Publications (54)98.85 Total impact
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Article: Cardiac cachexia and the aged: death by water, wind, Earth, and fire.
Journal of the American Geriatrics Society 10/2012; 60(10):1999-2000. · 3.74 Impact Factor -
Article: Calciphylaxis following coronary artery bypass surgery: an underappreciated cause of wound complications?
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ABSTRACT: Wound complications following cardiac surgery are typically infectious and associated with a high morbidity and mortality. Calciphylaxis, vascular calcification of small and medium sized vessels, often associated with end-stage renal disease, can result in extensive tissue necrosis. We hypothesize that calciphylaxis is an under-recognized and under-reported precipitating wound and breast complication following coronary artery bypass surgery and thereby necessitates further study.Heart Surgery Forum 08/2012; 15(4):E218-20. · 0.63 Impact Factor -
Article: Comorbidity-polypharmacy scoring facilitates outcome prediction in older trauma patients.
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ABSTRACT: To determine the association between comorbidity-polypharmacy score (CPS) and clinical outcomes in a large sample of older trauma patients, focusing on outcome prognostication. The CPS combines number of preinjury medications and comorbidities to more objectively quantify the severity of comorbid conditions. An urban tertiary care level 1 trauma center in the Midwest. Trauma patients aged 45 and older. Participants were stratified into four groups according to CPS ranges. Survival analyses were performed using Kaplan-Meier/Mantel-Cox testing. Factors influencing mortality, complications, and survivor discharge destination were evaluated using analysis of covariance and multivariate logistic regression. Records for 469 individuals (mean age 62.1, mean injury severity score 9.3) were reviewed. Higher CPS is associated with greater mortality, complications, longer hospital and intensive care unit stay, and need for discharge to a facility. Higher CPS is associated with lower 90-day survival (Mantel-Cox, P < .001). Mortality was independently associated with older age (odds ratio (OR) = 1.06 per year), higher injury severity score (OR = 1.19 per point), and higher CPS (OR = 1.11 per point) in multivariate analysis (all P < .01). Complications and need for discharge to a facility were independently associated with older age and higher injury severity score and CPS. CPS can be readily determined in the era of medication reconciliation. Trauma patients with CPS of 15 or greater are at greater risk of poor clinical outcomes. CPS constitutes a useful adjunct to currently available injury severity scoring tools as a predictor of morbidity, mortality, hospital resource utilization, and postdischarge disposition in older trauma patients.Journal of the American Geriatrics Society 07/2012; 60(8):1465-70. · 3.74 Impact Factor -
Article: Comorbidity-polypharmacy score: A novel adjunct in post-emergency department trauma triage.
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ABSTRACT: OBJECTIVE: Post-emergency department triage of older trauma patients continues to be challenging, as morbidity and mortality for any given level of injury severity tend to increase with age. The comorbidity-polypharmacy score (CPS) combines the number of pre-injury medications with the number of comorbidities to estimate the severity of comorbid conditions. This retrospective study examines the relationship between CPS and triage accuracy for older (≥45y) patients admitted for traumatic injury. METHODS: Patients aged 45y and older presenting to level 1 trauma center from 2005 to 2008 were included. Basic data included patient demographics, injury severity score, morbidity and mortality, and functional outcome measures. CPS was calculated by adding total numbers of comorbid conditions and pre-injury medications. Patients were divided into three triage groups: undertriage (UT), appropriate triage (AT), and overtriage (OT). UT criteria included initial admission to the floor or step-down unit followed by an unplanned transfer to intensive care unit (ICU) within 24h of admission. OT was defined as initial ICU admission for <1d without stated need for ICU level of care (i.e., lack of evidence for tracheal intubation or mechanical ventilation, injury-related hemorrhage, or other traditional ICU indications, such as intracranial bleeding). All other patients were presumed to be correctly triaged. The three triage groups were then analyzed looking for contributors to mistriage. RESULTS: Charts for 711 patients were evaluated (mean age, 63.5y; 55.7% male; mean ISS, 9.02). Of those, 11 (1.55%) met criteria for UT and 14 (1.97%) for OT. The remaining 686 patients had no evidence of mistriage. The three groups were similar in terms of injury severity and GCS. The groups were significantly different with respect to CPS, with UT CPSs (14.9±6.80) being nearly three times higher than OT CPSs (5.14±3.48). There were more similarities between AT and OT groups, with the UT group being characterized by greater number of complications and lower functional outcomes at discharge (all, P<0.05). The UT group had significantly higher mortality (27%) than the AT and OT groups (6% and 0%, respectively). CONCLUSIONS: In the era of medication reconciliation, CPS is easy to obtain and calculate in patients who are not critically injured. This study suggests that CPS may be a promising adjunct in identifying older trauma patients who are more likely to be undertriaged. The significance of our findings is especially important when considering that injury severity in the UT group was similar to that in the other groups. Further evaluation of CPS as a triage tool in acute trauma is warranted.Journal of Surgical Research 05/2012; · 2.25 Impact Factor -
Article: Advances in management of acute hypertension: a concise review.
