Publications by authors named "Sunil Verma"

185 Publications

An Interesting Case of Acute Asymptomatic Lead Perforation of a Permanent Cardiac Pacemaker.

Cureus 2021 Feb 14;13(2):e13334. Epub 2021 Feb 14.

Cardiology, All India Institute of Medical Sciences, New Delhi, IND.

Acute complications of pacemaker implantation such as lead dislodgement, pneumothorax, and myocardial perforation are not uncommon. Management of these usually requires reintervention. We herein describe lead perforation after a single chamber pacemaker implantation, which was successfully managed conservatively. This case underscores that vigilant monitoring post lead perforation can avoid a redo procedure.
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http://dx.doi.org/10.7759/cureus.13334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962039PMC
February 2021

Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis.

Ann Otol Rhinol Laryngol 2021 Feb 25:3489421995283. Epub 2021 Feb 25.

Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA.

Objectives: To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients.

Methods: Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence.

Results: The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression.

Conclusions: Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.
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http://dx.doi.org/10.1177/0003489421995283DOI Listing
February 2021

Stigma and Discrimination During COVID-19 Pandemic.

Front Public Health 2020;8:577018. Epub 2021 Jan 12.

Department of Applied Psychology, Vivekananda College, University of Delhi, New Delhi, India.

The COVID-19 pandemic has been instrumental in creating a dramatic shift from people's need to live in mutual association toward a desire to stigmatize distinctive others. Pandemic seems to be causing othering. Stated simply, stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose threat to the effective social living in the society. Based on the secondary evidence collected from news published online or in print, the present article delves into stigma associated with the COVID-19 pandemic among different social groups in the Indian society and the mounting cases of prejudice based on race, class, and religion. It also presents insights into the varied manifestations, and the deleterious consequences of COVID-19 inspired othering brought to its potential targets in India.
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http://dx.doi.org/10.3389/fpubh.2020.577018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874150PMC
February 2021

Stigma and Discrimination During COVID-19 Pandemic.

Front Public Health 2020;8:577018. Epub 2021 Jan 12.

Department of Applied Psychology, Vivekananda College, University of Delhi, New Delhi, India.

The COVID-19 pandemic has been instrumental in creating a dramatic shift from people's need to live in mutual association toward a desire to stigmatize distinctive others. Pandemic seems to be causing othering. Stated simply, stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose threat to the effective social living in the society. Based on the secondary evidence collected from news published online or in print, the present article delves into stigma associated with the COVID-19 pandemic among different social groups in the Indian society and the mounting cases of prejudice based on race, class, and religion. It also presents insights into the varied manifestations, and the deleterious consequences of COVID-19 inspired othering brought to its potential targets in India.
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http://dx.doi.org/10.3389/fpubh.2020.577018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874150PMC
February 2021

Prevalence of DEL phenotype in D- blood donors in India.

Immunohematology 2020 Dec;36(4):133-136

Professor, Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Conclusions: Unlike weak D and partial D, DEL represents a weakened form of D that cannot be detected by conventional serology and requires use of an adsorption-elution method for its detection; therefore, DEL+ samples might be mistyped as D-. The study was undertaken to determine the prevalence of the DEL phenotype among D- blood donors from northern India. A total of 1003 D- blood donors were tested for weak D and DEL by the indirect antiglobulin test and an adsorption-elution method, respectively. Of the total 21,135 blood donors typed for D, 20,132 (95.3%) were D+ and 1003 (4.7%) gave a negative reaction for D. Of the total 1003 D- samples, 8 (0.8%) were weak D and only 2 (0.2%) were DEL+ by adsorption-elution testing. For samples that typed as D-, the majority of individuals (91.1%) were cde/cde (rr) followed by dCe/dce (r´r) in 4.8 percent, and dCe/dCe (r´r´) in 2.2 percent. Both DEL+ samples were also C+. We conclude that the prevalence of the DEL phenotype as detected by serology in D- north Indian blood donors is 0.2 percent, although it is as high as 2.8 percent in D-C+ individuals. There is an association of DEL with C, which can be used as a cost-effective marker for screening large numbers of D- blood donors for DEL.
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December 2020

Surgical management of recurrent Zenker's diverticulum: A multi-institutional cohort study.

Am J Otolaryngol 2021 Jan - Feb;42(1):102755. Epub 2020 Oct 17.

UCI Health Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California Irvine School of Medicine, CA, United States of America. Electronic address:

Objective: This study identifies how recurrent Zenker's diverticula are treated.

Methods: A retrospective chart review was performed from four tertiary referral academic voice and swallowing centers to identify individuals who underwent surgery for recurrent Zenker's diverticulum. Demographic data, surgical modalities for primary and revision surgery, symptoms pre and post revision and complications were recorded.

Results: 56 individuals met inclusion criteria. Primary surgery was open in 30.3% (n = 17) and endoscopic in 69.6% (n = 39). Revision surgery was performed via an open approach in 37.5% of cases (N = 21) and via an endoscopic approach in 62.5% of cases (N = 35). Revision surgical technique was based on pouch size, patient age and comorbidities, as well as patient and surgeon preference. There were no major complications and few minor complications.

Conclusion: Zenker's diverticulum symptoms can recur regardless of primary treatment modality. Both endoscopic and open approaches can safely treat recurrent Zenker's diverticula.
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http://dx.doi.org/10.1016/j.amjoto.2020.102755DOI Listing
April 2021

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery.

Ann Otol Rhinol Laryngol 2021 May 1;130(5):497-503. Epub 2020 Oct 1.

Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA.

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events.

Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy.

Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes,  = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days,  < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02,  = 0.017), smoking (OR = 2.10,  = 0.044), and operation time (OR = 1.01;  = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( = 0.020), higher length of hospitalization ( < 0.001), and higher mortality ( = 0.027) and readmission rates ( = 0.023).

Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients.
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http://dx.doi.org/10.1177/0003489420962136DOI Listing
May 2021

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery.

Ann Otol Rhinol Laryngol 2021 May 1;130(5):497-503. Epub 2020 Oct 1.

Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA.

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events.

Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy.

Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes,  = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days,  < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02,  = 0.017), smoking (OR = 2.10,  = 0.044), and operation time (OR = 1.01;  = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( = 0.020), higher length of hospitalization ( < 0.001), and higher mortality ( = 0.027) and readmission rates ( = 0.023).

Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients.
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http://dx.doi.org/10.1177/0003489420962136DOI Listing
May 2021

Utilization and Influence of Online Support Communities in Idiopathic Subglottic Stenosis Patients.

Laryngoscope 2020 Sep 29. Epub 2020 Sep 29.

Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.

Objectives: To determine the factors that shape utilization of social media-based online support communities (OSCs) and study the influence of these communities on medical decision-making in patients with Idiopathic Subglottic Stenosis (iSGS).

Study Design: Survey study.

Methods: A survey investigating OSC use was sent to the 1,056 members of the North American Airway Collaborative (NoAAC) iSGS cohort in January 2018. Responses were merged with the existing NoAAC data set containing extensive demographic data, disease-specific history, and responses to validated patient-reported outcome measures.

Results: A total of 755 individuals with iSGS and mean age of 51.8 ± 11.6 years were included (99% female, 98% white, 63% college educated) and 58% were OSC users. Younger age, female gender, and college education were each associated with OSC use (P < .05). Users spent 2.5 ± 3.3 hours per week on the platforms. Time spent on OSC was not associated with total number of prior treatments. Higher disease anxiety (FoP-Q, R = 0.26, P < .001), lower social support (MOS, R = -0.12, P = .037), and lower level of shared-decision-making with the treating physician (SDM-Q9, R = -0.16, P = .007) were weakly associated with more hours spent engaging an OSC. OSC use influenced treatment and physician choice in 35% and 26% of users, respectively. Increased time spent on OSC use was associated with increased influence on patient medical decisions regarding treatment, surgery, and physician choice (P < .05).

Conclusion: OSC engagement is common in patients with iSGS. Disease anxiety, social support, and relationship with the physician may influence OSC utilization. More OSC engagement weakly associated with greater OSC influence on patient medical decision-making.

Level Of Evidence: N/A. Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.29110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005507PMC
September 2020

A novel nucleic acid extraction method from aromatic herbs and dried herbal powders using cow skim milk.

Sci Rep 2020 07 13;10(1):11513. Epub 2020 Jul 13.

S212, CSIR - Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, 500 007, India.

