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Bucobo JC, Kassim O, Konijeti GG, Abraham BP, Abegunde AT, Farraye FA, Guha S, Kowalski T, Kumar A, Markowitz AJ, Schoeppner HL, Tierney WM. Role of the industry representative in the practice of gastroenterology and GI endoscopy. Gastrointest Endosc 2024; 99:307-313. [PMID: 38260918 DOI: 10.1016/j.gie.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Juan Carlos Bucobo
- Division of Gastroenterology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Olufemi Kassim
- Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Gauree G Konijeti
- Division of Gastroenterology & Hepatology, Scripps Clinic, La Jolla, California, USA
| | - Bincy P Abraham
- Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas, USA
| | - Ayokunle T Abegunde
- Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sushovan Guha
- Section of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School and UT Health Science Center at UTHealth, Houston, Texas, USA
| | - Thomas Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand Kumar
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arnold J Markowitz
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - William M Tierney
- Section of Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Abegunde AT. The Grim Side of Microscopic Colitis. Clin Gastroenterol Hepatol 2024; 22:674-675. [PMID: 37730154 DOI: 10.1016/j.cgh.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, Illinois
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3
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Abegunde AT. Breast Feeding and Increased Risk of Colon Cancer: What is the Missing Link? Clin Gastroenterol Hepatol 2023:S1542-3565(23)00854-6. [PMID: 37879524 DOI: 10.1016/j.cgh.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, Illinois
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4
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Awad AK, Awan RU, Awad AK, Nabeel A, Dar S, Abegunde AT. Patients with enteropathy-associated T-cell lymphoma in the United States from 2000 to 2018: SEER data-base analysis. Cancer Treat Res Commun 2023; 36:100745. [PMID: 37499419 DOI: 10.1016/j.ctarc.2023.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/01/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Enteropathy-Associated T-Cell Lymphoma (EATL) is a rare lymphoma of T-cell origin associated with celiac disease. There is limited evidence in the literature about the incidence and causes of death in patients with EATL. METHODS We performed a retrospective study through analyzing the Surveillance, Epidemiology, and End Results (SEER) data base to determine the incidence, trends and causes of death of patients with EATL in the U.S from 2000 to 2018. Baseline characteristics with treatment options (surgery, radiotherapy, and chemotherapy), status of patients either alive, dead due to cancer itself or other non-cancerous causes with listing of those non-cancerous causes was retrieved. Sub-group analysis based on sex was also done. Multiple latency periods (<2 year, 2-5, 6-10, 11-15, and more than 15 years) were analyzed following EATL diagnosis. RESULTS There were 259 EATL patients, majority were aged 70-74 years old (n = 36, 13.9%), predominantly males 155 (59.8%), most common in whites, (76.4%, n = 198), EATL was the only primary tumor in 177 (68.3%) cases, most common site was small bowel at different sites 84 (32.4%) followed by jejunum specifically 57 (22%), majority went for surgical resection (69.9%, n = 181) followed by chemotherapy (47.5%, n = 123), 217 (83.7%) died during follow-up in this study, CONCLUSION: EATL is a rare entity, mostly seen in males, between 70 and 74 years, and mostly originated in the small bowel. With over 80% death in five-year follow up period, EATL patients showed better survival if they underwent chemotherapy. More studies are needed for further understanding of this rare entity.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
| | | | - Ayman K Awad
- Faculty of Medicine, El-Galala University, Suez, Egypt
| | - Ambreen Nabeel
- Ochsner Rush Health, Dept Internal Medicine, Meridian, MS, USA
| | - Sophia Dar
- Northshore University-Long Island Jewish Medical Center, Dept Internal Medicine, Manhasset, NY, USA
| | - Ayokunle T Abegunde
- Loyola University Medical Center Chicago, Department of Gastroenterology, Chicago, IL, USA
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Hong P, Ghanim M, Haseeb A, Ding X, Abegunde AT. Recurrence of Brunner Gland Adenocarcinoma After Duodenectomy and Gastrojejunostomy. ACG Case Rep J 2023; 10:e01060. [PMID: 37305801 PMCID: PMC10249712 DOI: 10.14309/crj.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Malignant neoplasms arising from the Brunner gland are exceedingly rare. A 62-year-old man with a history of surgical resection of Brunner gland adenocarcinoma presented with upper extremity cellulitis. Hospital course was complicated by atrial fibrillation and hematochezia. Bidirectional endoscopy was negative; however, small bowel enteroscopy revealed recurrence of Brunner gland adenocarcinoma 6 years after surgical resection. To our knowledge, this is the first reported case of recurrent Brunner gland adenocarcinoma after curative resection.