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ABSTRACT: Chronic hypertension affects >1 billion people worldwide and >70 million people in the United States. Acute hypertensive episodes (AHE) are defined as severe spikes in blood pressure that may result in end-organ damage. Although AHE may arise independently as de novo events, they are more likely to occur in patients with pre-existing hypertension. One of the controversies regarding the clinical approach to AHE is the selection of anti-hypertensive medication. Depending on the clinical presentation of the patient and the threat of end-organ damage resulting from blood pressure elevation, appropriate and prompt treatment is warranted. There are multiple agents available for the management of hypertension. However, the greatest challenge lies in the acute care setting where the need exists for better initial and sustained control of blood pressure spikes. Many anti-hypertensive agents effectively lower blood pressure, yet only few have the capacity to achieve strict control of hypertension in the acute setting. Clevidipine butyrate is an ultra short-acting intravenous dihydropyridine calcium-channel blocker. Clevidipine has unique pharmacodynamic and pharmacokinetic properties that enable the fast, safe, and adequate reduction of blood pressure in hypertensive emergencies, with the ability to provide highly precise titration necessary to maintain a narrowly-defined target blood pressure range. Several recently published phase I, II, and III clinical studies have shown Clevidipine to be an effective blood pressure modulator in such capacity.Discovery medicine 05/2012; 13(72):375-83. -
Article: Negative pressure pulmonary edema with laryngeal mask airway use: Recognition, pathophysiology and treatment modalities.
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ABSTRACT: Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide.International journal of critical illness and injury science. 05/2012; 2(2):98-103. -
Article: High-frequency oscillatory ventilation after cardiac surgery: a treatment for all ages.
Critical care (London, England) 01/2012; 16(1):405. · 4.61 Impact Factor -
Article: Nonconvective forces: a critical and often ignored component in the echocardiographic assessment of transvalvular pressure gradients.
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ABSTRACT: Echocardiography is routinely used to assess ventricular and valvular function, particularly in patients with known or suspected cardiac disease and who have evidence of hemodynamic compromise. A cornerstone to the use of echocardiographic imaging is not only the qualitative assessment, but also the quantitative Doppler-derived velocity characteristics of intracardiac blood flow. While simplified equations, such as the modified Bernoulli equation, are used to estimate intracardiac pressure gradients based upon Doppler velocity data, these modified equations are based upon assumptions of the varying contributions of the different forces that contribute to blood flow. Unfortunately, the assumptions can result in significant miscalculations in determining a gradient if not completely understood or they are misapplied. We briefly summarize the principles of fluid dynamics that are used clinically with some of the inherent limitations of routine broad application of the simplified Bernoulli equation.Cardiology research and practice. 01/2012; 2012:383217. -
Article: A bibliometric search of citation classics in anesthesiology.
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ABSTRACT: Articles cited counts are catalogued and help identify landmark papers. This study provides a citation classics of anesthesiology literature using the framework of subspecialties to provide a review of well-developed areas of research in anesthesiology. A comprehensive list of the most-cited articles in anesthesia was compiled using a bibliometric database and general search terms such as "anesthesia" as well as subspecialty-specific search terms. Queries were reviewed for relevance to anesthesiology practice, categorized by subspecialty, and ranked according to their citation counts. The database resulted in 2519 articles published between 1945 and 2008. The specialty areas most represented were chronic pain medicine (11%), pharmacology (9%), and pain sciences (9%). This citations classic allows for advances in anesthesiology and its subspecialties to be highlighted as well to provide useful manuscripts to guide patient care, direct future research, and serve as sources for future academic pursuit.BMC Anesthesiology 12/2011; 11:24. -
Article: The aging paradox: how old is old and all that jazz?
Journal of the American Geriatrics Society 10/2011; 59(10):1987-8. · 3.74 Impact Factor -
Article: To live a story.
