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Shanmugavel Geetha H, Prabhu S, Sekar A, Gogtay M, Singh Y, Mishra AK, Abraham GM, Martin S. Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease? World J Virol 2023; 12:286-295. [PMID: 38187498 PMCID: PMC10768391 DOI: 10.5501/wjv.v12.i5.286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance. AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19. METHODS We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L. RESULTS 290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%). CONCLUSION Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.
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Affiliation(s)
| | - Sushmita Prabhu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Abinesh Sekar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Hospice and Palliative Medicine, University of Texas Health-San Antonio, San Antonio, TX 78201, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Suzanne Martin
- Department of Nephrology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Suresh MG, Gogtay M, Singh Y, Yadukumar L, Mishra AK, Abraham GM. Case-control analysis of venous thromboembolism risk in non-alcoholic steatohepatitis diagnosed by transient elastography. World J Clin Cases 2023; 11:8126-8138. [PMID: 38130793 PMCID: PMC10731178 DOI: 10.12998/wjcc.v11.i34.8126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Studies have shown a strong association between non-alcoholic steatohepatitis (NASH) cirrhosis and portal vein thrombosis. Specifically, there is paucity of data on the association of NASH and venous thromboembolism (VTE), with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients. The mechanism is believed to be a hepatocellular injury, which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors. There has been no prior analysis of the degree of steatosis and fibrosis (measured using transient elastography, commonly known as FibroScan) in NASH and its association with VTE. AIM To examine the association between the degree of hepatic steatosis and fibrosis, quantified by transient elastography, and the incidence of VTE in patients with NASH. METHODS In our case-control study, we included patients with a documented diagnosis of NASH. We excluded patients with inherited thrombophilia, hemoglobinopathy, malignancy, alcohol use disorder, autoimmune hepatitis, and primary biliary cirrhosis. The collected data included age, demographics, tobacco use, recreational drug use, medical history, and vibration controlled transient elastography scores. VTE-specific data included the location, type of anticoagulant, need for hospital stay, and history of VTE recurrence. Steatosis was categorized as S0-S1 (mild) and S2-S3 (moderate to severe) based on the controlled attenuation parameter score. Fibrosis was classified based on the kilopascal score and graded as F0-F1 (Metavir stage), F2, F3, and F4 (cirrhosis). χ2 and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses, respectively. Furthermore, we performed a logistic regression using VTE as the dependent variable. RESULTS A total of 415 patients were analyzed, and 386 met the inclusion criteria. 51 and 335 patients were included in the VTE and non-VTE groups, respectively. Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group (P < 0.014). Patients with VTE had a higher body mass index (31.14 kg/m² vs 29.30 kg/m²) and a higher prevalence of diabetes mellitus (29.4% vs 13.1%). The history of NASH was significantly higher in the VTE group (45.1% vs 30.4%, P < 0.037). Furthermore, moderate-to-severe steatosis was significantly higher in the VTE group (66.7% vs 47.2%, P < 0.009). Similarly, the F2-F4 fibrosis grade had a prevalence of 58.8% in the VTE group compared to 38.5% in the non-VTE group (P < 0.006). On logistic regression, using VTE as a dependent variable, diabetes mellitus had an odds ratio (OR) =1.702 (P < 0.015), and F2-F4 fibrosis grade had an OR = 1.5 (P < 0.033). CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE, especially deep vein thrombosis. There was a statistically significant association between the incidence of VTE, moderate-to-severe steatosis, and fibrosis. All hospitalized patients should be considered for medical thromboprophylaxis, particularly those with NASH.
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Affiliation(s)
- Mithil Gowda Suresh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Yuvaraj Singh
- Department of Gastroenterology and Hepatology, University of Massachusetts, Worcester, MA 01605, United States
| | - Lekha Yadukumar
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
| | - Ajay Kumar Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - George M Abraham
- Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Qaseem A, Yost J, Abraham GM, Andrews R, Jokela JA, Miller MC, Humphrey LL, Dunn A, Haeme R, Lee R, Saini SD, Tschanz CMP, Etxeandia-Ikobaltzeta I, Harrod C, Shamliyan T, Umana K. Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2023; 176:1396-1404. [PMID: 37722112 PMCID: PMC10620951 DOI: 10.7326/m23-1636] [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: 09/20/2023] Open
Abstract
DESCRIPTION Evidence for the use of outpatient treatments in adults with confirmed COVID-19 continues to evolve with new data. This is version 2 of the American College of Physicians (ACP) living, rapid practice points focusing on 22 outpatient treatments for COVID-19, specifically addressing the dominant SARS-CoV-2 Omicron variant. METHODS The Population Health and Medical Science Committee (formerly the Scientific Medical Policy Committee) developed this version of the living, rapid practice points on the basis of a living, rapid review done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems). This topic will be maintained as living and rapid by continually monitoring and assessing the impact of new evidence. PRACTICE POINT 1 Consider molnupiravir to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease. PRACTICE POINT 2 Consider nirmatrelvir-ritonavir combination therapy to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease. PRACTICE POINT 3 Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 4 Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | | | - Janet A Jokela
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (J.A.J.)
| | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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Geetha HS, Singh G, Sekar A, Gogtay M, Singh Y, Abraham GM, Trivedi N. Hyperglycemia in COVID-19 infection without diabetes mellitus: Association with inflammatory markers. World J Clin Cases 2023; 11:1287-1298. [PMID: 36926123 PMCID: PMC10013116 DOI: 10.12998/wjcc.v11.i6.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/17/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND New onset hyperglycemia is common in patients with severe coronavirus disease 2019 (COVID-19) infection. Cytokine storm due to COVID-19 infection is an essential etiology for new-onset hyperglycemia, but factors like direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pancreatic β-cell failure have also been postulated to play a role.
AIM We plan to investigate further the mechanisms underlying SARS-CoV-2 infection-induced hyperglycemia, particularly the rationale of the cytokine-induced hyperglycemia hypothesis, by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with COVID-19 infection.
METHODS We conducted a retrospective case-control study on adults without diabetes mellitus hospitalized for COVID-19 infection. The serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were collected. Hyperglycemia was defined as glucose levels ≥ 140 mg/dL. C-Reactive protein (CRP) ≥ 100 mg/L, ferritin ≥ 530 ng/mL, lactate dehydrogenase (LDH) ≥ 590 U/L, and D-dimer ≥ 0.5 mg/L were considered elevated. We used the χ2 test for categorical variables and the Mann-Whitney U test for continuous variables and calculated the logistic regression for hyperglycemia.
RESULTS Of the 520 patients screened, 248 met the inclusion criteria. Baseline demographics were equally distributed between patients with hyperglycemia and those who were normoglycemic. Serum inflammatory markers in patients with or without new-onset hyperglycemia were elevated as follows: CRP (58.1% vs 65.6%, P = 0.29), ferritin (48.4% vs 34.9%, P = 0.14), D-dimer (37.1% vs 37.1%, P = 0.76) and LDH (19.4% vs 11.8%, P = 0.02). Logistic regression analysis showed LDH odds ratio (OR) = 1.623 (P = 0.256). We observed significantly higher mortality (24.2% vs 9.1%, P = 0.001; OR = 2.528, P = 0.024) and length of stay (8.89 vs 6.69, P = 0.026) in patients with hyperglycemia.
CONCLUSION Our study showed no association between CRP, ferritin, LDH, D-dimer levels, and new-onset hyperglycemia in non-diabetic patients with COVID-19 infection. It also shows an increased mortality risk and length of stay in patients with hyperglycemia. With new-onset hyperglycemia being closely associated with poor prognostic indices, it becomes pivotal to understand the underlying pathophysiological mechanisms behind the SARS-CoV-2 infection-induced hyperglycemia. We conclude that the stress hyperglycemia hypothesis is not the only mechanism of SARS-CoV-2 infection-induced hyperglycemia but rather a multicausal pathogenesis leading to hyperglycemia that requires further research and understanding. This would help us improve not only the clinical outcomes of COVID-19 disease and inpatient hyperglycemia management but also understand the long-term effects of SARS-CoV-2 infection and further management.