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Affiliation(s)
- Paul Hong
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL
| | - Marcel Ghanim
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
| | - Abdul Haseeb
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
| | - Xianzhong Ding
- Department of Pathology, Loyola University Medical Center, Maywood, IL
| | - Ayokunle T. Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
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6
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Bloomberg L, Hoscheit M, Hendler S, Abegunde AT. Superior Mesenteric Artery Syndrome in an Adolescent Female with Anorexia Nervosa. Clin Med Res 2023; 21:46-48. [PMID: 37130783 PMCID: PMC10153676 DOI: 10.3121/cmr.2022.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 05/04/2023]
Abstract
Superior mesenteric artery syndrome (SMAS) is a rare condition that develops from compression of the duodenum between the superior mesenteric artery (SMA) and abdominal aorta. SMAS is an atypical complication of restrictive eating disorders. The SMA is supported by adipose tissue to create an aortomesenteric angle that varies from 25-60 degrees. A reduction in adipose tissue causes narrowing of this angle, and SMAS develops when the aortomesenteric angle is narrow enough that it compresses the distal duodenum passing through. Patients present with small bowel obstructive symptoms. We report a severe case of SMAS in an adolescent female with anorexia nervosa who presented with acute and chronic symptoms of bowel obstruction. Awareness of the association between SMAS and restrictive eating disorders can help guide clinical decision-making and prevent delay of diagnosis and serious complications.
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Affiliation(s)
- Lauren Bloomberg
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Hoscheit
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, USA
| | - Steven Hendler
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, USA
| | - Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, USA
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Malik A, Nadeem M, Javaid S, Malik MI, Enofe I, Abegunde AT. Estimating the optimum number of colon biopsies for diagnosing microscopic colitis: a systematic review. Eur J Gastroenterol Hepatol 2022; 34:733-738. [PMID: 35170530 DOI: 10.1097/meg.0000000000002355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Microscopic colitis (MC) is an inflammatory disease of the colon characterized by persistent watery, nonbloody diarrhea. Subtypes of MC include collagenous and lymphocytic MC. Microscopic examination of colon tissue is crucial to confirming the diagnosis because the colonic mucosa often appears normal during flexible sigmoidoscopy or colonoscopy. We aim to determine the optimal sites and minimum number of colon biopsies required to diagnose MC from published studies. We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases from inception until October 2020 using the following keywords: microscopic, lymphocytic, collagenous, colitis, biopsy, and biopsies. We screened the search results for eligibility and extracted data from the included studies. We pooled the numbers of biopsies provided by each study to calculate the mean number of biopsies, SD, and SEM. We included three retrospective cohort studies with 356 patients (148 collagenous, 192 lymphocytic, and 16 mixed), and the total number of biopsies were 1854. The mean number of biopsies that were recommended by the included studies are 4, 4, and 9, respectively. The pooled mean ± SD is 5.67 ± 2.89. The included studies reported that biopsies from the ascending colon (AC) and descending colon (DC) had the highest diagnostic rates. To ensure a high level of certainty in diagnosing MC, a total of six biopsies should be taken from the AC and DC (3 AC and 3 DC). However, special care should be directed toward differentiating MC from other forms of colitis. In addition, detailed and comparative studies are needed to provide stronger recommendations to diagnose MC.
