2450 E River Rd
Tucson AZ 85718
Medical School: Other - 1979
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 20354
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*These referrals represent the top 10 that Dr. Talwar has made to other doctors
Quantitative data on the magnitude of the systemic inflammatory response and its relationship with serum measures of iron status. - Translational research : the journal of laboratory and clinical medicine
The present study aimed to quantify the magnitude of the systemic inflammatory response, measured by C-reactive protein (CRP) and albumin, and its relationship with common serum biochemical measures of iron status including total iron, transferrin, transferrin saturation, and ferritin. Retrospective interrogation of laboratory computer databases at 4 centers between 2006 and 2011 provided results from patients in which serum CRP and albumin had been measured together with iron studies (iron, transferrin, and transferrin saturation, nÂ =Â 16,522) and ferritin (nÂ =Â 7,226). Analyte results were categorized into groups according to CRP and albumin. When those groups with CRP <10Â mg/L and albumin >35Â g/L, CRP 11-80Â mg/L and albumin 25-35Â mg/L, and CRP >80Â mg/L and albumin <25Â g/L were compared, the median serum total iron was 15.0, 7.0, and 3.0Â Î¼mol/L, respectively (PÂ <Â 0.001), an overall reduction of 80%. The median serum transferrin concentration was 2.6, 2.0, and 1.3Â Î¼mol/L respectively (PÂ <Â 0.001), an overall reduction of 50%. The median transferrin saturation was 23%, 13%, and 10% respectively (PÂ <Â 0.001), an overall reduction of 56%. The median serum ferritin was 77, 173, and 445Â Î¼g/L respectively (PÂ <Â 0.001), an overall increase of 578%. The present study quantifies the impact of the systemic inflammatory response on serum measures of iron status. This association should be taken into account when measures of iron status are requested and interpreted to prevent misdiagnosis.Copyright Â© 2016 Elsevier Inc. All rights reserved.
The predictive value of low plasma copper and high plasma zinc in detecting zinc-induced copper deficiency. - Annals of clinical biochemistry
Zinc-induced copper deficiency is a condition whose diagnosis is often delayed allowing severe and usually irreversible neurology symptoms to develop. Plasma copper concentrations are usually low and plasma zinc concentrations high. The aim of this study was to measure the predictive value of this combination of results as a means of facilitating its early diagnosis.Low plasma copper (â‰¤6â€‰Âµmol/L) and high plasma zinc results (>18â€‰Âµmol/L) were retrieved from the laboratory database from 2000 to 2014. Medical records and laboratory notes of the corresponding 20 patients found were accessed to determine which were likely to have zinc-induced copper deficiency.Fifteen (75%) patients were diagnosed with zinc-induced copper deficiency which was symptomatic in 13. Of the five remaining patients, two were treated with zinc because of Wilson's disease which was the cause of hypocupraemia, two were treated parenterally with zinc, and insufficient information was available in the final patient.The combination of a low plasma copper and high plasma zinc is strongly predictive for the diagnosis of zinc-induced copper deficiency. There is the therefore an opportunity for the reporting biochemist to facilitate in its earlier diagnosis so enabling treatment to be implemented before the condition deteriorates.Â© The Author(s) 2016.
Regioselective acceptorless dehydrogenative coupling of N-heterocycles toward functionalized quinolines, phenanthrolines, and indoles. - Angewandte Chemie (International ed. in English)
A new strategy has been developed for the oxidant- and base-free dehydrogenative coupling of N-heterocycles at mild conditions. Under the action of an iridium catalyst, N-heterocycles undergo multiple sp(3) Cï£¿H activation steps, generating a nucleophilic enamine that reacts inâ€…situ with various electrophiles to give highly functionalized products. The dehydrogenative coupling can be cascaded with Friedel-Crafts addition, resulting in a double functionalization of the N-heterocycles.Â© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
The effect of the systemic inflammatory response on plasma zinc and selenium adjusted for albumin. - Clinical nutrition (Edinburgh, Scotland)
The magnitude of systemic inflammatory response, as evidenced by C-reactive protein (CRP), is a major factor associated with lower zinc and selenium. They may also be influenced by their binding proteins, such as albumin. The aim of the present study was to examine the relationships between plasma zinc, selenium and the systemic inflammatory response in a large cohort of patients referred for nutritional screen and also to examine these relationships in patients with critical illness.Patients referred for nutritional assessment of zinc (nÂ =Â 743) and selenium (nÂ =Â 833) and 114 patients with critical illness were examined. Intra-assay imprecision was <10% for these analytes.In the nutritional screen cohort, plasma zinc was significantly associated with CRP (rsÂ =Â -0.404, pÂ <Â 0.001) and albumin (rsÂ =Â 0.588, pÂ <Â 0.001). For each CRP category (â‰¤10, 11-80, >80Â mg/l) the zinc/albumin ratio x100 was similar (31, 33 and 32 respectively, pÂ =Â 0.029). Plasma selenium was significantly associated with CRP (rsÂ =Â -0.489, pÂ <Â 0.001) and albumin (rsÂ =Â 0.600, pÂ <Â 0.001). With increasing CRP category (â‰¤10, 11-80, >80Â mg/l) the selenium/albumin ratioÂ Ã—100 was lower (2.3, 2.1 and 1.8 respectively, pÂ <Â 0.001). Similar relationships were also observed in the cohort of patients with critical illness.Plasma zinc was associated with both CRP and albumin. The impact of the systemic inflammatory response could be largely adjusted by albumin concentrations. Plasma selenium was associated with both CRP and albumin. The impact of the systemic inflammatory response on plasma selenium concentrations could not be reasonably adjusted by albumin concentrations.Copyright Â© 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Systemic inflammation predicts all-cause mortality: a glasgow inflammation outcome study. - PloS one
Markers of the systemic inflammatory response, including C-reactive protein and albumin (combined to form the modified Glasgow Prognostic Score), as well as neutrophil, lymphocyte and platelet counts have been shown to be prognostic of survival in patients with cancer. The aim of the present study was to examine the prognostic relationship between these markers of the systemic inflammatory response and all-cause, cancer, cardiovascular and cerebrovascular mortality in a large incidentally sampled cohort.Patients (n = 160 481) who had an incidental blood sample taken between 2000 and 2008 were studied for the prognostic value of C-reactive protein (>10mg/l, albumin (>35mg/l), neutrophil (>7.5Ã—109/l) lymphocyte and platelet counts. Also, patients (n = 52 091) sampled following the introduction of high sensitivity C-reactive protein (>3mg/l) measurements were studied. A combination of these markers, to make cumulative inflammation-based scores, were investigated.In all patients (n = 160 481) C-reactive protein (>10mg/l) (HR 2.71, p<0.001), albumin (>35mg/l) (HR 3.68, p<0.001) and neutrophil counts (HR 2.18, p<0.001) were independently predictive of all-cause mortality. These associations were also observed in cancer, cardiovascular and cerebrovascular mortality before and after the introduction of high sensitivity C-reactive protein measurements (>3mg/l) (n = 52 091). A combination of high sensitivity C-reactive protein (>3mg/l), albumin and neutrophil count predicted all-cause (HR 7.37, p<0.001, AUC 0.723), cancer (HR 9.32, p<0.001, AUC 0.731), cardiovascular (HR 4.03, p<0.001, AUC 0.650) and cerebrovascular (HR 3.10, p<0.001, AUC 0.623) mortality.The results of the present study showed that an inflammation-based prognostic score, combining high sensitivity C-reactive protein, albumin and neutrophil count is prognostic of all-cause mortality.
A simple iridicycle catalyst for efficient transfer hydrogenation of N-heterocycles in water. - Chemistry (Weinheim an der Bergstrasse, Germany)
A cyclometalated iridium complex is shown to catalyse the transfer hydrogenation of various nitrogen heterocycles, including but not limited to quinolines, isoquinolines, indoles and pyridinium salts, in an aqueous solution of HCO2H/HCO2Na under mild conditions. The catalyst shows excellent functional-group compatibility and high turnover number (up to 7500), with catalyst loadings as low as 0.01â€…molâ€‰% being feasible. Mechanistic investigation of the quinoline reduction suggests that the transfer hydrogenation proceeds via both 1,2- and 1,4-addition pathways, with the catalytic turnover being limited by the step of hydride transfer.Â© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Versatile iridicycle catalysts for highly efficient and chemoselective transfer hydrogenation of carbonyl compounds in water. - Chemistry (Weinheim an der Bergstrasse, Germany)
Cyclometalated iridium complexes are shown to be highly efficient and chemoselective catalysts for the transfer hydrogenation of a wide range of carbonyl groups with formic acid in water. Examples include Î±-substituted ketones (Î±-ether, Î±-halo, Î±-hydroxy, Î±-amino, Î±-nitrile or Î±-ester), Î±-keto esters, Î²-keto esters and Î±,Î²-unsaturated aldehydes. The reduction was carried out at substrate/catalyst ratios of up to 50â€‰000 at pHâ€…4.5 and required no organic solvent. The protocol provides a practical, easy and efficient way for the synthesis of Î²-functionalised secondary alcohols, such as Î²-hydroxyethers, Î²-hydroxyamines and Î²-hydroxyhalo compounds, which are valuable intermediates in pharmaceutical, fine chemical, perfume and agrochemical synthesis.Â© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
The effect of the systemic inflammatory response on plasma vitamin 25 (OH) D concentrations adjusted for albumin. - PloS one