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Affiliation(s)
| | - Garima Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Abinesh Sekar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Department of Hospice and Palliative Medicine, University of Texas Health, San Antonio, TX 78229, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Nitin Trivedi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Ganatra S, Dani SS, Ahmad J, Kumar A, Shah J, Abraham GM, McQuillen DP, Wachter RM, Sax PE. Oral Nirmatrelvir and Ritonavir in Nonhospitalized Vaccinated Patients With Coronavirus Disease 2019. Clin Infect Dis 2023; 76:563-572. [PMID: 35986628 PMCID: PMC9452095 DOI: 10.1093/cid/ciac673] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [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: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Treatment of coronavirus disease 2019 (COVID-19) with nirmatrelvir plus ritonavir (NMV-r) in high-risk nonhospitalized unvaccinated patients reduced the risk of progression to severe disease. However, the potential benefits of NMV-r among vaccinated patients are unclear. METHODS We conducted a comparative retrospective cohort study using the TriNetX research network. Patients ≥18 years of age who were vaccinated and subsequently developed COVID-19 between 1 December 2021 and 18 April 2022 were included. Cohorts were developed based on the use of NMV-r within 5 days of diagnosis. The primary composite outcome was all-cause emergency room (ER) visit, hospitalization, or death at a 30-day follow-up. Secondary outcomes included individual components of primary outcomes, multisystem symptoms, COVID-19-associated complications, and diagnostic test utilization. RESULTS After propensity score matching, 1130 patients remained in each cohort. A primary composite outcome of all-cause ER visits, hospitalization, or death in 30 days occurred in 89 (7.87%) patients in the NMV-r cohort compared with 163 (14.4%) patients in the non-NMV-r cohort (odds ratio: .5; 95% confidence interval: .39-.67; P < .005) consistent with 45% relative risk reduction. A significant reduction in multisystem symptom burden and subsequent complications, such as lower respiratory tract infection, cardiac arrhythmia, and diagnostic radiology testing, were noted in NMV-r-treated patients. There was no apparent increase in serious complications between days 10 and 30. CONCLUSIONS Treatment with NMV-r in nonhospitalized vaccinated patients with COVID-19 was associated with a reduced likelihood of ER visits, hospitalization, or death. Complications and overall resource utilization were also decreased.
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Affiliation(s)
- Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Javaria Ahmad
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Jui Shah
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - George M Abraham
- Division of Infectious Disease, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Daniel P McQuillen
- Division of Infectious Disease, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Robert M Wachter
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Gogtay M, Singh Y, Yekula A, Abraham GM. Calculator for detection of colorectal adenomas by using artificial intelligence models in patients with chronic hepatitis C. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.70] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
70 Background: Hepatitis C virus (HCV) is known for its oncogenic potential, especially in hepatocellular carcinoma and non-Hodgkin lymphoma. On review, several studies have indicated that patients with chronic hepatitis C (CHC) have an increased risk of developing colorectal cancer (CRC). We developed an artificial intelligence (AI) based tool using machine learning (ML) algorithms to help stratify these patients into a higher risk of CRC/adenomas. Methods: The study was approved by the institutional review board. We developed an AI automated calculator uploaded to a graphical user interface (GUI), and we applied ML to train models to predict the probability and the number of adenomas detected on colonoscopy. Data collected were age, smoking history, significant alcohol consumption, aspirin intake, ethnicity, HCV status, gender, body mass index (BMI), and colonoscopy findings. The models can operate either in the presence or absence of the above parameters. Data sets were split into 70:30 ratios for training and internal validation. Scikit-learn StandardScaler was used to scale values of continuous variables. We used the colonoscopy findings as the gold standard and applied a deep learning architecture to train six ML models for prediction. The ML models used were Support Vector Classifier, Random Forest, Bernoulli Naïve Bayes (BNB), Gradient Boosting Classifier (GBC), Logistic Regression, and Deep Neural Networks. Additional regression models were trained and tested to predict the number of polyps. A Flask (customizable python framework) application programming interface (API) was used to deploy the trained ML model with the highest accuracy as a web application. Finally, Heroku was used for the deployment of the web-based API to https://adenomadetection.herokuapp.com. Results: Data was collected for 415 patients, of which only 206 had colonoscopy results. On internal validation with the remaining patients, BNB predicted the probability of adenoma detection with the highest accuracy of 56%, precision of 55%, recall of 55%, and F1 measure of 54%. Support Vector Regressor (SVR) predicted the number of adenomas with the least mean absolute error (MAE) of 0.905. Conclusions: Our AI-based tool shows an association between CHC and colorectal adenomas. This tool can help providers stratify patients with CHC for early referral for screening colonoscopy. Along with giving a numerical percentage, the calculator can also comment on the number of adenomatous polyps a gastroenterologist can expect while doing a colonoscopy, thus prompting a higher adenoma detection rate.
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Affiliation(s)
- Maya Gogtay
- Hospice and Palliative Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Yuvaraj Singh
- Internal Medicine, St. Vincent Hospital, Worcester, MA
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Soni A, Yekula A, Singh Y, Sood N, Dahiya DS, Bansal K, Abraham GM. Influence of non-alcoholic fatty liver disease on non-variceal upper gastrointestinal bleeding: A nationwide analysis. World J Hepatol 2023; 15:79-88. [PMID: 36744164 PMCID: PMC9896500 DOI: 10.4254/wjh.v15.i1.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease globally with an estimated prevalence of 25%, with the clinical and economic burden expected to continue to increase. In the United States, non-variceal upper gastrointestinal bleeding (NVUGIB) has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15% based on co-morbidity burden.
AIM To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.
METHODS We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States. This population was divided based on the presence and absence of NAFLD. Hospitalization characteristics, outcomes and complications were compared.
RESULTS The total number of hospitalizations for NVUGIB was 799785, of which 6% were found to have NAFLD. NAFLD and GIB was, on average, more common in younger patients, females, and Hispanics than GIB without NAFLD. Interestingly, GIB was less common amongst blacks with NAFLD. Multivariate logistic regression analysis was conducted, controlling for the multiple covariates. The primary outcome of interest, mortality, was found to be significantly higher in patients with NAFLD and GIB [adjusted odds ratio (aOR) = 1.018 (1.013-1.022)]. Secondary outcomes of interest, shock [aOR = 1.015 (1.008-1.022)], acute respiratory failure [aOR = 1.01 (1.005-1.015)] and acute liver failure [aOR = 1.016 (1.013-1.019)] were all more likely to occur in this cohort. Patients with NAFLD were also more likely to incur higher total hospital charges (THC) [$2148 ($1677-$2618)]; however, were less likely to have a longer length of stay [0.27 d (0.17-0.38)]. Interestingly, in our study, the patients with NAFLD were less likely to suffer from acute myocardial infarction [aOR = 0.992 (0.989-0.995)]. Patients with NAFLD were not more likely to suffer acute kidney injury, sepsis, blood transfusion, intubation, or dialysis.
CONCLUSION NVUGIB in NAFLD hospitalizations had higher inpatient mortality, THC, and complications such as shock, acute respiratory failure, and acute liver failure compared to those without NAFLD.
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Affiliation(s)
- Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anuroop Yekula
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Nitish Sood
- Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
| | - Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - GM Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Singh Y, Gogtay M, Yekula A, Soni A, Mishra AK, Tripathi K, Abraham GM. Detection of colorectal adenomas using artificial intelligence models in patients with chronic hepatitis C. World J Hepatol 2023; 15:107-115. [PMID: 36744168 PMCID: PMC9896503 DOI: 10.4254/wjh.v15.i1.107] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Hepatitis C virus is known for its oncogenic potential, especially in hepatocellular carcinoma and non-Hodgkin lymphoma. Several studies have shown that chronic hepatitis C (CHC) has an increased risk of the development of colorectal cancer (CRC).
AIM To analyze this positive relationship and develop an artificial intelligence (AI)-based tool using machine learning (ML) algorithms to stratify these patient populations into risk groups for CRC/adenoma detection.