Anesthesiology 08/2011; 116(6):1388-90. · 5.36 Impact Factor -
Article: "Life-threatening" Hypoxemia in One-lung Ventilation.
Anesthesiology 08/2011; 115(2):438; author reply 439-41. · 5.36 Impact Factor -
Article: ECMO and endogenous carboxyhemoglobin formation.
International journal of critical illness and injury science. 07/2011; 1(2):168. -
Article: An overview of end-of-life issues in the intensive care unit.
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ABSTRACT: The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care givers. It involves topics from economics to existentialism, and surgery to spiritualism. It requires education, communication, acceptance of diversity, and an ultimate acquiescence to the inevitable. Here, we present a comprehensive overview of issues in the care of patients at the end-of-life stage that may cause physicians and other healthcare providers, medical, ethical, social, and philosophical concerns in the intensive care unit.International journal of critical illness and injury science. 07/2011; 1(2):138-46. -
Article: Civilian nuclear incidents: An overview of historical, medical, and scientific aspects.
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ABSTRACT: Given the increasing number of operational nuclear reactors worldwide, combined with the continued use of radioactive materials in both healthcare and industry, the unlikely occurrence of a civilian nuclear incident poses a small but real danger. This article provides an overview of the most important historical, medical, and scientific aspects associated with the most notable nuclear incidents to date. We have discussed fundamental principles of radiation monitoring, triage considerations, and the short- and long-term management of radiation exposure victims. The provision and maintenance of adequate radiation safety among first responders and emergency personnel are emphasized. Finally, an outline is included of decontamination, therapeutic, and prophylactic considerations pertaining to exposure to various radioactive materials.Journal of Emergencies Trauma and Shock 04/2011; 4(2):260-72. -
Article: Neural network-based real-time prediction of glucose in patients with insulin-dependent diabetes.
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ABSTRACT: Continuous glucose monitoring (CGM) technologies report measurements of interstitial glucose concentration every 5 min. CGM technologies have the potential to be utilized for prediction of prospective glucose concentrations with subsequent optimization of glycemic control. This article outlines a feed-forward neural network model (NNM) utilized for real-time prediction of glucose. A feed-forward NNM was designed for real-time prediction of glucose in patients with diabetes implementing a prediction horizon of 75 min. Inputs to the NNM included CGM values, insulin dosages, metered glucose values, nutritional intake, lifestyle, and emotional factors. Performance of the NNM was assessed in 10 patients not included in the model training set. The NNM had a root mean squared error of 43.9 mg/dL and a mean absolute difference percentage of 22.1. The NNM routinely overestimates hypoglycemic extremes, which can be attributed to the limited number of hypoglycemic reactions in the model training set. The model predicts 88.6% of normal glucose concentrations (> 70 and < 180 mg/dL), 72.6% of hyperglycemia (≥ 180 mg/dL), and 2.1% of hypoglycemia (≤ 70 mg/dL). Clarke Error Grid Analysis of model predictions indicated that 92.3% of predictions could be regarded as clinically acceptable and not leading to adverse therapeutic direction. Of these predicted values, 62.3% and 30.0% were located within Zones A and B, respectively, of the error grid. Real-time prediction of glucose via the proposed NNM may provide a means of intelligent therapeutic guidance and direction.Diabetes Technology & Therapeutics 02/2011; 13(2):135-41. · 1.93 Impact Factor -
Article: Synergistic activation of NF-{kappa}B by bacterial chemoattractant and TNF{alpha} is mediated by p38 MAPK-dependent RelA acetylation.