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Affiliation(s)
- Adnan Malik
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Mahum Nadeem
- Department of1 Medicine, Oklahoma University Medical Center, Oklahoma City, Oklahoma, USA
| | - Sadia Javaid
- Department of Medicine, Nishtar Hospital, Multan, Pakistan
| | - Muhammad Imran Malik
- Department of Hematology Specialty, Airedale General Hospital, West Yorkshire, UK
| | - Ikponmwosa Enofe
- Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ayokunle T Abegunde
- Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA
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Farooq U, Tarar ZI, Kamal F, Malik A, Bresnahan J, Abegunde AT. Is acid suppression associated with the increased length of stay in diabetic ketoacidosis patients? A nationwide analysis. J Intern Med 2022; 292:136-145. [PMID: 35212056 PMCID: PMC9311185 DOI: 10.1111/joim.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) patients present with low serum bicarbonate ( HCO3-${\rm{HCO}}_{3}^{-} $ ), and an increase in its level to ≥15 mEq/L is considered one of the criteria for DKA resolution. Both proton pump inhibitors and histamine-2 receptor antagonists inhibit downstream functioning of H+ /K+ ATPase in the gastric parietal cells, which results in the decreased secretion of HCO3-${\rm{HCO}}_{3}^{-} $ into the bloodstream. OBJECTIVES We aimed to introduce the hypothesis that DKA patients on acid-suppressive medications may have a delayed rise in serum HCO3-${\rm{HCO}}_{3}^{-} $ to >15 mEq/L that may cause increased hospital length of stay (LOS) and sought to compare the outcomes of such patients. For the sake of simplicity, conditions requiring acid suppression are grouped under the term peptic ulcer disease (PUD) in this study. METHODS This is a retrospective study using Nationwide Inpatient Sample employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of DKA. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. RESULTS DKA patients with PUD had higher adjusted LOS, intensive care unit admission, and total hospital costs. Mortality and morbidity indicators were similar in both groups. The variables found to be independent predictors of increased LOS were malnutrition, Clostridium difficile infection, pneumonia, Glasgow Coma Scale score of 3-8, and higher Charlson comorbidity score. CONCLUSION We found that Clostridium difficile and pneumonia predicted longer LOS in DKA patients with concomitant PUD, hinting at the possible role of acid suppression in prolonging the LOS in such patients. However, further studies are needed to examine the effect of lesser HCO3-${\rm{HCO}}_{3}^{-} $ generation on LOS.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - Faisal Kamal
- Department of Gastroenterology, University of California San Francisco, San Francisco, California, USA
| | - Adnan Malik
- Department of Internal Medicine, Loyola University Health System, Maywood, Illinois, USA
| | - Joseph Bresnahan
- Department of Gastroenterology, Loyola Medicine/MacNeal Hospital Berwyn, Illinois, USA
| | - Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, Illinois, USA
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9
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Farooq U, Alcantar D, Ahmed Z, Abegunde AT. Outcomes of Vasoconstrictor-Induced Non-Occlusive Mesenteric Ischemia of Colon: A Systematic Review. Clin Med Res 2022; 20:cmr.2022.1726. [PMID: 35676075 PMCID: PMC9544191 DOI: 10.3121/cmr.2022.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Nonocclusive mesenteric ischemia (NOMI) is due to mesenteric arterial hypoperfusion from several causes, such as hypovolemia, heart failure, shock, vasoconstrictors, and severe liver or renal disease. Vasoconstrictor-induced NOMI is usually iatrogenic or associated with cocaine use. OBJECTIVES Anecdotal reports suggest that cocaine-induced NOMI has the highest mortality among vasoconstrictors. This review aims to compare the outcomes of colonic NOMI secondary to cocaine versus other vasoconstrictors. METHODS We conducted a systematic search of MEDLINE from inception through October 2016 to find articles on colonic NOMI. The study's primary outcomes were mortality and hospital length of stay (LOS), while secondary outcomes included the need for surgery. We reported descriptive