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Salas A, Fatola A, Krimins R, Kamel IR, Geetha D, Fine D, Monroy-Trujillo M, Rosenberg A, Arend L, Timlin H. COVID vaccine-induced lupus nephritis: Case report and review of the literature. Lupus 2024; 33:176-182. [PMID: 38164925 DOI: 10.1177/09612033231222390] [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] [Indexed: 01/03/2024]
Abstract
Vaccines offer an effective strategy to prevent infectious diseases with minimal adverse effects. On rare occasions, vaccination can disrupt the immune response leading to induction of autoimmune diseases. We describe a case of new-onset lupus nephritis following COVID-19 vaccination with the first dose of the Pfizer vaccine. Her symptoms and lab values improved with steroids, hydroxychloroquine, and mycophenolate mofetil.
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Affiliation(s)
- Antonio Salas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ayotola Fatola
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Krimins
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Duvuru Geetha
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek Fine
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manny Monroy-Trujillo
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Division of Kidney-Urologic Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lois Arend
- Division of Kidney-Urologic Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Homa Timlin
- Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA
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Baum R, Geetha D, Fatola A, Timlin H. Treatment Using Both Voclosporin and Belimumab in Four Patients With Lupus Nephritis. Cureus 2023; 15:e38848. [PMID: 37303434 PMCID: PMC10256255 DOI: 10.7759/cureus.38848] [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] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Nearly 50% of patients with systemic lupus erythematosus (SLE) will develop lupus nephritis (LN). Current treatment regimens for LN are suboptimal as the majority of patients fail to achieve complete renal response after several months of treatment and there are high rates of relapse. We report outcomes in four LN patients who were treated with both voclosporin and belimumab. These patients had no serious infections, and we were able to taper glucocorticoids and reduce proteinuria.
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Affiliation(s)
- Rebecca Baum
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Duruvu Geetha
- Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ayotola Fatola
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Homa Timlin
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA
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Tiako MJN, Fatola A, Nwadiuko J. Reported Visa Acceptance or Sponsorship for Non-US Citizen Applicants to US Internal Medicine Residency Programs. J Grad Med Educ 2022; 14:680-686. [PMID: 36591431 PMCID: PMC9765918 DOI: 10.4300/jgme-d-22-00072.1] [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] [Received: 01/22/2022] [Revised: 06/10/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Non-US citizen international medical graduates (IMGs) make up a significant proportion of the physician workforce, especially in physician shortage areas and specialties. IMGs face barriers matriculating in US residency programs. Whether a program reports accepting J-1 visas and sponsoring H-1B visas influences their decision to apply, it remains unclear which institutional factors shape programs' likelihood to consider visa-seeking applicants. OBJECTIVE We investigated factors associated with programs reporting accepting J-1 visas or sponsoring H-1B visas for non-citizen applicants in internal medicine, the specialty most sought after by IMGs. METHODS We performed multivariable regression analyses using publicly available data to identify characteristics associated with reported visa acceptance (J-1 and or H-1B). Covariates included university affiliation, program size, program type (academic, university-affiliated community, or community), and Doximity reputation ranking. RESULTS We identified 419 programs: 267 (63.7%) reported accepting J-1 visas. Among programs that accepted J-1 visas, 65.6% (n=175) accepted only J-1 visas while 34.5% (n=92) sponsored H-1B and accepted J-1 visas. Ranking in the third quartile (vs first quartile) was associated with lower odds of accepting J-1 (aOR 0.12; 95% CI 0.02-0.87; P=.04) and sponsoring H-1B visas (aOR 0.19; 95% CI 0.05-0.76; P=.02). Community status (vs academic) was associated with lower odds of accepting J-1 visas (aOR 0.2; 95% CI 0.06-0.64; P=.007), as was county hospital affiliation vs non-county hospitals (aOR 0.22; 95% CI 0.11-0.42; P<.001). CONCLUSIONS While prior evidence shows that most internal medicine programs that substantially enroll IMGs are low ranking, high-ranking internal medicine programs are paradoxically more likely to report that they consider and sponsor visa-seeking applicants.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Max Jordan Nguemeni Tiako, MD, MS, is a Resident in Internal Medicine, Department of Medicine, Brigham and Women's Hospital, and Clinical Fellow in Medicine, Harvard Medical School
| | - Ayotola Fatola
- Ayotola Fatola, MD, is a Resident, Department of Internal Medicine, Johns Hopkins University Hospital
| | - Joseph Nwadiuko
- Joseph Nwadiuko, MD, MPH, MSHP, is a PhD Student, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, and a General Internist, Department of Internal Medicine, University of Pennsylvania Perelman School of Medicine