METHODS To develop the AI automated calculator, we applied ML to train models to predict the probability and the number of adenomas detected on colonoscopy. Data sets were split into 70:30 ratios for training and internal validation. The Scikit-learn standard scaler was used to scale values of continuous variables. Colonoscopy findings were used as the gold standard and deep learning architecture was used to train six ML models for prediction. A Flask (customizable Python framework) application programming interface (API) was used to deploy the trained ML model with the highest accuracy as a web application. Finally, Heroku was used for the deployment of the web-based API to https://adenomadetection.herokuapp.com.
RESULTS Of 415 patients, 206 had colonoscopy results. On internal validation, the Bernoulli naive Bayes model predicted the probability of adenoma detection with the highest accuracy of 56%, precision of 55%, recall of 55%, and F1 measure of 54%. Support vector regressor predicted the number of adenomas with the least mean absolute error of 0.905.
CONCLUSION Our AI-based tool can help providers stratify patients with CHC for early referral for screening colonoscopy. Along with providing a numerical percentage, the calculator can also comment on the number of adenomatous polyps a gastroenterologist can expect, prompting a higher adenoma detection rate.
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Affiliation(s)
- Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Hospice and Palliative Medicine, University of Texas Health-San Antonio, San Antonio, TX 78201, United States
| | - Anuroop Yekula
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay Kumar Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Kartikeya Tripathi
- Division of Gastroenterology and Hepatology, UMass Chan School-Baystate Medical Center, Springfield, MA 01199, United States
| | - GM Abraham
- Division of Infectious Disease, Chief of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Qaseem A, Yost J, Miller MC, Andrews R, Jokela JA, Forciea MA, Abraham GM, Humphrey LL, Lee RA, Tschanz MP, Etxeandia-Ikobaltzeta I, Harrod C, Shamliyan T, Umana K. Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2023; 176:115-124. [PMID: 36442061 PMCID: PMC9707698 DOI: 10.7326/m22-2249] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
DESCRIPTION Strategies to manage COVID-19 in the outpatient setting continue to evolve as new data emerge on SARS-CoV-2 variants and the availability of newer treatments. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the best available evidence on the treatment of adults with confirmed COVID-19 in an outpatient setting. These practice points do not evaluate COVID-19 treatments in the inpatient setting or adjunctive COVID-19 treatments in the outpatient setting. METHODS The SMPC developed these living, rapid practice points on the basis of a living, rapid review done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems). The SMPC will maintain these practice points as living by monitoring and assessing the impact of new evidence. PRACTICE POINT 1 Consider molnupiravir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease. PRACTICE POINT 2 Consider nirmatrelvir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at high risk for progressing to severe disease. PRACTICE POINT 3 Consider remdesivir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 7 days of the onset of symptoms and at high risk for progressing to severe disease. PRACTICE POINT 4 Do not use azithromycin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 5 Do not use chloroquine or hydroxychloroquine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 6 Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 7 Do not use nitazoxanide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 8 Do not use lopinavir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 9 Do not use casirivimab-imdevimab combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. PRACTICE POINT 10 Do not use regdanvimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. PRACTICE POINT 11 Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. PRACTICE POINT 12 Do not use convalescent plasma to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 13 Do not use ciclesonide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 14 Do not use fluvoxamine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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10
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Mishra AK, Abraham BM, Sahu KK, George AA, Sargent J, Kranis MJ, George SV, Abraham GM. Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis. J Patient Saf 2022; 18:756-759. [PMID: 35797474 DOI: 10.1097/pts.0000000000001055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Patients leaving against medical advice (AMA) are commonly encountered in hospital medicine. The problem is prevalent worldwide and across all fields of medicine. A retrospective study of 47,583 patients reported a 3.3% AMA rate in 2015. OBJECTIVES In this retrospective study, we aimed (1) to study the demographic, clinical, and laboratory parameters of infective endocarditis (IE) patients leaving AMA. We also compared (2) the various risk factors and outcomes of these patients with IE patients who completed treatment. RESULTS A total of 111 patients diagnosed with IE were recruited for 36 months. Of the 74 patients with available details, 32 patients (29%) left AMA during their treatment. The mean age of patients leaving AMA was 39, and among those who left AMA, 66% were females. As compared with patients completing therapy, patients leaving AMA tend to have higher comorbidities, including injection drug use (68.1% versus 31.9%), prior IE (83.3% versus 16.7%), and chronic hepatitis C (72.4% versus 27.8%). Rates of consumption of substances of abuse were higher among those who left AMA. Patients leaving AMA also had higher psychiatric comorbidities (63% versus 37.5%), history of leaving AMA (70.5% versus 29.5%), and consumption of more than 2 substances of abuse. Morbidity was higher in patients leaving AMA. There was a statistically significant association between the development of distal embolus ( P < 0.001), the need for recurrent admissions ( P = 0.002), recurrent bacteremia ( P < 0.001), developing new embolus ( P < 0.001), and overall morbidity ( P = 0.002) among IE patients leaving AMA. CONCLUSIONS Infective endocarditis patients leaving AMA tend to be younger females. These patients have prior comorbidities of injection drug use, prior IE, multiple psychiatric comorbidities, drug use, and multiple socioeconomic issues. Patients leaving AMA tend to develop further non-Central nervous system embolic events, recurrent bacteremia, and require frequent admissions. Morbidity in these patients was higher.
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Affiliation(s)
- Ajay Kumar Mishra
- From the Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester
| | | | - Kamal K Sahu
- Division of Hematology and Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Jennifer Sargent
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts
| | - Mark J Kranis
- From the Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester
| | - Susan V George
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts
| | - George M Abraham
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts
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11
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Abraham S, Nohria A, Neilan TG, Asnani A, Saji AM, Shah J, Lech T, Grossman J, Abraham GM, McQuillen DP, Martin DT, Sax PE, Dani SS, Ganatra S. Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:1912-1924. [PMID: 36243540 PMCID: PMC9580069 DOI: 10.1016/j.jacc.2022.08.800] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, nonhospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease. Patients with cardiovascular risk factors and cardiovascular disease are at a high risk of developing adverse events from COVID-19 and as a result have a higher likelihood of receiving NMVr. Ritonavir, the pharmaceutical enhancer used in NMVr, is an inhibitor of the enzymes of CYP450 pathway, particularly CYP3A4 and to a lesser degree CYP2D6, and affects the P-glycoprotein pump. Co-administration of NMVr with medications commonly used to manage cardiovascular conditions can potentially cause significant drug-drug interactions and may lead to severe adverse effects. It is crucial to be aware of such interactions and take appropriate measures to avoid them. In this review, we discuss potential drug-drug interactions between NMVr and commonly used cardiovascular medications based on their pharmacokinetics and pharmacodynamic properties.