statistics as percentages or median and interquartile range (IQR). We compared continuous data with the Mann-Whitney test and categorical data with Fisher's exact test; P < 0.05 was statistically significant. RESULTS Of the 59 studies, 20 case reports and 3 case series (n= 27 patients) met the inclusion criteria. There was no difference in mortality between cocaine-induced NOMI and non-cocaine NOMI (P=1.0). There were statistically significant differences between cocaine and non-cocaine vasoconstrictor-induced colonic NOMI regarding surgery (60% vs. 5.8%, P=0.03) and median LOS (7 days vs. 4 days, P=0.04). CONCLUSION Cocaine-induced NOMI and non-cocaine NOMI both appear to have a relatively high but similar mortality rate, but the former is associated with increased requirement for surgery and LOS; prompt recognition of this clinical entity is required to improve outcomes.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL
| | - Daniel Alcantar
- Department of Internal Medicine, The University of Arizona, Phoenix, AZ
| | - Zahoor Ahmed
- Department of Internal Medicine, Mayo Hospital, Lahore, Pakistan
| | - Ayokunle T. Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
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Aje KT, Abegunde AT, Mirza K. Intestinal Infiltration of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Found on Screening Colonoscopy. Cureus 2022; 14:e21037. [PMID: 35155005 PMCID: PMC8824418 DOI: 10.7759/cureus.21037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/05/2022] Open
Abstract
B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a malignancy of dysregulated lymphocytes in bone marrow and lymphatics. Extra-nodal involvement has been previously cited to affect areas like the lungs, skin, central nervous system, and kidney. Gastrointestinal (GI) involvement in patients with chronic CLL/SLL is rare. We report a unique case of CLL/SLL found incidentally in a 71-year-old asymptomatic female undergoing a screening colonoscopy. Patients with GI infiltration of CLL/SLL may be asymptomatic like the patient described in this report, or present with symptoms that may resemble inflammatory bowel disease, microscopic colitis, or colon cancer. Therefore, it is important to remain vigilant for the occurrence of other malignancies during the follow-up of CLL/SLL patients.
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11
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Oruganti P, Awan R, Ding X, Wesolowski M, Abegunde AT. Epidemiology and Clinical Outcomes of Microscopic Colitis: Preliminary Results From the Loyola University Microscopic Colitis Registry (LUMiCoR). Front Med (Lausanne) 2021; 8:715458. [PMID: 34631738 PMCID: PMC8493955 DOI: 10.3389/fmed.2021.715458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Microscopic colitis (MC) is a common cause of chronic diarrhea with limited long-term data. We searched the pathology records at our institution from 2008 to 2018 to identify cases of MC. Total sample included patients with either a diagnosis of MC or incomplete MC (MCi).Chart review was performed and data were summarized for descriptive statistics. Logistic regression was used to estimate the unadjusted effects of predictors on MC. A total of 216 patients (88.32% white, 80.56% females, mean age 67.12 +/– 15.79) were studied; 50.00% had CC, 40.28% had LC and 9.72% had MCi. Majority (52.31%) were smokers and 21.84% of females were using some form of hormonal therapy. The odds of LC in reference to CC were significantly higher for those using tricyclic antidepressants (TCAs) (OR: 3.23, 95% C.I: 1.18–8.80, p = 0.02). The odds of smoking, statins, aspirin and beta-blocker use were decreased in MCi in reference to CC (all p < 0.05), 29 (74.35%) patients with unresolved symptoms underwent repeat colonoscopies with biopsies. One case of MCi resolved, 8 (72.73%) out of 11 cases of LC resolved, 2 (18.18%) continued to be LC and 1 (9.09%) transformed to CC, 8 (47.06%) out of 17 cases of CC resolved, 8 (47.06%) continued to be CC and 1 (5.88%) transformed to LC. Majority of patients had CC. TCA use resulted in increased odds of LC in reference to CC. Biopsies from repeat colonoscopies in some patients revealed changes in the pathological diagnoses raising the question of interchangeability of MC (CC to LC and vice versa).