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Yogeswaran V, Kanade R, Mejia C, Fatola A, Kothapalli S, Najam M, Sandhyavenu H, Angirekula M, Osma K, Jessey M, Hagler D, Egbe AC. Role of Doppler echocardiography for assessing right ventricular cardiac output in patients with atrial septal defect. CONGENIT HEART DIS 2019; 14:713-719. [PMID: 31207173 DOI: 10.1111/chd.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/10/2018] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although Doppler echocardiography is routinely used to assess left ventricle cardiac output, there are limited data about the feasibility of Doppler echocardiography for right ventricular (RV) cardiac output assessment in patients with left-to-right shunt. The purpose of the study was to determine the correlation between Doppler-derived and Fick-derived RV cardiac index (CI), and the interobserver correlation in Doppler-derived RV CI assessment. METHODS Retrospective study of patients (age ≥18 years) with unrepaired atrial septal defect who underwent cardiac catheterization and echocardiography (within 3 days), 2004-2017. RV CI was calculated using the hydraulic orifice formula: [.785 × (right ventricle outflow tract diameter)2 × right ventricular outflow tract (RVOT) time velocity integral × heart rate]/body surface area. RESULTS A total of 128 patients (age 52 ± 17 years; female 88 [69%]) met the inclusion criteria. There was a modest correlation between Doppler-derived and Fick-derived RV CI (r = .57, P < .001), and the mean difference between Doppler-derived and Fick-derived RV CI was -.3 (95% confidence interval of agreement, -.8 to +.9) L/min/m2 . There was also a modest correlation between Doppler-derived RV CI from observer #1 and observer #2 (r = .62, P < .001), and the mean difference between Doppler-derived RV CI from observer #1 and observer #2 was -.2 (95% confidence interval of agreement, -.9 to +.6). CONCLUSIONS The current study demonstrated a modest correlation between Doppler-derived and Fick-derived RV cardiac output, and a modest interobserver correlation in Doppler-derived RV cardiac output assessment. Further studies are required to validate these results and to explore other potential applications such as in patients with chronic pulmonary regurgitation.
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Affiliation(s)
| | - Rahul Kanade
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Camilo Mejia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ayotola Fatola
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Maria Najam
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mounika Angirekula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Karim Osma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mathews Jessey
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Donald Hagler
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Egbe AC, El-Harasis M, Miranda WR, Ammash NM, Rose CH, Fatola A, Kothapalli S, Abdelsamid MF, Connolly HM. Outcomes of Pregnancy in Patients With Prior Right Ventricular Outflow Interventions. J Am Heart Assoc 2019; 8:e011730. [PMID: 31195875 PMCID: PMC6645649 DOI: 10.1161/jaha.118.011730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/17/2023]
Abstract
Background The purpose of this study was to compare the incidence of pregnancy‐related adverse outcomes (PRAO) between patients with versus without hemodynamically significant right ventricle outflow tract (RVOT). Methods and Results This was a retrospective cohort study of all pregnant patients with isolated RVOT lesions undergoing evaluation at the Mayo Clinic, 1990 to 2017. Hemodynamic significance was defined as ≥moderate pulmonary/conduit stenosis (≥3 m/s) and/or ≥moderate regurgitation. Patients with concomitant significant left heart disease were excluded. PRAO was defined as cardiovascular, obstetric, and/or neonatal complications occurring during the pregnancy through 6 weeks postpartum. A total of 224 pregnancies in 114 patients with RVOT lesions were identified; 38 pregnancies occurred in 24 patients with hemodynamically significant RVOT. Forty‐eight (21%) pregnancies ended in spontaneous abortion. Of the 173 completed pregnancies, median gestational age at delivery was 38 (35–40) weeks and median birth weight 2965 (2065–4122) g. Seven pregnancies (4%) were complicated by cardiovascular events, 14 (8%) by obstetric complications, with adverse neonatal outcomes occurring in 38 (22%). There were no maternal deaths. The incidence of spontaneous abortion and PRAO were similar in both the RVOT and hemodynamically significant RVOT groups. As an isolated condition, Tetralogy of Fallot–pulmonary atresia was associated with spontaneous abortion and neonatal complications. Conclusions The risk of cardiovascular complications was low in patients with isolated RVOT lesions, and hemodynamically significant RVOT lesions were not associated with either cardiovascular complications or PRAO. Further studies are required to explore the factors responsible for PRAO in patients with Tetralogy of Fallot–pulmonary atresia.
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Affiliation(s)
- Alexander C Egbe
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Naser M Ammash
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Carl H Rose
- 3 Department of Obstetrics and Gynecology Mayo Clinic Rochester MN
| | - Ayotola Fatola
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Heidi M Connolly
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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Egbe AC, Miranda WR, Madhavan M, Ammash NM, Missula VR, Al-Otaibi M, Fatola A, Kothapalli S, Connolly HM. Cardiac implantable electronic devices in adults with tetralogy of Fallot. Heart 2018; 105:538-544. [PMID: 30377259 DOI: 10.1136/heartjnl-2018-314072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/25/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tachyarrhythmias and bradyarrhythmias affect 20%-50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator. METHODS The Mayo Adult Congenital Heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990-2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock. RESULTS There were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. Indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock. CONCLUSION The current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Naser M Ammash
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Venkata R Missula
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Mohammed Al-Otaibi
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ayotola Fatola
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Srikanth Kothapalli
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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