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Affiliation(s)
- Sonu Abraham
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aarti Asnani
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anu Mariam Saji
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Jui Shah
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Tara Lech
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Jason Grossman
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - George M Abraham
- Division of Infectious Disease, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Daniel P McQuillen
- Division of Infectious Disease, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - David T Martin
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Forciea MA, Miller MC, Humphrey LL. Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2, Update Alert 3). Ann Intern Med 2022; 175:W55-W57. [PMID: 35226518 PMCID: PMC8900283 DOI: 10.7326/m21-4810] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | - Jennifer Yost
- American College of Physicians, Philadelphia, Pennsylvania, and Villanova University, Villanova, Pennsylvania
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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13
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Forciea MA, Abraham GM, Miller MC, Obley AJ, Humphrey LL, Akl EA, Andrews R, Dunn A, Haeme R, Kansagara DL, Tschanz MP. What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2022; 175:556-565. [PMID: 35073153 PMCID: PMC8803138 DOI: 10.7326/m21-3272] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the current best available evidence on the antibody response to SARS-CoV-2 infection and protection against reinfection with SARS-CoV-2. This is version 2 of the ACP practice points, which serves to update version 1, published on 16 March 2021. These practice points do not evaluate vaccine-acquired immunity or cellular immunity. METHODS The SMPC developed this version of the living, rapid practice points based on an updated living, rapid, systematic review conducted by the Portland VA Research Foundation and funded by the Agency for Healthcare Research and Quality. PRACTICE POINT 1 Do not use SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. PRACTICE POINT 2 Do not use SARS-CoV-2 antibody tests to predict the degree or duration of natural immunity conferred by antibodies against reinfection, including natural immunity against different variants. RETIREMENT FROM LIVING STATUS Although natural immunity remains a topic of scientific interest, this topic is being retired from living status given the availability of effective vaccines for SARS-CoV-2 and widespread recommendations for and prevalence of their use. Currently, vaccination is the best clinical recommendation for preventing infection, reinfection, and serious illness from SARS-CoV-2 and its variants.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- University of Massachusetts Medical School/Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | | | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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14
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Miller MC, Forciea MA, Humphrey LL. Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2021; 174:W116-W117. [PMID: 34606308 PMCID: PMC8496689 DOI: 10.7326/l21-0607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | | | | | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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15
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Centor RM, Abraham GM, Jena AB. Web Exclusive. Annals On Call - The Importance of International Medical Graduates. Ann Intern Med 2021; 174:OC1. [PMID: 34724411 DOI: 10.7326/a20-0024] [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: 11/22/2022] Open
Affiliation(s)
- Robert M Centor
- Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)
| | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts (G.M.A.)
| | - Anupam B Jena
- Harvard Medical School, Boston, Massachusetts (A.B.J.)
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16
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Miller MC, Forciea MA, Humphrey LL, Dunn A, Andrews R, Haeme R, Tschanz MP. Update Alert: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2021; 174:W66-W67. [PMID: 34251904 PMCID: PMC8297419 DOI: 10.7326/l21-0389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | | | | | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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17
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Tripathi K, Loganathan S, Trivedi N, Abraham GM. Impact of hepatitis C remission on glycemic control in patients with type 2 diabetes mellitus: primary care outpatient experience. J Community Hosp Intern Med Perspect 2021; 11:354-356. [PMID: 34234905 PMCID: PMC8118393 DOI: 10.1080/20009666.2021.1886631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kartikeya Tripathi
- Department of Gastroenterology and Hepatology, University of Massachusetts Medical School- Baystate Springfield, MA
| | | | - Nitin Trivedi
- Department of Medicine, St Vincent Hospital, Worcester, MA.,Department of Medicine, University of Massachusetts, Worcester, MA
| | - George M Abraham
- Department of Medicine, St Vincent Hospital, Worcester, MA.,Department of Medicine, University of Massachusetts, Worcester, MA
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18
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Abraham GM, Saravolatz LD. The American Board of Internal Medicine's New Longitudinal Assessment Option and What It Means for Infectious Disease Specialists. Clin Infect Dis 2021; 72:1854-1857. [PMID: 33005939 DOI: 10.1093/cid/ciaa1493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/29/2020] [Indexed: 11/12/2022] Open
Abstract
As members of the American Board of Internal Medicine's (ABIM) Infectious Disease (ID) Board we've heard from many of our colleagues asking for greater flexibility in maintaining their ABIM Board Certification. The ID Board-and ABIM as a whole-has engaged with the physician community over the past several years to gain a deeper understanding of what is most important to them, and how an enhanced Maintenance of Certification (MOC) program could support their commitment to keeping up with advances in medical knowledge. This article serves as an update about how ABIM has evolved its assessments over time and on our progress in developing a new longitudinal pathway that is anticipated to become available in most specialties in 2022, and will launch in ID in 2023.
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Affiliation(s)
- George M Abraham
- American Board of Internal Medicine (ABIM) Infectious Disease Board, Saint Vincent Hospital, Worcester, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Louis D Saravolatz
- ABIM Infectious Disease Board, Department of Medicine at St John Hospital, Grosse Pointe Woods, Michigan, USA
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19
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Forciea MA, Abraham GM, Miller MC, Obley AJ, Humphrey LL, Centor RM, Akl EA, Andrews R, Bledsoe TA, Haeme R, Kansagara DL. What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2021; 174:828-835. [PMID: 33721518 PMCID: PMC8017476 DOI: 10.7326/m20-7569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The widespread availability of SARS-CoV-2 antibody tests raises important questions for clinicians, patients, and public health professionals related to the appropriate use and interpretation of these tests. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians developed these rapid, living practice points to summarize the current and best available evidence on the antibody response to SARS-CoV-2 infection, antibody durability after initial infection with SARS-CoV-2, and antibody protection against reinfection with SARS-CoV-2. METHODS The SMPC developed these rapid, living practice points based on a rapid and living systematic evidence review done by the Portland VA Research Foundation and funded by the Agency for Healthcare Research and Quality. Ongoing literature surveillance is planned through December 2021. When new studies are identified and a full update of the evidence review is published, the SMPC will assess the new evidence and any effect on the practice points. PRACTICE POINT 1 Do not use SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. PRACTICE POINT 2 Antibody tests can be useful for the purpose of estimating community prevalence of SARS-CoV-2 infection. PRACTICE POINT 3 Current evidence is uncertain to predict presence, level, or durability of natural immunity conferred by SARS-CoV-2 antibodies against reinfection (after SARS-CoV-2 infection).
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | | | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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20
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Alampoondi Venkataramanan SV, George L, Sahu KK, Abraham GM. A 5-Year Retrospective Analysis of Raoultella planticola Bacteriuria. Infect Drug Resist 2021; 14:1989-2001. [PMID: 34103946 PMCID: PMC8178696 DOI: 10.2147/idr.s306632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 02/14/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Raoultella planticola is an aerobic gram-negative rod predominantly found in soil and aquatic environments. The typical reservoirs of Raoultella spp. include the gastrointestinal tract and the upper respiratory tract. It usually causes pneumonia, biliary tract infections, and bacteremia. Urinary tract infection (UTI) secondary to R. planticola is an uncommon entity. Less than 10 cases of R. planticola-associated UTIs in adults have been published in the literature to date. Objective This is a single institution retrospective study undertaken to identify the epidemiology, patient characteristics, clinical spectrum, predisposing risk factors and the outcome of patients with UTI caused by R. planticola. Results A total of 37 R. planticola isolates were identified in urine samples over a 5-year study period. The mean age of the patient population was 77 years. The most common comorbidity was diabetes mellitus, which was present in 16 patients. Only 3 patients had a history of steroid use, an immunosuppressive condition, or were on chemotherapy. The most common presenting complaint was altered mental status followed by fever. Resistance to ampicillin was found in 35 isolates which seems to be an intrinsic characteristic of Raoultella spp. and 2 isolates were multidrug-resistant, but still susceptible to ciprofloxacin. The average length of stay was 3 days, and the average duration of antibiotic administration was 8 days. Ciprofloxacin was the most frequently prescribed antibiotic (9 patients). The severity of infection ranged from simple cystitis in 15 patients to urosepsis in 2 patients and septic shock in 2 patients. There were no mortalities in our cohort. Conclusion Our study revealed that patients with R. planticola UTI had higher proportion of diabetes mellitus, renal failure compared to the general population. Our study also confirms the intrinsic resistance to ampicillin of Raoultella spp., which has been documented previously in the literature.
