Publications by authors named "V Raman"

487 Publications

Pediatric obesity and perioperative medicine.

Curr Opin Anaesthesiol 2021 Jun;34(3):299-305

Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.

Purpose Of Review: Childhood obesity is a public health emergency that has reached a pandemic level and imposed a massive economic burden on healthcare systems. Our objective was to provide an update on (1) challenges of obesity definition and classification in the perioperative setting, (2) challenges of perioperative patient positioning and vascular access, (3) perioperative implications of childhood obesity, (3) anesthetic medication dosing and opioid-sparing techniques in obese children, and (4) research gaps in perioperative childhood obesity research including a call to action.

Recent Findings: Despite the near axiomatic observation that obesity is a pervasive clinical problem with considerable impact on perioperative health, there have only been a handful of research into the many ramifications of childhood obesity in the perioperative setting. A nuanced understanding of the surgical and anesthetic risks associated with obesity is essential to inform patients' perioperative consultation and their parents' counseling, improve preoperative risk mitigation, and improve patients' rescue process when complications occur.

Summary: Anesthesiologists and surgeons will continue to be confronted with an unprecedented number of obese or overweight children with a high risk of perioperative complications.
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http://dx.doi.org/10.1097/ACO.0000000000000991DOI Listing
June 2021

Utilization Trends and Volume-Outcomes Relationship of Endoscopic Resection for Early Stage Esophageal Cancer.

Ann Surg 2021 Mar 3. Epub 2021 Mar 3.

*Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC †Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Objectives: We describe utilization trends and center volume-outcomes relationship of endoscopic resection of early stage esophageal cancer using a large hospital-based registry.

Summary Background Data: Endoscopic resection is increasingly accepted as the preferred treatment for early stage esophageal cancer, however its utilization and the center volume-outcomes relationship in the United States is unknown.

Methods: The National Cancer Database was used to identify patients with cT1N0M0 esophageal cancer treated with endoscopic resection or esophagectomy between 2004 and 2015. Relative frequencies were plotted over time. Restricted cubic splines and maximally selected rank statistics were used to identify an inflection point of center volume and survival.

Results: 1136 patients underwent ER and 2829 patients underwent esophagectomy during the study period. Overall utilization of ER, as well as relative use compared to esophagectomy, increased throughout the study period. Median annualized center ER volume was 1.9 cases per year (IQR 0.5-5.8). Multivariable Cox regression showed increasing annualized center volume by one case per year was associated with improved survival. Postoperative 30- or 90-day mortality, 30-day readmission, and pathologic T upstaging rates were similar irrespective of center volume.

Conclusions: Utilization of ER compared to esophagectomy for stage I esophageal cancer has increased over the past decade, though many individual centers perform fewer than 1 case annually. Increasing annualized center volume by one procedure per year was associated with improved survival. Increased volume beyond this was not associated with survival benefit. Referral to higher volume centers for treatment of superficial esophageal cancer should be considered.
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http://dx.doi.org/10.1097/SLA.0000000000004834DOI Listing
March 2021

Eosinophilic pneumonia: a case of daptomycin induced lung injury.

J Community Hosp Intern Med Perspect 2021 Mar 23;11(2):280-285. Epub 2021 Mar 23.

Medstar Health, Maryland, United States.

Eosinophilic pneumonia is a category of lung diseases characterized by an increased number of eosinophils in alveolar spaces and interstitium. Acute cases are often caused by fungal infections, parasites, drugs or toxins and can present with respiratory failure. Daptomycin has been identified as one of the rare causes of acute eosinophilic pneumonia. We describe a case of an elderly man on daptomycin for MRSA endocarditis treatment who presented to the hospital with fevers and dyspnea within two weeks of daptomycin initiation. As an inpatient, he developed an increasing oxygen requirement necessitating intensive care unit management. Daptomycin cessation improved his symptoms and he was placed on a steroid taper. These findings suggested a diagnosis of daptomycin-induced eosinophilic pneumonia. However, the patient deteriorated and eventually passed away despite resuscitative efforts. This case highlights the importance of prompt identification of eosinophilic pneumonia, its potential severity and the need for more exploration regarding the timing of corticosteroid taper. This in turn will inform more effective approaches to this condition in the future.
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http://dx.doi.org/10.1080/20009666.2021.1883813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043520PMC
March 2021

Common cloaca: An uncommon entity posing diagnostic and management challenges: Our experience with nine cases.

Med J Armed Forces India 2021 Apr 4;77(2):165-169. Epub 2020 May 4.

Senior Advisor (Surgery) and Pediatric Surgeon, Army Hospital (R&R), Delhi Cantt, 110010, India.

Background: Cloacal anomalies are the severest and most complex of all anorectal malformations (ARMs). They require careful evaluation and meticulous surgery tailored to suit each variant. We present our experience in a series of nine cases.

Methods: This includes a retrospective review of 9 cases of cloaca managed at a tertiary care centre between 2015 and 2019.

Results: Associated anomalies were seen in 44% cases. The definitive surgery was performed at a mean age of 15.2 months (10 months-19 months), the definitive surgery being rectal separation with total urogenital mobilisation. The common channel as measured during panendoscopy was up to 3 cm in 7 patients (78%), and only 2 patients had a common channel of more than 3 cm (22%). Of the 34 procedures that these nine patients underwent, there were four complications (12%). The median follow-up period after stoma closure was 18 months (5-32 months), and the mean age at last follow-up was 38 months (22-48 months). Five children (63%) had spontaneous voiding and remained dry in the intervening period. Three patients (37%) had poor urinary stream with dribbling and high postvoid residue requiring clean intermittent catheterisation. Six patients had faecal soiling (66%); four had daily soiling; and two had occasional soiling. Four patients had constipation (44%). Seven patients (77%) required daily enemas for bowel evacuation and to remain dry.

Conclusion: Cloacal anomalies are rare and complex ARMs. Satisfactory urinary and bowel continence rates can be achieved even in these complex anomalies.
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http://dx.doi.org/10.1016/j.mjafi.2020.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042495PMC
April 2021

Impact of Time to Endoscopic Resection on Outcomes for Stage I Esophageal Adenocarcinoma.

Ann Thorac Surg 2021 Apr 12. Epub 2021 Apr 12.

Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Background: Endoscopic resection (ER) is the preferred treatment for superficial esophageal cancer; however, a safe timeframe for performing ER has not been established. The aim of this study was to evaluate the period in which ER can be performed for patients with stage I esophageal adenocarcinoma without compromising outcomes.

Methods: The 2004-2015 National Cancer Database was used to identify patients with cT1N0M0 esophageal adenocarcinoma who underwent upfront ER. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards methods. The secondary outcome was rate of margin-positive resection, which was evaluated using a multivariable logistic regression.

Results: A total of 983 patients met study criteria. The median time from diagnosis to ER was 34 days (IQR 5-70). Patients in the highest quartile of time to ER were more likely to be treated at a high-volume center and at a center different from that of diagnosis compared to those in the lowest quartile. Increasing time to ER was not independently associated with survival (adjusted HR per 10 days 1.02; 95% CI 0.98-1.05; p=0.32) nor margin-positive resection (OR per 10 days 1.01; 95% CI 0.96-1.06; p=0.60) CONCLUSIONS: In this NCDB analysis, increasing time to endoscopic resection, up to 180 days from diagnosis, was not associated with worsened survival or increased odds of margin-positive resection in patients with cT1N0M0 esophageal adenocarcinoma. Given these findings, patients may be afforded time to be seen in specialty centers without risk of tumor progression.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.001DOI Listing
April 2021