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ABSTRACT: In the host immune system, leukocytes are often exposed to multiple inflammation inducers. NF-κB is of considerable importance in leukocyte function because of its ability to activate the transcription of many proinflammatory immediate-early genes. Tremendous efforts have been made toward understanding how NF-κB is activated by various inducers. However, most research on NF-κB regulation has been focused on understanding how NF-κB is activated by a single inducer. This is unlike the situation in the human immune system where multiple inflammation inducers, including both exogenous and endogenous mediators, are present concurrently. We now present evidence that the formylated peptide f-Met-Leu-Phe (fMLP), a bacterial chemoattractant, synergizes with TNFα to induce NF-κB activation and the resultant inflammatory response in vitro and in vivo. The mechanism of synergistic activation of NF-κB by bacterial fMLP and TNFα may be involved in the induction of RelA acetylation, which is regulated by p38 MAPK. Thus, this study provides direct evidence for the synergistic induction of NF-κB-dependent inflammatory responses by both exogenous and endogenous inducers. The ability of fMLP to synergize with TNFα and activate NF-κB represents a novel and potentially important mechanism through which bacterial fMLP not only attracts leukocytes but also directly contributes to inflammation by synergizing with the endogenous mediator TNFα.Journal of Biological Chemistry 11/2010; 285(45):34348-54. · 4.77 Impact Factor -
Article: Synergistic Activation of NF-κB by Bacterial Chemoattractant and TNFα Is Mediated by p38 MAPK-dependent RelA Acetylation
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ABSTRACT: In the host immune system, leukocytes are often exposed to multiple inflammation inducers. NF-κB is of considerable importance in leukocyte function because of its ability to activate the transcription of many proinflammatory immediate-early genes. Tremendous efforts have been made toward understanding how NF-κB is activated by various inducers. However, most research on NF-κB regulation has been focused on understanding how NF-κB is activated by a single inducer. This is unlike the situation in the human immune system where multiple inflammation inducers, including both exogenous and endogenous mediators, are present concurrently. We now present evidence that the formylated peptide f-Met-Leu-Phe (fMLP), a bacterial chemoattractant, synergizes with TNFα to induce NF-κB activation and the resultant inflammatory response in vitro and in vivo. The mechanism of synergistic activation of NF-κB by bacterial fMLP and TNFα may be involved in the induction of RelA acetylation, which is regulated by p38 MAPK. Thus, this study provides direct evidence for the synergistic induction of NF-κB-dependent inflammatory responses by both exogenous and endogenous inducers. The ability of fMLP to synergize with TNFα and activate NF-κB represents a novel and potentially important mechanism through which bacterial fMLP not only attracts leukocytes but also directly contributes to inflammation by synergizing with the endogenous mediator TNFα.Journal of Biological Chemistry 11/2010; 285(45):34348-34354. · 4.77 Impact Factor -
Article: Synergistic activation of nuclear factor kappaB (NF-kappaB)by bacterial chemoattractant and tumor necrosis factor alpha (TNFalpha) is mediated by p38MAPK-dependent RelA acetylation
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ABSTRACT: In the host immune system, leukocytes are often exposed to multiple inflammation inducers. NF-kB is of considerable importance in leukocyte function owing to its ability to activate the transcription of many proinflammatory immediate-early genes. Tremendous efforts have been made toward understanding how NF-kB is activated by various inducers. However, most research on NF-kB regulation has been focused on understanding how NF-kB is activated by a single inducer. This is unlike the situation in human immune system where multiple inflammation inducers, including both exogenous and endogenous mediators, are present concurrently. We now present evidence that fMLP, a bacterial chemoattractant, synergizes with TNFa to induce NF-kB activation and the resultant inflammatory response in vitro and in vivo. The mechanism of synergistic activation of NF-kB by bacterial fMLP and TNFa may involve in induction of RelA acetylation, which is regulated by p38 MAP kinase. Thus, the present studies provide direct evidence for the synergistic induction of NF-kB-dependent inflammatory responses by both exogenous and endogenous inducers. The ability of fMLP to synergize with TNFa and activate NF-kB represents a novel and potentially important mechanism through which bacterial fMLP can not only attracts leukocytes but also directly contribute to inflammation by synergizing with endogenous mediator TNFa.Journal of Biological Chemistry 08/2010; · 4.77 Impact Factor -
Article: Development of a neural network model for predicting glucose levels in a surgical critical care setting.
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ABSTRACT: Development of neural network models for the prediction of glucose levels in critically ill patients through the application of continuous glucose monitoring may provide enhanced patient outcomes. Here we demonstrate the utilization of a predictive model in real-time bedside monitoring. Such modeling may provide intelligent/directed therapy recommendations, guidance, and ultimately automation, in the near future as a means of providing optimal patient safety and care in the provision of insulin drips to prevent hyperglycemia and hypoglycemia.Patient Safety in Surgery 01/2010; 4(1):15.
Top co-authors
Top Journals
Institutions
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2011–2012
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The Ohio State University
- Department of Anesthesiology
Columbus, OH, USA -
Cooper University Hospital
- Department of Surgery
Camden, NJ, USA
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2002–2010
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Medical University of Ohio at Toledo
- Department of Medicine
Toledo, OH, USA
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2007–2009
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University of Toledo
- • Department of Medical Microbiology and Immunology
- • Department of Anesthesiology
Toledo, OH, USA
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