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Affiliation(s)
| | - Lovin George
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Kamal Kant Sahu
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - George M Abraham
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA
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21
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Lal A, Abraham GM. Utility of CD4 Cell Count and Viral Load Assay in Hospitalized Patients with Known HIV Infection: High Value Care Exercise. Infect Disord Drug Targets 2021; 20:486-490. [PMID: 31648634 DOI: 10.2174/1871526519666191011162018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/16/2019] [Accepted: 09/17/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Healthcare spending as a percentage of Gross domestic product (GDP) is at all-time high and continues to rise in the United States. The Centers for Medicare and Medicaid Services estimate that 33% of resources spent on healthcare goes to waste. As part of a 'high value care' exercise, we studied if estimating CD4 cell counts and HIV viral load in hospitalized patients with a known diagnosis of HIV led to any meaningful change in HAART regimen and discharge diagnosis. METHODS Retrospective chart review for all patients admitted with a known diagnosis of HIV from January 1, through December 31, 2017. RESULTS A total of 83 patient encounters were reviewed during the period. The mean age was 54.1 ± 16.4 years, 64.1 % of patients were males. 75 patients (90.3%) were already on highly active antiretroviral therapy (HAART). The median hospital length of stay (LOS) was 3 days (IQR 2.0 - 5.0). The mean turnaround time for CD4 counts and HIV viral load assay was 2.9 days (95% CI 2.1 - 3.7) and 3.9 days (95% CI, 3.2 - 4.6), respectively. A CD4 count estimation led to no change in HAART regimen. HIV viral load assay testing had no impact on a change in treatment or a change in diagnosis. CONCLUSIONS In our study, testing CD4 counts and HIV viral load for inpatients did not confer any benefit in altering the diagnosis or HAART regimen. We believe that our study identifies a systems level opportunity to add to the concept of 'Choosing Wisely.'
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Affiliation(s)
- Amos Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, 200 1st St, SW, Rochester MN 55902, United States
| | - George M Abraham
- Department of Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Governor, MA Chapter, and Regent, American College of Physicians (ACP), 123 Summer Street, Worcester, MA 01608, United States
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Forciea MA, Miller MC, Humphrey LL, Centor RM, Andrews R, Haeme R. Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2021; 174:673-679. [PMID: 33560862 PMCID: PMC7983309 DOI: 10.7326/m20-8101] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Indexed: 11/25/2022] Open
Abstract
Clinicians must have access to the best available evidence to inform point-of-care decisions about the use of remdesivir in patients with COVID-19. This article provides updated advice from the American College of Physicians for clinicians based on an updated rapid review.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Forciea MA, Miller MC, Humphrey LL, Centor RM, Andrews R, Haeme R, Kansagara DL, Marcucci M. Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2021; 174:229-236. [PMID: 33017175 PMCID: PMC7556654 DOI: 10.7326/m20-5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/04/2022] Open
Abstract
These rapid and living practice points from the American College of Physicians address the effectiveness and harms of remdesivir treatment in patients with COVID-19.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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24
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Abraham GM, Obley AJ, Humphrey LL, Qaseem A, Centor RM, Akl E, Forceia MA, Haeme R, Hamilton PG, Hood GA, Jokela JA, Kansagara DL, Levine MA, Mason JR, Marcucci M. World Health Organization Guidelines on Treatment of Hepatitis C Virus Infection: Best Practice Advice From the American College of Physicians. Ann Intern Med 2021; 174:98-100. [PMID: 33017566 DOI: 10.7326/m19-3860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/09/2022] Open
Affiliation(s)
- George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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25
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Gantzer HE, Fincher JW, Fox WE, Kane GC, Cooney TG, Abraham GM, Andrews R. Election 2020: Comparison of the American College of Physicians' Vision for a Better U.S. Health Care System With the Presidential Candidates' Plans. Ann Intern Med 2020; 173:929-932. [PMID: 33105093 DOI: 10.7326/m20-7089] [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: 11/22/2022] Open
Affiliation(s)
- Heather E Gantzer
- Park Nicollet Clinic, Methodist Hospital, St. Louis Park, Minnesota (H.E.G.)
| | | | - William E Fox
- Fox and Brantley Internal Medicine, PLC, Charlottesville, Virginia (W.E.F.)
| | - Gregory C Kane
- The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (G.C.K.)
| | - Thomas G Cooney
- Portland VA Medical Center, Oregon Health and Science University, Portland, Oregon (T.G.C.)
| | - George M Abraham
- Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, Massachusetts (G.M.A.)
| | - Rebecca Andrews
- UConn Health, University of Connecticut Health Center, Farmington, Connecticut (R.A.)
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Kanaan AO, Sullivan KM, Seed SM, Cookson NA, Spooner LM, Abraham GM. In the Eye of the Storm: The Role of the Pharmacist in Medication Safety during the COVID-19 Pandemic at an Urban Teaching Hospital. Pharmacy 2020; 8:pharmacy8040225. [PMID: 33233363 PMCID: PMC7712060 DOI: 10.3390/pharmacy8040225] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease (COVID-19) pandemic, has challenged practitioners with complex clinical scenarios as well as conflicting and scarce data to support treatment strategies. The pandemic has also placed strains on institutions due to drug shortages, alterations in medication use processes, economic losses, and staff exposure to the virus. This article provides pharmacist-led suggestions and strategies to various case questions, describing some of the challenges faced by practitioners at an urban teaching hospital during the COVID-19 pandemic. The strategies suggested can be explored at other institutions.
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Affiliation(s)
- Abir O. Kanaan
- School of Pharmacy Worcester/Manchester, MCPHS University, Worcester, MA 01608, USA; (A.O.K.); (K.M.S.); (L.M.S.)
- Saint Vincent Hospital, Worcester, MA 01608, USA; (N.A.C.); (G.M.A.)
| | - Karyn M. Sullivan
- School of Pharmacy Worcester/Manchester, MCPHS University, Worcester, MA 01608, USA; (A.O.K.); (K.M.S.); (L.M.S.)
- Saint Vincent Hospital, Worcester, MA 01608, USA; (N.A.C.); (G.M.A.)
| | - Sheila M. Seed
- School of Pharmacy Worcester/Manchester, MCPHS University, Worcester, MA 01608, USA; (A.O.K.); (K.M.S.); (L.M.S.)
- Saint Vincent Hospital, Worcester, MA 01608, USA; (N.A.C.); (G.M.A.)
- Correspondence: ; Tel.: +1-508-373-5622
| | - Nathan A. Cookson
- Saint Vincent Hospital, Worcester, MA 01608, USA; (N.A.C.); (G.M.A.)
| | - Linda M. Spooner
- School of Pharmacy Worcester/Manchester, MCPHS University, Worcester, MA 01608, USA; (A.O.K.); (K.M.S.); (L.M.S.)
- Saint Vincent Hospital, Worcester, MA 01608, USA; (N.A.C.); (G.M.A.)
| | - George M. Abraham
- Saint Vincent Hospital, Worcester, MA 01608, USA; (N.A.C.); (G.M.A.)