Authenticity of dried aromatic herbs and herbal powders for the ASU (ayurvedic, siddha, unani) drug formulations is a key of their clinical success. The DNA based authentication is an answer; however, extraction of PCR quality DNA from such material is often problematic due to the presence of various co-extracted PCR inhibitors. Here, we report a novel DNA isolation and purification method utilizing cow skim milk that successfully yields PCR quality DNA from the aromatic herbs and dried herbal powders. The improved method presented in this study could be used as an alternative to successfully extract PCR quality DNA from such plant materials. Further, we present a set of robust matK primers which could be used as plant barcoding resource in future studies.
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http://dx.doi.org/10.1038/s41598-020-68467-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359320PMC
July 2020

Fiberoptic endoscopic evaluation of swallowing findings in individuals with Zenker's diverticulum and cricopharyngeal bar.

Eur Arch Otorhinolaryngol 2020 Jul 30;277(7):2017-2021. Epub 2020 Mar 30.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 200 S. Manchester Ave., Ste 400, Orange, CA, 92868-3201, USA.

Purpose: To assess fiberoptic endoscopic evaluation of swallowing (FEES) findings in individuals with cricopharyngeal bar (CPB) and Zenker's diverticulum (ZD).

Methods: In this retrospective chart review spanning from 2010-2018, individuals diagnosed with CPB or ZD and undergoing FEES were identified. Patient demographics, radiographic studies, and treatments were recorded, and findings were compared between CPB, ZD of < 3 cm, and ZD ≥ 3 cm.

Results: Sixty-one individuals consisting of 48 patients with ZD and 13 patients with CPB met inclusion criteria. Post-swallow hypopharyngeal reflux (PSHR) of undigested food bolus, present with or without Valsalva maneuver, was noted in 23%, 84%, and 75% of patients with CPB, ZD < 3 cm, and ZD ≥ 3 cm, respectively. The sensitivity and specificity of the finding for those with ZD were 81% and 83%, respectively. Of patients with ZD, reflux resolved in all but six individuals after surgery. Four of these patients underwent revision surgery with the reflux subsequently resolving, and two patients with persistent reflux were asymptomatic and did not desire further treatment.

Conclusions: PSHR is a good tool to identify the presence of a ZD and is less helpful to identify a CPB. Elimination of PSHR is a good tool to determine treatment success in patients with ZD and CPB.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00405-020-05922-yDOI Listing
July 2020

Is nasogastric tube feeding necessary after hypopharyngeal diverticulum surgery?

Am J Otolaryngol 2020 May - Jun;41(3):102453. Epub 2020 Mar 10.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA. Electronic address:

Objectives: Nasogastric tubes (NGT) are often placed after surgery for cricopharyngeal muscle pathology due to risk of infection and mediastinitis. The aim of this study was to examine if this practice is necessary.

Methods: A retrospective case series of subjects who underwent surgery for hypopharyngeal diverticula or cricopharyngeal bars from March 2011 to June 2018 was conducted. Demographic data, type of surgery, placement of feeding tube, initiation of oral feeding, and any complications were recorded.

Results: Sixty-four surgeries were performed for Zenker's diverticula (ZD; N = 52), Killian-Jamieson diverticula (N = 2), and cricopharyngeal bar (N = 10). Mean age and ZD pouch size were 74.0 ± 10.6 years and 3.1 ± 1.8 cm, respectively. Procedures included 48 carbon dioxide laser-assisted myotomies, 14 open diverticulectomies, and 2 endoscopic stapler-assisted diverticulotomies. Of the 64 patients, 19 (29.7%) received intraoperative NGTs while the remaining 45 (70.3%) did not receive NGTs. The former cohort had the NGTs removed on post-operative day (POD) 4.5 ± 2.5, and the non-NGT cohort started clear liquid diet (CLD) on POD 1.2 ± 0.7 days, where 38 patients (84.4%) started CLD on POD 1, and 5 patients (7.8%) were started on oral diet on POD 2-4. Over time, fewer NGTs were placed and oral diets were started sooner. There were 5 complications occurring in 3 patients from the NGT cohort (15.5%) and 2 from the non-NGT cohort (4.4%).

Conclusions: Surgery for hypopharyngeal diverticula and CPB may not require routine perioperative NGT placement which can be associated with higher rates of complication. Patients can safely receive CLD on POD 1.
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http://dx.doi.org/10.1016/j.amjoto.2020.102453DOI Listing
September 2020

Pulmonary nocardiosis in patient with pulmonary tuberculosis in an immunocompetent male: A rare case report.

Indian J Tuberc 2020 01 18;67(1):130-132. Epub 2019 Apr 18.

