Overview

Departments

Anesthesia, Critical Care & Pain Medicine

Centers & Specialties

MassGeneral Hospital for Children

Clinical Interests
  • Pediatric anesthesia
  • Critical care
  • Physiology
  • Pharmacology
  • Burn injury
Medical Education
  • MD, University of Ceylon - Sri Lanka
  • Residency, New York Presbyterian Hospital
  • Fellowship, Radcliffe Infirmary
Board Certifications
  • Anesthesiology
  • Critical Care Medicine
Foreign Languages
  • Tamil
  • Sinhalese
Locations
  • Boston: Massachusetts General Hospital
Insurances Accepted
  • Aetna Health Inc.
  • Beech Street
  • Blue Cross Blue Shield - Blue Care 65
  • Blue Cross Blue Shield - Indemnity
  • Blue Cross Blue Shield - Managed Care
  • Blue Cross Blue Shield - Partners Plus
  • Cigna (PAL #'s)
  • Fallon Community HealthCare
  • Great-West Healthcare (formally One Health Plan)
  • Harvard Pilgrim Health Plan - other
  • Harvard Pilgrim Health Plan - PBO
  • Health Care Value Management (HCVM)
  • Humana/Choice Care PPO
  • MassHealth
  • Medicare
  • Neighborhood Health Plan - ACD
  • Neighborhood Health Plan - PBO
  • OSW - Maine
  • OSW - New Hampshire
  • OSW - New York
  • OSW - Rhode Island
  • Private Health Care Systems (PHCS)
  • Senior Whole Health
  • TriCare
  • Tufts Health Plan
  • Unicare
  • United Healthcare (non-HMO) - ACD
  • United Healthcare (non-HMO) - PBO

Note: This provider may accept more insurance plans than shown; please call the practice to find out if your plan is accepted.

Patient Age Group
Pediatric and Adult
Gender
Male

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Biography

Critical illness with and without sepsis is associated with loss of skeletal muscle mass and muscle weakness. The skeletal muscle weakness results in hypoventilation, difficulties in weaning off respirators, contractures and decreased mobilization. Despite increased survival rates following burns and critical illness, the survivors have prolonged rehabilitation extending from months to years.

One recognized pathway for accelerated muscle protein breakdown is the ubiquitin-proteosome pathway. Our group has identified apoptosis as an additional mechanism for loss of muscle mass. In contrast to necrosis, this form of cell death is a gene-mediated, energy-dependent event. Our studies have demonstrated apoptosis in muscles following critical illness and/or immobilization alone, with upregulation of certain death-inducing molecules and downregulation of some anti-apoptotic genes and/or their proteins. Currently, our group is further characterizing the pro-apoptotic signaling pathways and finding methods to attenuate the apoptosis in these tissues. Inhibition of apoptosis may decrease critical illness-induced skeletal muscle wasting and weakness.

Critically ill patients also have insulin resistance, which leads to hyperglycemia, decreased glucose uptake in muscle, enhanced gluconeogenesis and glycogenolysis and decreased protein anabolism. Our group recently has characterized the molecular mechanism inducing this state in critical illness. The post receptor pathways that cause the insulin resistance include decreased phosphorylation of insulin receptor, insulin receptor substrate-1 and activation of Akt/PKB.

Similar biochemical changes in insulin signaling can be seen in immobilization and denervation states concomitantly associated with critical illness. Therefore, the anabolic actions of insulin, including glucose uptake and protein synthesis are impaired in critical illness of burns. Studies are ongoing on methods to enhance insulin signaling.

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Research & Publications

Research Summary
Critical illness with and without sepsis is associated with loss of skeletal muscle mass and muscle weakness. The skeletal muscle weakness results in hypoventilation, difficulties in weaning off respirators, contractures and decreased mobilization. Despite increased survival rates following burns and critical illness, the survivors have prolonged rehabilitation extending from months to years.

One recognized pathway for accelerated muscle protein breakdown is the ubiquitin-proteosome pathway. Our group has identified apoptosis as an additional mechanism for loss of muscle mass. In contrast to necrosis, this form of cell death is a gene-mediated, energy-dependent event. Our studies have demonstrated apoptosis in muscles following critical illness and/or immobilization alone, with upregulation of certain death-inducing molecules and downregulation of some anti-apoptotic genes and/or their proteins. Currently, our group is further characterizing the pro-apoptotic signaling pathways and finding methods to attenuate the apoptosis in these tissues. Inhibition of apoptosis may decrease critical illness-induced skeletal muscle wasting and weakness.

Critically ill patients also have insulin resistance, which leads to hyperglycemia, decreased glucose uptake in muscle, enhanced gluconeogenesis and glycogenolysis and decreased protein anabolism. Our group recently has characterized the molecular mechanism inducing this state in critical illness. The post receptor pathways that cause the insulin resistance include decreased phosphorylation of insulin receptor, insulin receptor substrate-1 and activation of Akt/PKB.

Similar biochemical changes in insulin signaling can be seen in immobilization and denervation states concomitantly associated with critical illness. Therefore, the anabolic actions of insulin, including glucose uptake and protein synthesis are impaired in critical illness of burns. Studies are ongoing on methods to enhance insulin signaling.
Publications
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News & Events

Contact

Shriner's Hospital for Children
51 Blossom Street
Boston MA, 02114
Phone: 617-726-8807
Fax: 617-371-4821
Anesthesia, Critical Care and Pain Medicine
55 Fruit Street
Boston MA, 02114-2696
Phone: 617-726-3030

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