics

Radial artery access is usually achieved using a micropuncture system. Hydrophilic introducers are used to improve comfort, probably by reducing spasm. A vasodilator cocktail should be administered to prevent severe spasm and anticoagulation; usually, unfractionated heparin is administered to prevent subsequent radial artery occlusion (RAO). Hemostasis at the radial artery puncture site is easily achievable by local compression. Application of local compression frequently leads to interruption of radial artery flow and subsequent occlusion. Careful attention to maintenance of radial artery patency during hemostatic compression has been shown to decrease the risk of RAO without increasing access-related bleeding complications. © 2015 Elsevier Inc. Source

Patel T.M.,Apex Heart Institute | Patel T.M.,Smt NHL Municipal Medical College | Shah S.,Apex Heart Institute | Shah S.,Smt NHL Municipal Medical College | Pancholy S.B.,The Wright Center for Graduate Medical Education
Interventional Cardiology Clinics

This article discusses different methods of working through arm and chest vasculature to increase the success rate of the transradial approach (TRA). Despite lower rates of bleeding and vascular complications as compared with the transfemoral approach, adoption of the TRA has been slow, particularly because of higher failure rates. Anatomic complexities of arm and chest vasculature play an important role in cases of TRA failure. Using a simple framework to classify the anatomic or functional problem and approaching these challenges in a logical sequence should facilitate management and increase the success rate for TRA. © 2015 Elsevier Inc. Source

Cata J.P.,University of Houston | Keerty V.,University of Houston | Keerty D.,The Wright Center for Graduate Medical Education | Feng L.,University of Houston | And 4 more authors.
Cancer Medicine

Preclinical studies have demonstrated that opioid receptor agonists increase the rate of non-small cell lung cancer (NSCLC) growth and metastasis. Following institutional review board approval, we retrieved data on 901 patients who underwent surgery for NSCLC at MD Anderson Cancer Center. Comprehensive demographics, intraoperative data, and recurrence-free survival (RFS) and overall survival (OS) at 3 and 5 years were obtained. Cox proportional analyses were conducted to assess the association between intraoperative opioid exposure and RFS and OS. The median intraoperative fentanyl equivalents dosage was 10.15 μg/kg. The multivariate analysis by stage indicated that a trend toward significance for opioid consumption as a risk factor in stage I patients (P = 0.053). No effect was found on RFS for stage II or III patients. Alternatively, opioid consumption was a risk factor for OS for stage I patients (P = 0.036), whereas no effect was noted for stage II or III patients. Intraoperative opioid use is associated with decreased OS in stage I but not stage II-III NSCLC patients. Until randomized controlled studies explore this association further, opioids should continue to be a key component of balanced anesthesia. © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. Source

Palamaner Subash Shantha G.,The Wright Center for Graduate Medical Education | Cheskin L.J.,Johns Hopkins University | Cheskin L.J.,Center for Human Nutrition | Pancholy S.B.,The Wright Center for Graduate Medical Education | Pancholy S.B.,The Commonwealth Medical College
Sleep Medicine

Objective/background: Via this systematic review and meta-analysis, we assessed the associatio between sleep-disordered breathing (SDB)/obstructive sleep apnea (OSA) and cancer incidence. Method: Medline, Embase, Cochrane Central, and electronic databases were searched for relevant studies in any language. Studies were included based on the following criteria: (1) those on patients with SDB/OSA, (2) those reporting cancer incidence rates specific to patients with SDB/OSA, and (3) those defining SDB/OSA using sleep-study-based objective measures. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOQA). Results: Of the 8766 retrieved citations, five studies that defined SDB/OSA using the apnea-hypopnea index (AHI) or the respiratory disturbance index (RDI) totaling 34,848 patients with SDB and 77,380 patients without SDB were pooled into a meta-analysis. All five studies were of good quality (NOQA ≥ 6). A total of 574 (1.6%) and 290 (0.37%) incident cancers were reported in patients with and without SDB, respectively. In the unadjusted analysis, patients with SDB/OSA were at an increased risk of incident cancer (relative risk [RR]: 1.53, 95% confidence interval [CI]: 1.31-1.79, P < 0.001, I2: 0, five included studies). When adjusted for traditional cancer risk factors, the association between SDB/OSA and cancer incidence, although attenuated (RR: 1.40, 95% CI: 1.01-1.95, P = 0.04, I2: 60%, five included studies), remains significant. Conclusions: SDB/OSA may increase the risk of incident cancer. Inferring an independent association is not possible from our analysis considering the retrospective cohort design of the included studies and high inter-study heterogeneity. An individual patient data meta-analysis would help validate our findings. © 2015 Elsevier B.V. Source

Shantha G.P.S.,The Wright Center for Graduate Medical Education | Pancholy S.B.,The Wright Center for Graduate Medical Education | Pancholy S.B.,The Commonwealth Medical College
Sleep and Breathing

Purpose: Recent evidence associates sympathetic tone with severity of obstructive sleep apnea (OSA). Renal sympathetic denervation (RDN), by decreasing sympathetic tone, has the potential to decrease OSA severity. Small observational studies that assessed this hypothesis lacked precision. Hence, in this meta-analysis, we have attempted to pool available data from studies that have assessed the effect of RDN on OSA severity in patients with OSA. Methods: Medline, Embase, Cochrane central, Ovid, Cinahl, web of science, and conference abstracts were searched for eligible citations by two independent reviewers using key words “renal denervation,” “hypertension,” and “obstructive sleep apnea.” From a total of 2,863 identified citations, using meta-analysis of observational studies in epidemiology method, five studies were assessed eligible and included in the meta-analysis. Results: All five studies followed an observational study design, involved patients with OSA and HTN, and reported an apnea-hypopnea index (AHI) 6 months post-RDN. Four were “before and after” studies and one compared continuous positive airway pressure with RDN. In the pooled analysis, involving 49 patients, RDN was associated with a significant reduction in mean AHI [weighted mean difference −9.61 (95 % CI −15.43 to −3.79, P = 0.001)] 6 months post-RDN. One study also reported improvement in oxygen desaturation index and Epworth sleepiness scale score 6 months post-RDN. Conclusions: RDN is associated with significant improvement in OSA severity. However, our results need validation in RCTs that assess effect of RDN in patients with OSA, which can potentially broaden the clinical applicability of RDN. © 2014, Springer-Verlag Berlin Heidelberg. Source

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