Department of Radiology, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow, UP, 226010, India.

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http://dx.doi.org/10.1016/j.ijtb.2019.04.003DOI Listing
January 2020

Role of Psychological Makeup in Psychological Rehabilitation of Acid Attack Victims.

J Interpers Violence 2020 Mar 13:886260520905100. Epub 2020 Mar 13.

Vivekanand College, University of Delhi, India.

From eve-teasing to more aggressive forms of sexual violence, subjection of women to sexual violence has been on the rise. One heinous form of sexual violence is the acid attack. Acid attack refers to the intentional act of throwing acid on an individual with the intent of harming, torturing, disfiguring, injuring, or killing them. Despite an increase in the number of reported cases of acid attacks, the initial nonavailability of strict legislatures and underreporting of the crime have led to gross underrepresentation of the acid attack victims in the scientific literature. Moreover, most researches focus on the impact of acid attack and not on the process of recovery for these victims. Hence, this paper attempts to explore the role of psychological makeup in the psychological rehabilitation of acid attack victims. This study adopted the homogeneous purposive sampling method. The sample consisted of 30 female victims of acid attack between the age group of 18 to 25 years. The narratives of these victims focusing on their experiences before and after the incidence were collected. Findings of this study indicate that psychological makeup is an important variable that is responsible for the successful recovery from trauma. Nearly all of the victims have shown symptoms of maladaptive psychological makeup after facing a violent event. However, after participation in the rehabilitation program, the victims moved from having maladaptive psychological makeup toward having adaptive psychological makeup. The emergent subthemes comprising maladaptive psychological makeup consists of cognitive distortions, hopelessness, shame, and suicidal ideation; and for adaptive psychological makeup, these are positive life orientation, belief in the just world, and self-efficacy. The insights of the study will contribute to an improved understanding of the recovery process of the acid attack victims and help in planning intervention protocols for them.
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http://dx.doi.org/10.1177/0886260520905100DOI Listing
March 2020

Ancient mtDNA from the extinct Indian cheetah supports unexpectedly deep divergence from African cheetahs.

Sci Rep 2020 03 12;10(1):4618. Epub 2020 Mar 12.

Complexity Institute, Nanyang Technological University, Singapore, Singapore.

The Indian cheetah was hunted to extinction by the mid-20th century. While analysis of 139 bp of mitochondrial DNA (mtDNA) has confirmed that the Indian cheetah was part of the Asiatic subspecies (Acinonyx jubatus venaticus), the detailed relationships between cheetah populations remains unclear due to limited genetic data. We clarify these relationships by studying larger fragments of cheetah mtDNA, both from an Indian cheetah museum specimen and two African cheetah, one modern and one historic, imported into India at different times. Our results suggest that the most recent common ancestor of cheetah mtDNA is approximately twice as ancient as currently recognised. The Indian and Southeast African (Acinonyx jubatus jubatus) cheetah mtDNA diverged approximately 72 kya, while the Southeast and Northeast African (Acinonyx jubatus soemmeringii) cheetah mtDNA diverged around 139 kya. Additionally, the historic African cheetah sampled from India proved to have an A. j. jubatus haplotype, suggesting a hitherto unrecognised South African route of cheetah importation into India in the 19 century. Together, our results provide a deeper understanding of the relationships between cheetah subspecies, and have important implications for the conservation of A. j. venaticus and potential reintroduction of cheetahs into India.
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http://dx.doi.org/10.1038/s41598-020-60751-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067882PMC
March 2020

Jet Ventilation in the Pregnant Patient with Airway Stenosis: Surgical Safety and Outcomes.

Ann Otol Rhinol Laryngol 2020 May 21;129(5):489-493. Epub 2019 Dec 21.

Department of Otolaryngology, University of Texas Health San Antonio, San Antonio, TX, USA.

Objective: To review pregnancy outcomes and the safety of jet ventilation use in the gravid patient undergoing surgical airway intervention.

Methods: A multi-institutional retrospective review of medical records was performed to identify women who underwent low-frequency jet ventilation during pregnancy for surgical treatment of airway stenosis. Postoperative complications were noted, and patients were interviewed regarding pregnancy outcomes.