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Sahu KK, Lal A, Mishra AK, Abraham GM. Aerococcus-Related Infections and their Significance: A 9-Year Retrospective Study. J Microsc Ultrastruct 2020; 9:18-25. [PMID: 33850708 PMCID: PMC8030539 DOI: 10.4103/jmau.jmau_61_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 10/28/2019] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Aerococcus spp. is a Gram-positive, catalase- and oxidase-negative, microaerophilic, nonmotile bacteria species rarely associated with human infections such as arthritis, bacteremia, endocarditis, and meningitis. The bacteria are also often confused with streptococci species or treated as a contaminant. Patients and Methodology: We conducted a retrospective, observational cohort study on all patients with Aerococcus spp. isolates in blood samples from July 2010 to June 2019. All categorical data were presented as counts and proportions, whereas continuous data were presented as median and interquartile ranges. Results: A total of 20 Aerococcus spp. isolates were identified over the study period of 9 years. Of these, Aerococcus urinae was isolated in 10 (50%), Aerococcus viridans in 6 (30%), and Aerococcus spp. (not speciated) in 4 (20%). The median age was 74.3 years (12 males and 8 females). The two most frequent presentations were fever (15 of 20) and altered mentation (6 of 15). Most of the patients (11 of 15) had at least one predisposing comorbidity related to the urinary tract system (8 with recurrent urinary tract infection, 7 with urinary incontinence, 3 with an indwelling catheter, 2 with renal stones, and 1 each with benign prostatic hyperplasia and a recent cystoscopy). The median white blood cell count was 18,426 cells/mL, median hemoglobin 10.96 g/dL, median platelet count 191,000 cells/μL, median blood urea nitrogen 28.6 mg/dL, and median creatinine 1.54 mg/dL. The urinary tract was the most likely source of bacteremia (10 of 20) based on either imaging findings (5 cases), positive urine culture for Aerococcus spp. (4 cases), or instrumentation history (1 case). In the rest, the cause of bacteremia could not be found. Endocarditis was suspected in 9 out of 20 patients. Transthoracic echocardiography/transesophageal echocardiography (TEE) confirmed 3 cases (2 aortic valves, 1 mitral valve and pacemaker). Interestingly, one case had septic emboli causing a right frontal stroke with a normal TEE and normal Doppler study for deep venous thrombosis. Blood cultures were positive in 35% (7 of 20) with polymicrobial growth, 3 with coagulase-negative staphylococci, 2 with Enterococcus faecalis, and the other 2 each with Diphtheroids spp. and Proteus mirabilis. Of the 20 cases, 9 and 10 required intensive care unit level care and vasopressor support, respectively. Most of the patients were treated for 5–14 days except the 3 cases with infective endocarditis (IE). The median hospital stay duration was 6.55 days with 2 fatalities (2 out of 20 patients). Conclusion: Old age and underlying urologic conditions are the best-known risk factors for Aerococcus spp. infection. Recent advances in diagnostic technology have led to an increase in detection of Aerococcus spp.-related infections. The rare occurrence of Aerococcus spp. in human infections and resultant lack of randomized control trials have resulted in a significant degree of clinical uncertainty in the management of Aerococcus spp. IE.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
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Qaseem A, Etxeandia-Ikobaltzeta I, Yost J, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL, Centor RM, Andrews R, Bledsoe TA, Haeme R, Kansagara DL, Marcucci M. Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2020; 173:642-649. [PMID: 32551813 PMCID: PMC7357230 DOI: 10.7326/m20-3234] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Indexed: 12/25/2022] Open
Abstract
Controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. In this article, the American College of Physicians (ACP) provides recommendations based on the best available evidence through 14 April 2020 on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection. The ACP plans periodic updates of these recommendations on the basis of ongoing surveillance of the literature for 1 year from the initial search date.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | | | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | | | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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29
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL, Centor RM, Andrews R, Bledsoe TA, Haeme R, Kansagara DL, Marcucci M. Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2020; 173:137-142. [PMID: 32422063 PMCID: PMC7281715 DOI: 10.7326/m20-1998] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- University of Massachusetts Medical School/Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam Jacob Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Mary Ann Forciea
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.)
| | - Janet A Jokela
- University of Illinois at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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30
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL. Update Alert: Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians. Ann Intern Med 2020; 173:W48-W51. [PMID: 32551892 PMCID: PMC7322813 DOI: 10.7326/m20-3862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center, Portland, Oregon (A.J.O.)
| | | | - Janet A Jokela
- University of Illinois College of Medicine, Urbana, Illinois (J.A.J.)
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31
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Sullivan KM, Nicolas SE, Burton SJ, Spooner LM, Kanaan AO, Abraham GM. Innovative approach for sustaining an institutional medication safety committee. Am J Health Syst Pharm 2020; 77:826-829. [DOI: 10.1093/ajhp/zxaa068] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Samar E Nicolas
- Department of Pharmacy Practice MCPHS University Worcester, MA
| | | | - Linda M Spooner
- Department of Pharmacy Practice MCPHS University Worcester, MA
| | - Abir O Kanaan
- Department of Pharmacy Practice MCPHS University Worcester, MA
| | - George M Abraham
- Department of Medicine University of Massachusetts Medical School Saint Vincent Hospital Worcester, MA
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32
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Abraham GM, Morton JB, Saravolatz LD. Baloxavir: A Novel Antiviral Agent in the Treatment of Influenza. Clin Infect Dis 2020; 71:1790-1794. [DOI: 10.1093/cid/ciaa107] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
Abstract
Baloxavir marboxil (formerly S-033188) is a prodrug of baloxavir acid (S-033447) and inhibits cap-dependent endonuclease, an essential protein involved in the initiation of viral transcription by cleaving capped mRNA bound to PB2. Its adverse event profile is comparable to oseltamivir but is still vulnerable to resistance. The single-dose baloxavir marboxil is an appealing antiviral regimen for the treatment of influenza among outpatients when compared with longer, twice-daily regimens of oral and inhaled neuraminidase inhibitors. This review focuses on the mode of action, antiviral activity, pharmacokinetics, clinical indications, and safety profiles of this drug. Considerations for formulary addition and its place in therapy are also discussed.
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Affiliation(s)
- George M Abraham
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jacob B Morton
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Louis D Saravolatz
- Department of Medicine, Ascension St John Hospital, Grosse Pointe Woods, Michigan, USA
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Sahu KK, Mishra AK, Lal A, Abraham GM. Mycobacterium Avium Complex: A Rare Cause of Pancytopenia in HIV Infection. J Microsc Ultrastruct 2019; 8:27-30. [PMID: 32166062 PMCID: PMC7045622 DOI: 10.4103/jmau.jmau_18_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 04/03/2019] [Accepted: 06/29/2019] [Indexed: 11/12/2022] Open
Abstract
Opportunistic infections in HIV infection are challenging to diagnose and treat, especially when the prevalence of disease is rare. Mycobacterial infections can have debilitating morbidity and mortality in HIV individuals if prompt diagnosis and treatment is not done. A 33-year-old African-American female presented for the complaints of easy fatigability, unintentional weight loss, and diarrhea of 3-month duration. Initial laboratory results suggested bicytopenia; however, there was an initial delay of a couple of months in evaluation because of her poor compliance. A final diagnosis of HIV with a low CD4 count of 9 cells/mm3 and disseminated Mycobacterium avium complex (MAC) infection was made. She was started on anti-MAC therapy, followed by antiretroviral therapy however soon succumbed to her illness.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - George M Abraham
- Department of Internal Medicine, Chief of Medicine, Saint Vincent Hospital, Worcester, MA, USA.,Professor of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Abraham GM, Spooner LM. Citius, Altius, Fortius: The New Paradigm in the Treatment of Chronic Hepatitis C Disease. Clin Infect Dis 2019; 66:464-474. [PMID: 29020275 DOI: 10.1093/cid/cix746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/17/2017] [Indexed: 12/31/2022] Open
Abstract
With the advent of the direct-acting antiviral agents (DAAs) for chronic hepatitis C infection, the treatment paradigm has dramatically changed, especially the duration, tolerability, and response to therapy. The DAAs fall into several classes and are variously indicated in the treatment of one or more genotypes of infection. All these agents are orally administered and, as they are largely renally eliminated (with exceptions), do not require adjustment in mild to moderate renal insufficiency. Most of these agents demonstrate a high barrier to resistance and are extremely well-tolerated by patients. Overall efficacy rates are ≥90%.
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Affiliation(s)
- George M Abraham
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Saint Vincent Hospital.,University of Massachusetts Medical School
| | - Linda M Spooner
- Department of Pharmacy Practice, School of Pharmacy-Worcester/Manchester, Massachusetts College of Pharmacy and Health Sciences University
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35
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Lal A, Mishra AK, Sahu KK, Abraham GM. Machine Learning and Patient Expectations: Potential Point of Disconnect. Am J Med 2019; 132:e750. [PMID: 31375214 DOI: 10.1016/j.amjmed.2019.04.053] [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: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Mass.