Plasma 25-hydroxyvitamin D (25(OH) D) deficiencies are associated with several diseases. The magnitude of systemic inflammatory response, as evidenced by C-reactive protein (CRP), is a major factor associated with lower 25(OH)D. Other aspects of the systemic inflammatory response may be important in determining plasma 25 (OH)D concentrations.To examine the relationship between plasma 25(OH)D, CRP and albumin concentrations in two patient cohorts.5327 patients referred for nutritional assessment and 117 patients with critical illness were examined. Plasma 25 (OH) D concentrations were measured using standard methods. Intra and between assay imprecision was <10%.In the large cohort, plasma 25 (OH) D was significantly associated with CRP (r(s) â€Š=â€Š -0.113, p<0.001) and albumin (rs = 0.192, p<0.001). 3711 patients had CRP concentrations â‰¤ 10 mg/L; with decreasing albumin concentrations â‰¥ 35, 25-34 and <25 g/l, median concentrations of 25 (OH) D were significantly lower from 35 to 28 to 14 nmol/l (p<0.001). This decrease was significant when albumin concentrations were reduced between 25-34 g/L (p<0.001) and when albumin <25 g/L (p<0.001). 1271 patients had CRP concentrations between 11-80 mg/L; with decreasing albumin concentrations â‰¥ 35, 25-34 and <25 g/l, median concentrations of 25 (OH) D were significantly lower from 31 to 24 to 19 nmol/l (p<0.001). This decrease was significant when albumin concentration were 25-34 g/L (p<0.001) and when albumin <25 g/L (p<0.001). 345 patients had CRP concentrations >80 mg/L; with decreasing albumin concentrations â‰¥ 35, 25-34 and <25 g/l, median concentrations of 25 (OH) D were not significantly altered varying from 19 to 23 to 23 nmol/l. Similar relationships were also obtained in the cohort of patients with critical illness.Plasma concentrations of 25(OH) D were independently associated with both CRP and albumin and consistent with the systemic inflammatory response as a major confounding factor in determining vitamin D status.
Primary amines by transfer hydrogenative reductive amination of ketones by using cyclometalated Ir(III) catalysts. - Chemistry (Weinheim an der Bergstrasse, Germany)
Cyclometalated iridium complexes are found to be versatile catalysts for the direct reductive amination (DRA) of carbonyls to give primary amines under transfer-hydrogenation conditions with ammonium formate as both the nitrogen and hydrogen source. These complexes are easy to synthesise and their ligands can be easily tuned. The activity and chemoselectivity of the catalyst towards primary amines is excellent, with a substrate to catalyst ratio (S/C) of 1000 being feasible. Both aromatic and aliphatic primary amines were obtained in high yields. Moreover, a first example of homogeneously catalysed transfer-hydrogenative DRA has been realised for Î²-keto ethers, leading to the corresponding Î²-amino ethers. In addition, non-natural Î±-amino acids could also be obtained in excellent yields with this method.
Assessment of plasma and red cell trace element concentrations, disease severity, and outcome in patients with critical illness. - Journal of critical care
The purpose of the study is to examine the value of both plasma and red cell trace element measurements when assessing nutritional status in patients with critical illness.A total of 125 patients who were admitted to intensive care unit with evidence of systemic inflammatory response as per Bone's criteria were recruited. Venous blood samples were obtained from all on admission and, in 31 of the 125 patients, on approximately days 4 and 7. Copper, zinc, and selenium concentrations were measured in plasma and erythrocytes and results related to mortality and patient outcome measures.A total of 125 critically ill patients were recruited; 81 (66%) were male, the median age was 60 (range, 18-100), and the medical/surgical proportion was 55/70 (44%/56%). The median (lower and upper 2.5th percentile) Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, and length of stay and mortality were 21 (16-26), 7 (4-9) 3.7 days (1.5-11.1) and 19%, respectively. Plasma zinc and selenium concentrations were significantly lower on admission compared with reference intervals, whereas copper was increased. Normal plasma glutathione peroxidase activity suggested selenium status was adequate on admission; erythrocyte concentrations of glutathione peroxidase and trace elements were normal, suggesting adequate nutritional status 1 to 2 months before admission. Only plasma zinc and selenium were inversely associated with C-reactive protein (rs = -0.266, P = .004, rs = -0.322, P < .001, respectively). Compared with survivors, albumin (P < .001) concentrations were significantly lower in the nonsurvivor group. No significant difference of plasma selenium and zinc between survivors and nonsurvivors was found, although plasma selenium concentrations tended to be lower (P = .04). On multivariate logistic regression analysis of the significant variables, none was independently associated with mortality.The altered plasma concentrations of zinc, selenium, and copper in patients with critical illness were primarily due to the effects of the systemic inflammatory response and do not reliably indicate their status.Copyright Â© 2014 Elsevier Inc. All rights reserved.
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2450 E River Rd Tucson, AZ 85718
1840 E River Rd Ste 210
6651 N Campbell Ave Apt. 156
2450 E River Rd
4357 N Rio Cancion Apt 370
2404 E River Rd Bld.2, Ste 100