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Affiliation(s)
- Poornima Oruganti
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, United States
| | - Rehmat Awan
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, United States
| | - Xianzhong Ding
- Department of Pathology, Loyola University Medical Center, Maywood, IL, United States
| | - Michael Wesolowski
- Loyola University Chicago, Clinical Research Office Biostatistics Collaborative Core, Chicago, IL, United States
| | - Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, United States
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12
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Vohra I, Attar B, Haghbin H, Mutneja H, Katiyar V, Sharma S, Abegunde AT, Demetria M, Gandhi S. Incidence and risk factors for 30-day readmission in ulcerative colitis: nationwide analysis in biologic era. Eur J Gastroenterol Hepatol 2021; 33:1174-1184. [PMID: 34034271 DOI: 10.1097/meg.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIM Ulcerative colitis (UC) is a chronic relapsing and remitting disease requiring frequent hospitalization. Biologics have become the recommended initial therapy for Biologics in patients with moderate to severe UC. Our aim was to estimate the changes in Nationwide Healthcare utilization and assess predictive factors of 30-day readmission, morbidity and mortality of UC. METHODS This is a retrospective observational study analyzing the Nationwide Readmission database from 2016 to 2017 using ICD-10 codes. The primary outcomes of the study were to assess the predictors of 30-day readmission in patients with UC. RESULTS Of the 54 138 adult patients with a primary diagnosis of UC, 13.2% were readmitted within 30 days of index hospitalization. The mortality rate (1.4 vs. 0.3%, P < 0.01), length of stay (7 vs. 4.9 days, P < 0.01) and hospital cost ($62 552 vs. $46 971, P < 0.01) were higher on readmission as compared to index hospitalization. We identified multiple patient-related factors (age <65years, men, VTE, protein calorie malnutrition, electrolyte imbalance, anemia, anxiety and alcohol abuse), hospital-related factors (teaching hospitals, high quintile hospitals), as independent predictors of 30-day UC readmission. Colonoscopy, Cannabis use, and colectomy were associated with decreased odds of 30-day readmission. The most common cause of UC was septicemia. CONCLUSIONS This is the largest nationwide study demonstrating predictors of 30-day readmission, mortality and morbidity associated with UC. Identification and amelioration of these risk factors will decrease readmission rate and mortality amongst UC patients.
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Affiliation(s)
| | - Bashar Attar
- Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, Illinois
| | - Hossein Haghbin
- Department of Medicine, The University of Toledo, Toledo, Ohio
| | - Hemant Mutneja
- Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, Illinois
| | - Vatsala Katiyar
- Department of Hematology and Oncology, University of Louisville, Louisville, Kentucky
| | - Sachit Sharma
- Department of Medicine, The University of Toledo, Toledo, Ohio
| | - Ayokunle T Abegunde
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Chicago, Illinois, USA
| | - Melchor Demetria
- Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, Illinois
| | - Seema Gandhi
- Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, Illinois
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13
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Oruganti P, Betcher S, Wakade Z, Ding X, Abegunde AT. Cannabidiol Oil-Associated Microscopic Colitis. Cureus 2020; 12:e10528. [PMID: 33094069 PMCID: PMC7574987 DOI: 10.7759/cureus.10528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Microscopic colitis (MC) is a chronic inflammation condition of the colon characterized by watery diarrhea and normal appearing mucosa. A 75-year-old female presented with one-year history of chronic diarrhea while taking cannabidiol (CBD) for pain. Colonoscopy with random colon biopsies revealed collagenous colitis. She started budesonide and stopped CBD. At six-week follow-up, her diarrhea improved, and the budesonide dose was decreased. She restarted CBD oil twice but had diarrhea both times. Her diarrhea resolved after taking budesonide and stopping CBD. We report a case of CBD-associated MC to make clinicians aware of this potential adverse effect in patients who chronically use CBD.
