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Khalid S, Albaba I, Neu K. Hypocalcemia: A Little Known Cause of Supraventricular Tachyarrhythmia. Cureus 2023; 15:e38456. [PMID: 37273362 PMCID: PMC10234768 DOI: 10.7759/cureus.38456] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/06/2023] Open
Abstract
Calcium is an essential electrolyte in impulse generation and contraction of cardiac muscle. Hypocalcemia can occur in cases of parathyroid hormone deficiency, primarily due to inadvertent removal of the parathyroid gland during thyroidectomy, however most cases are idiopathic. We present a case of an adult male who developed sustained narrow complex tachycardia due to hypocalcemia in the setting of untreated idiopathic hypoparathyroidism.
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Affiliation(s)
- Sualeha Khalid
- Internal Medicine, Stratton VA Medical Center, Albany, USA
| | - Isam Albaba
- Internal Medicine, Stratton VA Medical Center, Albany, USA
| | - Kristofer Neu
- Internal Medicine, Stratton VA Medical Center, Albany, USA
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Albaba I, Azher S, Mehta S, Faddoul G. A Case of a Novel MAGED2 Mutation Resulting in Non-transient Bartter's Syndrome in an Adult Female. Cureus 2023; 15:e38681. [PMID: 37288186 PMCID: PMC10243719 DOI: 10.7759/cureus.38681] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Bartter's syndrome (BS) is a disorder caused by a group of rare mutations that result in defective salt reabsorption in the thick ascending loop of Henle. BS is characterized by salt wasting, hypokalemia, and metabolic alkalosis, among other abnormalities. A MAGE-D2 mutation results in an X-linked form of BS. It results in a transient antenatal presentation that is observed to completely resolve by early infancy, usually occurring in males. We present a case of an adult female with intermittent recurrence of symptoms and metabolic derangements consistent with BS. She also has a family history of polyhydramnios and renal disease. Genetic testing later confirmed a novel MAGE-D2 mutation. Her atypical presentation emphasizes the heterogenous presentation of the different mutations and raises the possibility of persistence of abnormalities beyond infancy in mutations of the MAGE-D2 gene.
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Affiliation(s)
- Isam Albaba
- Internal Medicine, Albany Medical Center, New York, USA
| | - Sharmeen Azher
- Internal Medicine, Baystate Medical Center, Springfield, USA
| | - Swati Mehta
- Nephrology, Internal Medicine, Albany Medical Center, New York, USA
| | - Geovani Faddoul
- Nephrology, Internal Medicine, Albany Medical Center, New York, USA
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Oweis J, Leamon A, Al-Tarbsheh AH, Goodspeed K, Khorolsky C, Feustel P, Naseer U, Albaba I, Parimi SA, Shkolnik B, Tiwari A, Chopra A, Torosoff M. Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients. Heart Lung 2023; 57:19-24. [PMID: 35987113 PMCID: PMC9365873 DOI: 10.1016/j.hrtlng.2022.08.007] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The impact of the right ventricular (RV) structure and function on the in-hospital outcomes in patients with COVID-19 infection has not been rigorously investigated. OBJECTIVES The main aim of our study was to investigate in-hospital outcomes including mortality, ICU admission, mechanical ventilation, pressor support, associated with RV dilatation, and RV systolic dysfunction in COVID-19 patients without a history of pulmonary hypertension. METHODS It was a single academic tertiary center, retrospective cohort study of 997 PCR-confirmed COVID-19 patients. One hundred ninty-four of those patients did not have a history of pulmonary hypertension and underwent transthoracic echocardiography at the request of the treating physicians for clinical indications. Clinical endpoints which included mortality, ICU admission, need for mechanical ventilation or pressor support were abstracted from the electronic charts. RESULTS Patients' mean age was 68+/-16 years old and 42% of the study population were females. COPD was reported in 13% of the study population, whereas asthma was 10%, and CAD was 25%. The mean BMI was 29.8+/-9.5 kg/m2. Overall mortality was 27%, 46% in ICU patients, and 9% in the rest of the cohort. There were no significant differences in co-morbidities between expired patients and the survivors. A total of 19% of patients had evidence of RV dilatation and 17% manifested decreased RV systolic function. RV dilatation or decreased RV systolic function were noted in 24% of the total study population. RV dilatation was significantly more common in expired patients (15% vs 29%, p = 0.026) and was associated with increased mortality in patients treated in the ICU (HR 2.966, 95%CI 1.067-8.243, p = 0.037), who did not need require positive pressure ventilation, IV pressor support or acute hemodialysis. CONCLUSIONS In hospitalized COVID-19 patients without a history of pulmonary hypertension, RV dilatation is associated with a 2-fold increase in inpatient mortality and a 3-fold increase in ICU mortality.
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Affiliation(s)
- Jozef Oweis
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America.
| | - Annie Leamon
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Ali H Al-Tarbsheh
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Katharine Goodspeed
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Ciril Khorolsky
- Department of Cardiology, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Usman Naseer
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Isam Albaba
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Sai Anoosh Parimi
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Anupama Tiwari
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Mikhail Torosoff
- Department of Cardiology, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
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Khatim I, Albaba I, Hu K, Huggins T, Chopra A. Diagnosis of non-expandable lung using thoracic ultrasound. Respir Med Case Rep 2022; 40:101749. [PMID: 36211531 PMCID: PMC9535404 DOI: 10.1016/j.rmcr.2022.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Non-expandable lung (NEL) commonly occurs secondary to chronic pleural processes, including pleural effusions, endobronchial obstruction, atelectasis, or chronic pleural inflammatory processes. Patients with NEL frequently undergo unnecessary procedures (e.g., thoracentesis), resulting in pneumothorax and discomfort (usually chest pain). Identifying a chronic process and likely development of NEL may prevent this. Diagnostic modalities currently used in practice include pleural manometry and ultrasonography. This case report demonstrates that blunting of transmitted cardiac impulse on M-Mode of ultrasonography predicts the presence of NEL.