Results: Six women were included in this series. No immediate complications relating to anesthesia or surgical intervention were noted in five of the six women. One patient with a well-known history of uncontrolled seizures experienced seizure activity postoperatively. One patient returned to the operating room at a later date for debridement of tracheal crusts. Five mothers delivered via cesarean section and one via spontaneous vaginal delivery. The mean gestation age was 37.3 weeks. One of the six infants delivered prematurely and three were delivered at low birth weight. Three of the six infants required elevated care immediately post-delivery but, at present, all are in good health.

Conclusion: Low-frequency jet ventilation and surgical management of airway stenosis should be recognized as a safe treatment option in the gravid patient. Surgical intervention should not be delayed in patients with severe symptoms, particularly given the potential risk associated with prolonged corticosteroid use.

Level Of Evidence: 4.
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http://dx.doi.org/10.1177/0003489419896598DOI Listing
May 2020

The Role of Coaches within Academic Medical Departments: Is There Value to Integrating This into Academic Mentorship Programs?

Healthc Q 2019 Oct;22(3):68-72

Sunil Verma, is a professor and the department head of the Department of Oncology at Cumming School of Medicine, University of Calgary and the medical director of Tom Baker Cancer Centre, Calgary, AB.

This study evaluated the benefits of formal coaching within a mentorship program in a Canadian academic medical department. Between April 2016 and September 2018, an executive coach was made available to members of the Department of Oncology at the University of Calgary. Thirty-seven individuals sought and received formal coaching during this period, using up an average of four hourly sessions; of these individuals, 13% (20/150) are full-time faculty. Issues that facilitated interest in coaching included the following: needing to develop an individual life plan, wanting to improve work-life balance/time management and seeking advice about promotion or job application. This study found that coaching enabled participants to address their concerns 70% of the time and describes the elements of a coaching function within academic medical departments. We strongly recommend that academic departments provide opportunities for interested individual academics to receive coaching.
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http://dx.doi.org/10.12927/hcq.2019.26013DOI Listing
October 2019

Prevalence of hypertension among Indian adults: Results from the great India blood pressure survey.

Indian Heart J 2019 Jul - Aug;71(4):309-313. Epub 2019 Sep 18.

Objective: Hypertension is the most important risk factor for cardiovascular morbidity and mortality. There is limited data on hypertension prevalence in India. This study was conducted to estimate the prevalence of hypertension among Indian adults.

Methods: A national level survey was conducted with fixed one-day blood pressure measurement camps across 24 states and union territories of India. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or a diastolic BP ≥90 mmHg or on treatment for hypertension. The prevalence was age- and gender-standardized according to the 2011 census population of India.

Results: Blood pressure was recorded for 180,335 participants (33.2% women; mean age 40.6 ± 14.9 years). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%), and 2,878 (1.6%) participants were of the age group 18-19, 20-44, 45-54, 55-64, 65-74, and ≥ 75 years, respectively. Overall prevalence of hypertension was 30.7% (95% confidence interval [CI]: 30.5, 30.9) and the prevalence among women was 23.7% (95% CI: 23.3, 24). Prevalence adjusted for 2011 census population and the WHO reference population was 29.7% and 32.8%, respectively.

Conclusion: There is a high prevalence of hypertension, with almost one in every three Indian adult affected.
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http://dx.doi.org/10.1016/j.ihj.2019.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890959PMC
May 2020

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.

JAMA Otolaryngol Head Neck Surg 2020 01;146(1):20-29

Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.

Importance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research.

Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease.

Design, Setting, And Participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook.

Main Outcomes And Measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications.

Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk.

Conclusions And Relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.
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http://dx.doi.org/10.1001/jamaoto.2019.3022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824232PMC
January 2020

Research priorities in metastatic breast cancer: A James Lind Alliance Priority Setting Partnership.

Breast J 2020 03 2;26(3):488-493. Epub 2019 Sep 2.

Tom Baker Cancer Centre, Calgary, AB, Canada.

Breast cancer remains the most common cancer among women, and the second most common cause of cancer death. With advances in treatment, women are living longer, in some cases many years, with metastatic breast cancer (MBC). These advances are a direct result of research, however, many studies are primarily researcher or industry led, with minimal input from patients and caregivers. The James Lind Alliance (JLA) brings patients, caregivers, and clinicians together in priority setting partnerships (PSPs) to determine key priorities in research. In this study, we utilized the JLA approach to identify unanswered questions on MBC from patient and clinical perspectives and prioritized to reach a top 10. Following the established JLA approach, MBC patients, caregivers, and health care professionals (HCPs) were surveyed to elicit their questions regarding MBC. Research questions were generated from survey responses, and following literature review to ensure the questions were currently not completely answered, an interim prioritization survey was conducted to identify a shortlist of questions taken to a final consensus meeting. One thousand, one-hundred and ninety-four responses were collected from 668 individuals, which were refined into 62 unique unanswered questions. The interim prioritization survey was completed by 174 individuals, and the top 27 questions were taken to a final meeting to determine by consensus the top 10. The top 10 questions cover a wide range of research questions, identified by valuable stakeholders as being priorities. This list can be used to inform prioritization and funding of future MBC research.
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http://dx.doi.org/10.1111/tbj.13525DOI Listing
March 2020