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Mass
| | - Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Mass
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Mass
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36
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Sahu KK, Mishra AK, Lal A, Siddiqui AD, Abraham GM. From Oncologist's Desk: Hemato-Oncological Aspect of Using Vaporizers, E-Cigarettes, and Other Electronic Nicotine Delivery Systems (ENDS). Indian J Hematol Blood Transfus 2019; 36:202-204. [PMID: 32158108 DOI: 10.1007/s12288-019-01177-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kamal Kant Sahu
- 1Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608 USA
| | - Ajay Kumar Mishra
- 1Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608 USA
| | - Amos Lal
- 2Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 USA
| | - Ahmad Daniyal Siddiqui
- Division of Hematology and Medical Oncology, Saint Vincent Cancer and Wellness Center, 1 Eaton Place, Worcester, MA 01608 USA
| | - George M Abraham
- 1Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608 USA.,4University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01608 USA
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37
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Lal A, Davaro R, Mishra AK, Sahu KK, Abraham GM. Detection of coexisting toxigenic Clostridium difficile and nontyphoidal Salmonella in a healthcare worker with diarrhea: A therapeutic dilemma. J Family Med Prim Care 2019; 8:2724-2727. [PMID: 31548964 PMCID: PMC6753814 DOI: 10.4103/jfmpc.jfmpc_227_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 03/16/2019] [Accepted: 06/08/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Clostridium difficile infection (CDI) and nontyphoidal Salmonella infection (NSI) have similar clinical manifestations and are seldom seen simultaneously. The decision-making in terms of antibiotic therapy becomes difficult when both the pathogens are isolated from the same patient. Case Presentation: We describe a case of Clostridium difficile (CD) enterocolitis in a healthcare provider who concomitantly tested positive for nontyphoidal Salmonella. Discussion: To the best of our knowledge after extensive literature review (English), this is only the fourth report highlighting this association. Conclusion: Although Salmonella is not a risk factor for CDI, it can cause intestinal inflammation and alteration in the intestinal flora. When two pathogens are isolated from the same patient, it is tempting to treat both with antibiotics as highlighted. When it involves healthcare workers, there is no difference in guidelines and should not be prescribed antibiotics with intent of reducing secondary transmission.
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Affiliation(s)
- Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Raul Davaro
- Division of Infectious Diseases, Worcester Medical Center, Reliant Medical Group, Worcester, MA, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Kamal Kant Sahu
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - George M Abraham
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Lal A, Mishra AK, Sahu KK, Abraham GM. The return of Koch's: Ineffective treatment or re-infection. Enferm Infecc Microbiol Clin 2019; 38:144-145. [PMID: 31307825 DOI: 10.1016/j.eimc.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - George M Abraham
- Department of Medicine, Saint Vincent Hospital, USA; University of Massachusetts Medical School, USA; American College of Physicians (ACP), USA; Board of Governors (ACP), USA; Infectious Disease Board, American Board of Internal Medicine (ABIM), USA; Board of Registration in Medicine (BORIM), Commonwealth of Massachusetts, Worcester, MA, USA
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Spooner LM, Abraham GM. Sustained virological response in a treatment-experienced patient with hepatitis C virus genotype 6 infection: Follow-up on a reported case. Am J Health Syst Pharm 2019; 74:555. [PMID: 28389452 DOI: 10.2146/ajhp170018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Linda M Spooner
- School of PharmacyMassachusetts College of Pharmacy and Health SciencesWorcester,
| | - George M Abraham
- Division of Infectious Disease and Geographic MedicineSaint Vincent HospitalUniversity of Massachusetts Medical SchoolWorcester, MA
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Sullivan KM, Spooner LM, Harris E, Lowe K, Abraham GM. A Bitter Pill to Swallow: Why Medication Safety Is Critical in Hepatitis C Treatment. P T 2018; 43:764-768. [PMID: 30559590 PMCID: PMC6281151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To provide medication safety tips to optimize the management of patients receiving treatment for chronic hepatitis C virus (HCV) infection. SUMMARY Ensuring safe medication use in patients who receive treatment for HCV infection is a crucial component in providing optimal patient care. Because of the complexity of available treatment options, numerous challenges exist in preventing medication errors with HCV therapies. This article will focus on the selection of appropriate treatment options along with proper dosing and duration, awareness of concomitant disease states and drug interactions, identifying adverse drug reactions (ADRs) and patient counseling points, the provision of adherence counseling and prevention of treatment interruptions, improving communication with patients and between pharmacies, and recognizing the importance of a multidisciplinary approach. CONCLUSION Maintaining awareness of medication safety strategies geared toward HCV pharmacotherapy is critical for providing optimal care for patients while minimizing the opportunity for errors.
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Lal A, Akhtar J, Isaac S, Mishra AK, Khan MS, Noreldin M, Abraham GM. Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature. Respir Med Case Rep 2018; 25:270-273. [PMID: 30364740 PMCID: PMC6197799 DOI: 10.1016/j.rmcr.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 08/09/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022] Open
Abstract
Chest pain is a common symptom culminating in hospital admissions and specialist referrals. Although cardiac work up is pursued in most of the cases, cardiac etiology is found to be the culprit in minority of the cases. Acute chest pain is a clinical syndrome that may be caused by almost any condition affecting the thorax, abdomen, or internal organs. On occasions this extensive and expensive diagnostic work up can be avoided with awareness of commoner and non-lethal reasons. We report a case of a woman with Bornholm disease secondary to Coxsackievirus B5 (CB5) infection and supplementary review of literature till date.
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Affiliation(s)
- Amos Lal
- Department of Internal Medicine, 123 Summer Street, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Jamal Akhtar
- Department of Internal Medicine, 123 Summer Street, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - Sangeetha Isaac
- Department of Intensive Care Unit, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
| | - Ajay Kumar Mishra
- Department of Internal Medicine, 123 Summer Street, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | | | - Mohsen Noreldin
- Department of Internal Medicine, 123 Summer Street, Saint Vincent Hospital, Worcester, MA, 01608, USA
| | - George M Abraham
- Department of Internal Medicine, 123 Summer Street, Saint Vincent Hospital, Worcester, MA, 01608, USA
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Li Y, George A, Arnaout S, Wang JP, Abraham GM. Splenic Infarction: An Under-recognized Complication of Infectious Mononucleosis? Open Forum Infect Dis 2018; 5:ofy041. [PMID: 29577060 PMCID: PMC5853003 DOI: 10.1093/ofid/ofy041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Received: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022] Open
Abstract
Splenic infarction is a rare complication of infectious mononucleosis. We describe 3 cases of splenic infarction attributed to infectious mononucleosis that we encountered within a 2-month period. We underscore the awareness of this potential complication of infectious mononucleosis and discuss the differential diagnosis of splenic infarction, including infectious etiologies. While symptomatic management is usually sufficient for infectious mononucleosis-associated splenic infarction, close monitoring for other complications, including splenic rupture, is mandated.
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Affiliation(s)
- Yan Li
- Saint Vincent Hospital, Worcester, Massachusetts
| | - Ann George
- Saint Vincent Hospital, Worcester, Massachusetts
| | - Sami Arnaout
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer P Wang
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - George M Abraham
- Saint Vincent Hospital, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
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Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM, Abraham GM, Centor R, DeLong DM, Gantzer HE, Horwitch CA, Humphrey LL, Jokela JA, Li JMW, Lohr RH, López AM, McLean RM. Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2017; 167:794-804. [PMID: 29159414 DOI: 10.7326/m17-1106] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Vaccination, screening, and linkage to care can reduce the burden of chronic hepatitis B virus (HBV) infection. However, recommendations vary among organizations, and their implementation has been suboptimal. The American College of Physicians' High Value Care Task Force and the Centers for Disease Control and Prevention developed this article to present best practice statements for hepatitis B vaccination, screening, and linkage to care. METHODS A narrative literature review of clinical guidelines, systematic reviews, randomized trials, and intervention studies on hepatitis B vaccination, screening, and linkage to care published between January 2005 and June 2017 was conducted. BEST PRACTICE ADVICE 1 Clinicians should vaccinate against hepatitis B virus (HBV) in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection. BEST PRACTICE ADVICE 2 Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers. BEST PRACTICE ADVICE 3 Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for posttest counseling and hepatitis B-directed care.