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Affiliation(s)
- Ibrahim Khatim
- Department of Medicine, Albany Medical Center, Albany, NY, USA
- Corresponding author. PGY-2, Internal Medicine Internal Medicine Department, Albany Medical College, Mail Code 17 47 New Scotland Avenue, Albany, NY, 12208-3479, USA.
| | - Isam Albaba
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Kurt Hu
- Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Terrill Huggins
- Division of Pulmonary and Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
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Abstract
PURPOSE We retrospectively analyzed the frequency and clinical characteristics of organs rarely involved with sarcoidosis in a cohort of 1158 sarcoidosis patients cared for over nearly 11 years in a university outpatient sarcoidosis clinic. METHODS Data were analyzed from an institution-approved sarcoidosis clinical database containing demographic and clinical characteristics of sarcoidosis outpatients cared for between May 2011 and March 2021 at a university medical center sarcoidosis clinic. The diagnosis of sarcoidosis was established by standard international criteria. Rare organ involvement was defined as an organ not individually listed in the Word Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Organ Assessment Instrument. RESULTS Twenty-six of the 1158 patients (2.2%) had 27 instances of rare organ involvement. The most common rare organ involved was the GI tract, followed by the testicle and then the female reproductive tract. Only 1 of the 26 patients with rare sarcoidosis organ involvement required therapy for that organ involvement. In comparison with sarcoidosis patients without rare organ involvement, patients with rare organ involvement were more likely to be black, have more total organs involved with sarcoidosis, and more likely require anti-sarcoidosis therapy at some point during the course of their disease. There were no differences between these groups in terms of sex, age at diagnosis, and most recent percent predicted forced vital capacity. CONCLUSIONS Rare sarcoidosis organ involvement occurred in 2.2 percent of this cohort. Although rare organ involvement rarely required treatment, it was associated with more extensive disease that was more likely to require therapy.
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Affiliation(s)
- Isam Albaba
- Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - M Fish Kenneth
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
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Albaba I, Medarov BI. A case of severe cancer-related pulmonary hypertension; An unexpected resolution. Respir Med Case Rep 2022; 38:101671. [PMID: 35663111 PMCID: PMC9157252 DOI: 10.1016/j.rmcr.2022.101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Pulmonary hypertension (PH) in cancer patients can be caused by several mechanisms. It can be a direct cancer effect through pulmonary tumor thrombotic microangiopathy, pulmonary tumor emboli, extrinsic compression, intravascular tumors, or a secondary consequence of therapy, including chemotherapy agents, radiation, and stem cell transplantation. We present the first case of complete resolution of cancer-related PH.
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Albaba I, Chopra A, Al-Tarbsheh AH, Feustel PJ, Mustafa M, Oweis J, Parimi SA, Santelises Robledo FM, Mehta S. Incidence, Risk Factors, and Outcomes of Rhabdomyolysis in Hospitalized Patients With COVID-19 Infection. Cureus 2021; 13:e19802. [PMID: 34956789 PMCID: PMC8693832 DOI: 10.7759/cureus.19802] [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] [Accepted: 11/21/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION There is a paucity of studies examining the prevalence and clinical characteristics of rhabdomyolysis in hospitalized patients with COVID-19 infection. The purpose of this study is to examine the incidence, clinical characteristics, and outcome of hospitalized patients with COVID-19 infection who develop rhabdomyolysis. METHODOLOGY This is a single-center retrospective analysis of all hospitalized patients with COVID-19 admitted between March 8, 2020, and January 11, 2021. All patients with creatinine kinase (CK) levels available during the hospital admission were included. Rhabdomyolysis was defined as an elevation in CK level higher than five times the upper limit of normal (i.e., 1125 U/L). We compared clinical characteristics and outcomes of patients who developed rhabdomyolysis with patients who did not develop rhabdomyolysis. RESULTS The incidence of rhabdomyolysis in hospitalized patients with COVID-19 infection was 9.2%. There was no significant difference noted in comorbidities and clinical characteristics between the two groups. Moreover, there was no significant difference noted in the presence of severe COVID-19 infection (72.7% vs 54.6%, p = 0.1), mortality (27.3% vs 23.9%, p = 0.72), acute kidney injury (59.1% vs 42.7%, p = 0.14), or need for intensive care unit (ICU) care (72.7% vs 51.4%, p = 0.051). However, a higher percentage of patients in the rhabdomyolysis group required physical rehabilitation after discharge (40.9% vs 19.3%, p = 0.02). CONCLUSION The overall incidence of rhabdomyolysis in hospitalized patients with COVID-19 infection was high (9.2%). The presence of rhabdomyolysis was not associated with the increased severity of the disease. Patients with rhabdomyolysis more frequently required physical rehabilitation compared to those without rhabdomyolysis.
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Affiliation(s)
- Isam Albaba
- Internal Medicine, Albany Medical Center, Albany, USA
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, USA
| | | | - Paul J Feustel
- Department of Research, Albany Medical Center, Albany, USA
| | | | - Jozef Oweis
- Internal Medicine, Albany Medical Center, Albany, USA
| | | | | | - Swati Mehta
- Nephrology and Internal Medicine, Albany Medical Center, Albany, USA
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