Incidence and predictors of pacemaker-induced cardiomyopathy with comparison between apical and non-apical right ventricular pacing sites.

J Interv Card Electrophysiol 2019 Oct 30;56(1):63-70. Epub 2019 Jul 30.

Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India.

Background: Asynchronous activation of left ventricle (LV) due to chronic right ventricular (RV) pacing has been known to predispose to LV dysfunction. The predictors of LV dysfunction remain to be prospectively studied. This study was designed to follow up patients with RV pacing to look for development of pacing-induced cardiomyopathy (PiCMP), identify its predictors and draw comparison between apical vs non-apical RV pacing sites.

Methods: Three hundred sixty-three patients undergoing dual-chamber and single-chamber ventricular implants were enrolled and followed up. Baseline clinical parameters; paced QRS duration and axis; RV lead position by fluoroscopy; LV ejection fraction (LVEF) by Simpson's method on transthoracic echocardiography (TTE); intraventricular dyssynchrony (septal-posterior wall contraction delay) and interventricular dyssynchrony (aortopulmonary ejection delay) on TTE were recorded. The patients were followed up at 6-12 monthly interval with estimation of LVEF and pacemaker interrogation at each visit. Pacemaker-induced cardiomyopathy (PiCMP) was defined as a fall in ejection fraction of 10% as compared to the baseline LVEF. Patients developing PiCMP were compared to other patients to identify predictors.

Results: The mean age of study population was 59.8 years, 68.3% being males. Fifty-one percent and 49% patients underwent VVIR and DDDR pacemaker implantation, respectively. After attrition, 254 patients were analysed. PiCMP developed in 35 patients (13.8%) over a mean follow-up of 14.5 months. After multivariate analysis, burden of ventricular pacing > 60% [HR 4.26, p = 0.004] and interventricular dyssynchrony (aortopulmonary ejection delay > 40 msec) [HR 3.15, p = 0.002] were identified as predictors for PiCMP in patients undergoing chronic RV pacing. There was no effect of RV pacing site (apical vs non-apical) on incidence of PiCMP [HR 1.44, p = 0.353).

Conclusions: Incidence of PiCMP with RV pacing was found to be 13.8% over a mean follow-up of 14.5 months. Burden of right ventricular pacing and interventricular dyssynchrony were identified as the most important predictors for the development of PiCMP. Non-apical RV pacing site did not offer any benefit in terms of incidence of PiCMP over apical lead position.
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http://dx.doi.org/10.1007/s10840-019-00602-2DOI Listing
October 2019

Palbociclib with Letrozole in Postmenopausal Women with ER+/HER2- Advanced Breast Cancer: Hematologic Safety Analysis of the Randomized PALOMA-2 Trial.

Oncologist 2019 12 19;24(12):1514-1525. Epub 2019 Jun 19.

David Geffen School of Medicine at UCLA, Santa Monica, California, USA.

Background: PALOMA-2 confirmed that first-line palbociclib + letrozole improved progression-free survival (hazard ratio, 0.58; 95% confidence interval, 0.46-0.72) in postmenopausal women with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). This analysis evaluated palbociclib-associated hematologic adverse events (AEs) and provides insight on managing these AEs.

Materials And Methods: Postmenopausal women with ER+/HER2- ABC were randomly assigned 2:1 to letrozole (2.5 mg daily continuously) plus oral palbociclib (125 mg daily; 3 weeks on/1 week off) or placebo. Safety assessments were performed at baseline, days 1 and 15 (first two cycles) and day 1 of subsequent cycles, and included white blood cell, platelet, and absolute neutrophil count (ANC).