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Affiliation(s)
- Winston E Abara
- From Centers for Disease Control and Prevention, Atlanta, Georgia; American College of Physicians, Philadelphia, Pennsylvania; and Alaska Native Tribal Health Consortium and Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Amir Qaseem
- From Centers for Disease Control and Prevention, Atlanta, Georgia; American College of Physicians, Philadelphia, Pennsylvania; and Alaska Native Tribal Health Consortium and Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Sarah Schillie
- From Centers for Disease Control and Prevention, Atlanta, Georgia; American College of Physicians, Philadelphia, Pennsylvania; and Alaska Native Tribal Health Consortium and Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Brian J McMahon
- From Centers for Disease Control and Prevention, Atlanta, Georgia; American College of Physicians, Philadelphia, Pennsylvania; and Alaska Native Tribal Health Consortium and Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Aaron M Harris
- From Centers for Disease Control and Prevention, Atlanta, Georgia; American College of Physicians, Philadelphia, Pennsylvania; and Alaska Native Tribal Health Consortium and Centers for Disease Control and Prevention, Anchorage, Alaska
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Al Hammadi A, Mitchell M, Abraham GM, Wang JP. Recrudescence of Plasmodium falciparum in a Primigravida After Nearly 3 Years of Latency. Am J Trop Med Hyg 2017; 96:642-644. [PMID: 28044045 PMCID: PMC5361538 DOI: 10.4269/ajtmh.16-0803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/21/2016] [Indexed: 01/25/2023] Open
Abstract
We present a case of a primigravid woman who presented with Plasmodium falciparum nearly 3 years after she last visited a malaria-endemic region. We review the literature to identify case reports of recrudescent P. falciparum malaria during pregnancy, including those with prolonged latency. Reports of recrudescence of P. falciparum during pregnancy are limited. Plasmodium falciparum infection can persist for years. Recrudescence can occur with waning of immunity following departure from endemic areas. Pregnancy, particularly the primigravid state, is a risk factor for severe infection.
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Affiliation(s)
- Ahmed Al Hammadi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michael Mitchell
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer P. Wang
- University of Massachusetts Medical School, Worcester, Massachusetts
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Abstract
Advancements in technology have led to the development of medical applications (apps). Contents of 44 apps related to travel medicine were assessed demonstrating that many were updated infrequently and several developers had no medical background. There is an opportunity for healthcare professionals to develop apps in travel medicine.
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Sterling RK, Kuo A, Rustgi VK, Sulkowski MS, Stewart TG, Fenkel JM, El-Genaidi H, Mah’moud MA, Abraham GM, Stewart PW, Akushevich L, Nelson DR, Fried MW, Di Bisceglie AM. Virological outcomes and treatment algorithms utilisation in observational study of patients with chronic hepatitis C treated with boceprevir or telaprevir. Aliment Pharmacol Ther 2015; 41:671-85. [PMID: 25627020 PMCID: PMC4529024 DOI: 10.1111/apt.13095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/25/2014] [Accepted: 01/10/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND HCV-TARGET is a longitudinal observational study of chronic hepatitis C virus (HCV) patients treated with direct-acting anti-viral agents (DAAs) in a US consortium of 90 academic and community medical centres. AIM To assess utilisation of response-guided therapy (RGT) and sustained virological response (SVR) of a large cohort of patients. METHODS Patients received peginterferon (PEG-IFN), ribavirin and either telaprevir or boceprevir. Demographical, clinical and virological data were collected during treatment and follow-up. RGT and treatment futility stopping rules was assessed at key time points. RESULTS Of 2084 patients, 38% had cirrhosis and 56% had received prior treatment for HCV. SVR rates were 31% (95% CI: 24-40) and 50% (95% CI: 44-56) in boceprevir patients with and without cirrhosis, respectively. SVR rates were 46% (95% CI: 42-50) and 60% (95% CI: 57-64) in telaprevir patients with and without cirrhosis, respectively. Early clearance of virus, IL28B genotype, platelet counts and diabetes were identified as predictors of SVR among boceprevir patients, while early clearance of virus, IL28B, cirrhosis, HCV subtype, age, haemoglobin, bilirubin and albumin levels were identified as predictors of SVR for telaprevir patients. CONCLUSIONS In academic and community centres, triple therapy including boceprevir or telaprevir led to SVR rates somewhat lower than those noted in large phase 3 clinical trials. Response rates were consistently higher among patients without cirrhosis compared to those with cirrhosis regardless of DAA used and prior treatment response. Trial registration clinicaltrials.gov NCT01474811.
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Affiliation(s)
| | | | - Vinod K Rustgi
- Metropolitan Liver Diseases/Gastroenterology Center, Fairfax, VA
| | | | | | | | | | | | | | | | | | - David R. Nelson
- University of Florida, Division of Gastroenterology, Hepatology and Nutrition, Gainesville, Florida
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Spooner LM, Abraham GM. Retreatment of a treatment-experienced patient with genotype 6 hepatitis C virus infection: Follow-up on a reported case. Am J Health Syst Pharm 2015; 72:14-6. [DOI: 10.2146/ajhp140662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Linda M. Spooner
- School of Pharmacy—Worcester/Manchester Massachusetts College of Pharmacy and Health Sciences Worcester, MA
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Gammal RS, Spooner LM, Abraham GM. Failed triple therapy in a treatment-experienced patient with genotype 6 hepatitis C infection. Am J Health Syst Pharm 2014; 71:204-8. [PMID: 24429013 DOI: 10.2146/ajhp130432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The first published report of the use of triple therapy in a patient with hepatitis C virus (HCV) genotype 6 infection-a treatment that was prescribed due to incorrect HCV genotyping and which ultimately failed-is presented. SUMMARY A 70-year-old male U.S. resident of Vietnamese descent requested treatment for chronic HCV infection acquired decades earlier. He reported experiencing hepatitis C treatment failures twice before-13 years prior (interferon alfa monotherapy for six months) and 7 years prior (standard dual therapy with pegylated interferon alfa-2b and ribavirin for nine months). Initial viral genotyping indicated infection with HCV genotypes 1a and 6c (a form of mixed HCV disease amenable to triple therapy), and treatment with pegylated interferon alfa-2a, ribavirin, and boceprevir was initiated. By week 8 of triple therapy, the patient's viral load had decreased from 15,700,000 (7.20 log) to 462,882 (5.67 log) IU/mL, but the viral load subsequently rebounded to baseline levels, and treatment was discontinued at week 16. When repeat HCV genotyping was performed, it was discovered that initial genotyping was incorrect and that the man's infection involved not mixed genotypes but only genotype 6; he was not an appropriate candidate for triple therapy. The case emphasizes the need for clinicians to be cognizant of potential HCV genotyping errors, particularly with regard to patients of Southeast Asian descent. CONCLUSION Three courses of interferon-based treatment, including triple therapy with boceprevir, failed to produce a sustained therapeutic response in a 70-year-old ethnic Vietnamese man with genotype 6 HCV infection.
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Affiliation(s)
- Roseann S Gammal
- Roseann S. Gammal, Pharm.D., is Postgraduate Year 1 Pharmacy Practice Resident, Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill. Linda M. Spooner, Pharm.D., BCPS, is Associate Professor of Pharmacy Practice, School of Pharmacy, MCPHS University, Worcester, MA. George M. Abraham, M.D., M.P.H., is Professor of Medicine, University of Massachusetts Medical School, Worcester, and Associate Chief of Medicine, Division of Infectious Disease and Geographic Medicine, Saint Vincent Hospital, Worcester
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Abstract
The existing standard of care for chronic hepatitis C virus (HCV) infection includes the use of pegylated interferon and ribavirin as primary components of treatment, with the addition of a direct-acting antiviral for genotype 1 infection. Sofosbuvir, an oral nucleotide inhibitor of the HCV nonstructural protein 5B RNA-dependent RNA polymerase enzyme, was recently approved for use in combination with ribavirin and/or pegylated interferon for chronic HCV infection, depending on the genotype. Sofosbuvir is orally administered, and peak plasma concentrations are not affected by food. The drug is renally eliminated and does not require adjustment in mild to moderate renal insufficiency or in any degree of hepatic impairment. Sofosbuvir is not metabolized by cytochrome P450 isoenzymes, nor does it induce or inhibit the metabolism of agents that are substrates of these enzymes. Sofosbuvir demonstrates a high barrier to resistance and was well tolerated by patients in clinical trials. Overall efficacy rates vary between 70% and 90%.
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Affiliation(s)
- George M Abraham
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts Medical School
| | - Linda M Spooner
- Department of Pharmacy Practice, School of Pharmacy-Worcester/Manchester, MCPHS University, Worcester, Massachusetts
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