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Affiliation(s)
| | | | - Zuie Wakade
- Gastroenterology, Loyola University Medical Center, Maywood, USA
| | - Xianzhong Ding
- Pathology, Loyola University Medical Center, Maywood, USA
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14
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Mbachi CU, Abegunde AT. Letter to Editor: Screening Colonoscopy in Patients Evaluated for Liver Transplantation: Look Before You Leap. Hepatology 2019; 70:1874-1875. [PMID: 31121069 DOI: 10.1002/hep.30786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Chimezie U Mbachi
- Department of Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL
| | - Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
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Abegunde AT, Muhammad BH, Ali T. Preventive health measures in inflammatory bowel disease. World J Gastroenterol 2016; 22:7625-7644. [PMID: 27678347 PMCID: PMC5016364 DOI: 10.3748/wjg.v22.i34.7625] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/10/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023] Open
Abstract
We aim to review the literature and provide guidance on preventive health measures in inflammatory bowel disease (IBD). Structured searches were performed in PubMed, MEDLINE, EMBASE, Web of Science and Cochrane Library from January 1976 to June 2016 using the following keywords: (inflammatory bowel disease OR Crohn’s disease OR ulcerative colitis) AND (health maintenance OR preventive health OR health promotion). Abstracts of the articles selected from each of these multiple searches were reviewed, and those meeting the inclusion criteria (that is, providing data regarding preventive health or health maintenance in IBD patients) were recorded. Reference lists from the selected articles were manually reviewed to identify further relevant studies. Patients with IBD are at increased risk of developing adverse events related to the disease course, therapeutic interventions, or non-adherence to medication. Recent studies have suggested that IBD patients do not receive preventive services with the same thoroughness as patients with other chronic diseases. Preventive health measures can avert morbidity and improve the quality of life of patients with IBD. Gastroenterologists and primary care physicians (PCPs) should have an up to date working knowledge of preventive health measures for IBD patients. A holistic approach and better communication between gastroenterologists and PCPs with explicit clarification of roles will prevent duplication of services and streamline care.
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Abegunde AT, Muhammad BH, Bhatti O, Ali T. Environmental risk factors for inflammatory bowel diseases: Evidence based literature review. World J Gastroenterol 2016; 22:6296-6317. [PMID: 27468219 PMCID: PMC4945988 DOI: 10.3748/wjg.v22.i27.6296] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/19/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: Advances in genetics and immunology have contributed to the current understanding of the pathogenesis of inflammatory bowel diseases (IBD).
METHODS: The current opinion on the pathogenesis of IBD suggests that genetically susceptible individuals develop intolerance to dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental insults. Environmental exposures are innumerable with varying effects during the life course of individuals with IBD. Studying the relationship between environmental factors and IBD may provide the missing link to increasing our understanding of the etiology and increased incidence of IBD in recent years with implications for prevention, diagnosis, and treatment. Environmental factors are heterogeneous and genetic predisposition, immune dysregulation, or dysbiosis do not lead to the development of IBD in isolation.
RESULTS: Current challenges in the study of environmental factors and IBD are how to effectively translate promising results from experimental studies to humans in order to develop models that incorporate the complex interactions between the environment, genetics, immunology, and gut microbiota, and limited high quality interventional studies assessing the effect of modifying environmental factors on the natural history and patient outcomes in IBD.
CONCLUSION: This article critically reviews the current evidence on environmental risk factors for IBD and proposes directions for future research.