Results: PALOMA-2 randomized 666 women to palbociclib + letrozole ( = 444) or placebo + letrozole (n = 222). Neutropenia was the most common AE (95.3%) with palbociclib (grade 3, 55.6%; grade 4, 11.5%) and was managed by dose modifications; progression-free survival was similar between patients who experienced grade ≥ 3 neutropenia versus those who did not. Median (range) time to onset of neutropenia with palbociclib + letrozole was 15 (12-700) days (grade ≥ 3, 28.0 [12-854] days); median duration of each neutropenia episode grade ≥ 3 was 7.0 days. Asian ethnicity and low baseline ANC were associated with increased risk of grade 3/4 neutropenia with palbociclib ( < .001).

Conclusion: Palbociclib + letrozole was generally well tolerated. Neutropenia, the most frequently reported AE in women with ER+/HER2- ABC, was mostly transient and manageable by dose modifications in patients who experienced grade ≥ 3 neutropenia, without appearing to compromise efficacy. (Pfizer; NCT01740427) IMPLICATIONS FOR PRACTICE: Palbociclib demonstrated an acceptable safety profile in PALOMA-2 in women with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) receiving first-line palbociclib + letrozole. Although hematologic adverse events (AEs) are typically expected with anticancer therapies and are often clinically significant, palbociclib-related hematologic AEs, particularly neutropenia (most frequent AE), were transient/manageable by dose reduction, interruption, or cycle delay, which is in contrast to the more profound neutropenia associated with chemotherapy. Palbociclib dose adjustments decreased hematologic AE severity without appearing to compromise efficacy, supporting palbociclib + letrozole as a first-line treatment for ER+/HER2- ABC.
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http://dx.doi.org/10.1634/theoncologist.2019-0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6975938PMC
December 2019

Pulmonary artery from the left main coronary artery.

Ann Pediatr Cardiol 2019 May-Aug;12(2):176-177

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

The usual sources of pulmonary blood flow in pulmonary atresia (PA) with(VSD) are patent ductus arteriosus and aortopulmonary collaterals. However, rarely fistulous collaterals may also arise from the coronary arteries which usually open into the main pulmonary trunk or branch pulmonary arteries. In such cases, selective coronary angiogram may be required for the demonstration of pulmonary arterial anatomy. A case of PA with VSD with failure to demonstrate pulmonary arteries on routine catheterization study (ventricular, aortic root, and descending aortic angiograms) is being presented here. A coronary artery-to-pulmonary artery fistula was suspected in view of dilated left main coronary artery, and pulmonary arteries were well demonstrated with selective coronary angiogram.
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http://dx.doi.org/10.4103/apc.APC_163_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521668PMC
May 2019

Identification and Management of Chronic Laryngitis.

Otolaryngol Clin North Am 2019 Aug 14;52(4):607-616. Epub 2019 May 14.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Building 56, Suite 500, Orange, CA 92868, USA. Electronic address:

Chronic laryngitis is an inflammatory process of at least 3 weeks duration and affects phonation, breathing, and swallowing. This article describes the infectious, inflammatory, and autoimmune causes of chronic laryngitis. Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy.
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http://dx.doi.org/10.1016/j.otc.2019.03.004DOI Listing
August 2019

Redrawing the Lines: The Next Generation of Treatment in Metastatic Breast Cancer.

Am Soc Clin Oncol Educ Book 2019 Jan 17;39:e8-e21. Epub 2019 May 17.

1 Tom Baker Cancer Centre, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Although not considered curative in nature, new therapeutic advances in metastatic breast cancer (MBC) have substantially improved patient outcomes. This article discusses the state-of-the-art and emerging therapeutic options for management of MBC. BC systemic therapy targets multiple key pathways, including estrogen receptor signaling, HER2 signaling, and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling. Other therapeutic strategies include targeting DNA repair, inhibiting immune checkpoints, and developing antibody-drug conjugates. Although surgery historically was reserved for palliation of symptomatic, large, or ulcerating masses, some data suggest a possibly expanding role for more aggressive locoregional therapy in combination with systemic therapy. As technology develops, biomarker-specific, line-agnostic, and receptor-agnostic treatment strategies will redraw the current lines of MBC care. However, tumor heterogeneity remains a challenge. To effectively reshape our approach to MBC, careful consideration of the patient perspective, the costs and value of novel treatments, and accessibility (especially in developing countries) is paramount.
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http://dx.doi.org/10.1200/EDBK_237419DOI Listing
January 2019

Left anterior descending artery from right coronary sinus and left circumflex artery from pulmonary artery- a rare association.

J Cardiovasc Comput Tomogr 2020 Sep - Oct;14(5):e61-e62. Epub 2019 Feb 23.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India. Electronic address:

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http://dx.doi.org/10.1016/j.jcct.2019.02.006DOI Listing
October 2020

CDK4/6 inhibitors in breast cancer: beyond hormone receptor-positive HER2-negative disease.

Ther Adv Med Oncol 2018 17;10:1758835918818346. Epub 2018 Dec 17.

Medical Oncology Department, Tom Baker Cancer Centre, Calgary, Alberta, Canada.

The development of cyclin-dependent kinase (CDK) 4/6 inhibitors has been more prominent in hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative breast cancers, with a significant improvement in progression-free survival (PFS) in first and later lines of metastatic breast cancer (MBC) therapy. Preclinical evidence suggests that there is activity of CDK4/6 inhibitors in nonluminal cell lines. Here, we present a review of the current preclinical and clinical data on the use of CDK inhibitors in HER2-positive and triple-negative breast cancer (TNBC).
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http://dx.doi.org/10.1177/1758835918818346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299331PMC
December 2018

The Online Support Group as a Community: A Thematic Content Analysis of an Online Support Group for Idiopathic Subglottic Stenosis.

Ann Otol Rhinol Laryngol 2019 Apr 4;128(4):293-299. Epub 2019 Jan 4.

1 University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, UC Irvine School of Medicine, Irvine, CA, USA.

Objective:: Idiopathic subglottic stenosis (iSGS) is a rare disease with few local resources for individuals to use. With the explosive growth of online social networking, platforms such as Facebook possess compelling potential to facilitate user-driven sharing of health information and peer support. This study was performed to better understand the content shared in a busy online community for individuals with iSGS.

Methods:: The largest online community (OC) for individuals with iSGS, Living With Idiopathic Subglottic Stenosis (LwiSGS), was examined. A thematic content analysis of the communications shared in February of 2018 was performed. A conventional qualitative analysis model was employed to analyze aggregated data. The data were then codified.

Results:: Analysis demonstrated that communications primarily encompassed three major thematic elements: (1) information sharing; (2) emotional support, expression, and experience sharing; and (3) community building. Positively toned posts grossly overshadowed negatively toned posts by almost a factor of 3. A significant portion of group members requested information from their peers, suggesting a high level of trust toward the resources provided in this group, even those involving a surgical procedure or medication.

Conclusion:: LwiSGS is a forum for patients with a rare chronic condition to share informational resources, personal experiences, and emotional support, as well as a community with their peers. These data suggest that LwiSGS could be a powerful resource for individuals with iSGS to share information, personal experiences, or emotional support.
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http://dx.doi.org/10.1177/0003489418820348DOI Listing
April 2019

Safety of outpatient unilateral medialization laryngoplasty across two academic institutions.

Laryngoscope 2019 07 26;129(7):1647-1649. Epub 2018 Dec 26.

Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A.

Objectives/hypothesis: Unilateral ML is a commonly performed surgery for dysphonia secondary to glottic insufficiency. The safety of this procedure performed in the outpatient setting has not been extensively examined. The purpose of the study was to assess the safety of outpatient unilateral ML in adults and determine the incidence and timing of postoperative complications across two tertiary-care academic medical centers.

Study Design: Retrospective chart review, METHODS: A review of patients undergoing unilateral ML at two tertiary-care academic centers from 2011 to 2017 was performed. Patients undergoing bilateral medialization laryngoplasty, revision surgery, or those undergoing additional laryngeal framework procedures including arytenoid adduction were excluded. Patient demographics, operative details, and perioperative and postoperative complications were recorded. Comparisons were made between those individuals who underwent inpatient versus outpatient ML.

Results: One hundred three total procedures met inclusion criteria. Fifty-seven were performed as outpatient procedures, and 46 individuals were observed for at least 23 hours following surgery. Silastic or Gore-Tex implants were used in all but two surgeries. There were no postoperative complications in either setting, including hematoma, dyspnea, wound infections or seromas.

Conclusions: The incidence of adverse events during and immediately following unilateral ML is very low. Patients can be discharged safely the day of surgery without geographic restrictions.

Level Of Evidence: 4 Laryngoscope, 129:1647-1649, 2019.
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http://dx.doi.org/10.1002/lary.27688DOI Listing
July 2019