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Abegunde AT. Chromoendoscopy, White-Light, or Narrow-Band Imaging Colonoscopy in Colorectal Cancer Surveillance in Inflammatory Bowel Disease: True Illumination or Game of Shadows. Clin Gastroenterol Hepatol 2016; 14:1062. [PMID: 26453956 DOI: 10.1016/j.cgh.2015.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Ayokunle T Abegunde
- Section of Digestive Diseases and Nutrition, Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
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Abstract
BACKGROUND Onchocerciasis, also known as "river blindness," is a parasitic disease that is caused by infection from the filarial nematode (roundworm), Onchocerca volvulus. Nematodes are transmitted from person to person by blackflies of the Simulium genus, which usually breed in fast flowing streams and rivers. The disease is the second leading infectious cause of blindness in endemic areas.Ivermectin (a microfilaricide) is widely distributed to endemic populations for prevention and treatment of onchocerciasis. Doxycycline, an antibiotic, targets Wolbachia organisms that are crucial to the survival of adult onchocerca (macrofilaricide). Combined treatment with both drugs is believed to cause direct microfilarial death by ivermectin and indirect macrofilarial death by doxycycline. Long-term reduction in the numbers of microfilaria in the skin and eyes and in the numbers of adult worms in the body has the potential to reduce the transmission and occurrence of onchocercal eye disease. OBJECTIVES The primary aim of this review was to assess the effectiveness of doxycycline plus ivermectin versus ivermectin alone for prevention and treatment of onchocerciasis. The secondary aim was to assess the effectiveness of doxycycline plus ivermectin versus ivermectin alone for prevention and treatment of onchocercal ocular lesions in communities co-endemic for onchocerciasis and Loa loa (loiasis) infection. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 7, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2015), EMBASE (January 1980 to July 2015), PubMed (1948 to July 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to July 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 1 July 2014), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 15 July 2015. SELECTION CRITERIA We included randomized controlled trials (RCTs) that had compared doxycycline plus ivermectin versus ivermectin alone. Participants with or without one or more characteristic signs of ocular onchocerciasis resided in communities where onchocerciasis was endemic. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and extracted data. We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We identified three RCTs including a total of 466 participants with a diagnosis of onchocerciasis. All trials compared doxycycline plus ivermectin versus ivermectin alone. One study investigated improvement in visual impairment at six-month follow-up; the other two studies measured microfilarial loads in skin snips to assess sustained effects of treatment at follow-up of 21 months or longer. The studies were conducted at various centers across three countries (Cameroon, Ghana, and Liberia). We judged all studies to be at overall high risk of bias because of inadequate randomization and lack of masking (one study), missing data (two studies), and selective outcome reporting (three studies).Only one study measured visual outcomes. This study reported uncertainty about the difference in the proportion of participants with improvement in visual impairment at six-month follow-up for doxycycline plus ivermectin compared with ivermectin alone (risk ratio (RR) 1.06, 95% confidence interval (95% CI) 0.80 to 1.39; 240 participants; very low-quality evidence). No participant in either group showed improvement in optic atrophy, chorioretinitis, or sclerosing keratitis at six-month follow-up. More participants in the doxycycline plus ivermectin group than in the ivermectin alone group showed improvement in iridocyclitis (RR 1.24, 95% CI 0.69 to 2.22) and punctate keratitis (RR 1.43, 95% CI 1.02 to 2.00) at six-month follow-up; however, we graded these results as very low quality.Two studies reported that a six-week course of doxycycline may result in Wolbachia depletion and macrofilaricidal and sterilizing activities in female Onchocerca worms; however, no analysis was possible because data were missing and incomplete (graded evidence as very low quality). Adverse events were reported in 16 of 135 (12%) participants in one of these studies and included itching, headaches, body pains, and vertigo; no difference between treatment groups was reported for any adverse event. The second study reported that one (1.3%) participant in the doxycycline plus ivermectin group had bloody diarrhea after treatment was initiated. AUTHORS' CONCLUSIONS Available evidence on the effectiveness of doxycycline plus ivermectin compared with ivermectin alone in preventing and treating onchocerciasis is unclear. Limited evidence of very low quality from two studies indicates that a six-week course of doxycycline followed by ivermectin may result in more frequent macrofilaricidal and microfilaricidal activity and sterilization of female adult Onchocerca compared with ivermectin alone; however, effects on vision-related outcomes are uncertain. Future studies should consider the effectiveness of treatments in preventing visual acuity and visual field loss and their effects on anterior and posterior segment lesions, particularly chorioretinitis. These studies should report outcomes in a uniform and consistent manner at follow-up of three years or longer to allow detection of meaningful changes in vision-related outcomes.
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Affiliation(s)
- Ayokunle T Abegunde
- John H. Stroger, Jr. Hospital of Cook CountyDivision of Internal Medicine1900 W. Polk StreetChicagoILUSA60612
| | - Richard M Ahuja
- John H. Stroger, Jr. Hospital of Cook CountyDivision of Ophthalmology1900 W. Polk StreetChicagoILUSA60612
| | - Nkem J Okafor
- Kaplan Medical205 W. Randolph Street, Suite #200ChicagoILUSA60606
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Abegunde AT, Jain M, Amblee A. Methimazole-Induced Concomitant Agranulocytosis and Cholestasis in a Young Female. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15666.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT. Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. World J Cardiol 2015; 7:931-937. [PMID: 26730299 PMCID: PMC4691820 DOI: 10.4330/wjc.v7.i12.931] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/14/2015] [Accepted: 09/30/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To study trends in the epidemiology, clinical presentation, microbiology and prognosis of non-typhoid Salmonella (NTS) myocarditis.
METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation, electrocardiogram (ECG) changes, transthoracic echocardiographic findings, cardiac magnetic resonance findings, microbiology cultures, Salmonella species, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases (defined as < 18 years old) and adult cases (defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics (Windows, Version 20.0. Armonk, NY: IBM Corp.) for demographic characteristics, presenting symptoms, microbiology, diagnostic methods, treatment modalities and outcome.
RESULTS: From the selected articles, we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years (range 1 mo-67 years), 16% of cases were children aged < 18 years. Most patients presented with chest pain, fever, and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia (40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group (100% vs 63.1%). Eighty-three percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.
CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.
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Affiliation(s)
| | - Benjamin Mba
- John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
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Abegunde AT, Mba B, Babu A. Treatment refractory hypothyroidism as a result of excessive donation of plasma. Endocrine 2013; 44:268-9. [PMID: 23334986 DOI: 10.1007/s12020-013-9879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Abegunde AT. Risk for hepatocellular carcinoma in patients with alcoholic cirrhosis. Ann Intern Med 2012; 157:677; author reply 678. [PMID: 23128871 DOI: 10.7326/0003-4819-157-9-201211060-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abegunde AT. Screening for colorectal cancer. Ann Intern Med 2012; 157:217; author reply 218-9. [PMID: 22868844 DOI: 10.7326/0003-4819-157-3-201208070-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abegunde AT. Diagnosing Malaria in UK Migrants from Sub-Saharan Africa. Med Chir Trans 2006; 99:386. [PMID: 16893935 PMCID: PMC1533507 DOI: 10.1177/014107680609900809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abegunde AT. Sickle cell anemia and academic achievement in Africa. J Natl Med Assoc 2005; 97:1426. [PMID: 16353665 PMCID: PMC2594733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Kehinde MO, Ohwovoriole AE, Ekanem OJ, Odusote K, Abegunde AT, Adeniji A, Okechukwu AN, Esoimeme AE. Effect of acute uncomplicated malaria on platelet counts. Niger Postgrad Med J 2005; 12:10-3. [PMID: 15827589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine the effect of uncomplicated malaria on platelet count. PATIENTS AND METHODS Adult Nigerians (residing in the Lagos metropolis) who were diagnosed as having uncomplicated malaria were treated with a standard regime of chloroquine. Platelet counts were obtained before treatment, Day 0, and again on day 14 when parasitaemia had been cleared in the patients. There were 40 (21 males, 19 females) patients enrolled for the study. Their ages ranged from 15 years to 56 years with a mean +/- SEM of 27. 4 +/- 1.8 years. 28 (14 males, 14 females) patients had both day 0 and 14 platelet counts. RESULTS The malaria parasite counts ranged from 1020 /mm(3) to 72,000 /mm(3) at day 0 with a mean +/-SEM of 15,638.0 +/- 3,727.0/mm(3) and zero on day 14. The mean platelet count on day 0 was 137.0 +/- 58.4x 10(9)/L while the day 14 mean platelet count was 234.0 +/- 96.9 x 10(9)/L. Comparison of mean platelet counts on day 0 with those on day 14 showed a highly statistically significant difference (p < 0.001). The degree of malaria parasitaemia was not significantly related to the level of platelet count. Transient thrombocytopenia is very common in uncomplicated malaria in semi -immune adults. The mechanism, aetiology, and clinical relevance of the phenomenon deserve further studies.
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Affiliation(s)
- M O Kehinde
- Department of Medicine, College of Medicine, Lagos University Teaching Hospital, P. M. B. 12003, Lagos, and Malaria Unit, Yaba, Lagos
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