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Dawadi S, Oli PR, Shrestha DB, Shtembari J, Pant K, Shrestha B, Mattumpuram J, Katz DH. Transcarotid versus trans-axillary/subclavian transcatheter aortic valve replacement (TAVR): A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102488. [PMID: 38417474 DOI: 10.1016/j.cpcardiol.2024.102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral access is difficult or impossible to obtain. METHODS This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023482842). This meta-analysis was performed to compare the safety of the transcarotid and trans-axillary/subclavian approach for TAVR including studies from inception to October 2023. RESULTS Seven studies with a total of 6227 patients were included in the analysis (TCa: 2566; TAx/Sc: 3661). Transcarotid TAVR approach had a favorable trend for composite of stroke and all-cause mortality (OR 0.79, CI 0.60-1.04), all-cause mortality, stroke, major vascular complication, and new requirement of permanent pacemaker though those were statistically insignificant. On sub-analysis of the results of the studies based on the territory (USA vs French), composite outcome of all cause mortality, stroke and major bleeding (OR 0.54, CI 0.54-0.81), composite of stroke and all cause mortality (OR 0.64, CI 0.50-0.81), and stroke/TIA (OR 0.53, CI 0.39-0.73) showed lower odds of occurrence among patient managed with TCa approach in the American cohort. CONCLUSION Overall, transcarotid approach had favorable though statistically insignificant odds for composite (stroke and all-cause mortality) and individual outcomes (stroke, all-cause mortality, etc.). There are significant variations in observed outcomes based on study's geographic location. Large prospective randomized clinical trials comparing the two approaches with representative samples are necessary to guide the clinicians in choosing among these approaches.
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Affiliation(s)
- Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Karnali Province 21700, Nepal
| | | | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Kailash Pant
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Illinois College of Medicine, OSF Healthcare, Peoria, IL 61614, USA
| | - Bishesh Shrestha
- Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, 1 Atwell Rd, Cooperstown, NY 13326, USA
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Internal Medicine, University of Louisville School of Medicine, 550 S Jackson St, Louisville, KY 40202, USA.
| | - Daniel H Katz
- Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, 1 Atwell Rd, Cooperstown, NY 13326, USA
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Adelkhanova A, Oli PR, Shrestha DB, Shtembari J, Jha V, Shantha G, Bodziock GM, Biswas M, Zaman MO, Patel NK. Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e2044. [PMID: 38650729 PMCID: PMC11033493 DOI: 10.1002/hsr2.2044] [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] [Received: 09/13/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aim Obesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well-established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta-analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF. Methods The PRISMA guidelines were followed for this meta-analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full-text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure. Results Two thousand two hundred fifty-nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66-0.75) and (OR 0.47, CI 0.35-0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54-0.83), major bleeding (OR 0.62, CI 0.54-0.72), and composite outcome (OR 0.72, CI 0.63-0.81). Conclusion Based on the findings from this meta-analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population.
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Affiliation(s)
- Alla Adelkhanova
- Department of Internal MedicineMount Sinai HospitalChicagoIllinoisUSA
| | - Prakash Raj Oli
- Department of Internal MedicineProvince HospitalBirendranagarNepal
| | | | - Jurgen Shtembari
- Department of Internal MedicineMount Sinai HospitalChicagoIllinoisUSA
| | - Vivek Jha
- Department of Internal MedicineJohn H. Stroger, Jr. Hospital of Cook CountyChicagoIllinoisUSA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of Cardiac ElectrophysiologyWake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | - George Michael Bodziock
- Department of Internal Medicine, Division of Cardiac ElectrophysiologyWake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | - Monodeep Biswas
- Department of Internal Medicine, Division of Cardiac ElectrophysiologyUniversity of Maryland Medical CenterBaltimoreMarylandUSA
| | - Muhammad Omer Zaman
- Department of Internal Medicine, Division of CardiologyRudd Heart HospitalLouisvilleKentuckyUSA
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Oli PR, Shrestha DB, Dawadi S, Shtembari J, Regmi L, Pant K, Shrestha B, Mattumpuram J, Katz DH. Immediate vs. multistage revascularization of non-infarct coronary artery(-ies) in patients with hemodynamically stable multivessel disease acute myocardial infarction: a systematic review and meta-analysis. Coron Artery Dis 2024:00019501-990000000-00208. [PMID: 38451559 DOI: 10.1097/mca.0000000000001353] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year . Current guidelines recommend percutaneous coronary intervention (PCI) for significant non-infarct artery (-ies) (non-IRA) stenosis in hemodynamically stable AMI patients with MVD, either during or after successful primary PCI, within 45-days. However, deciding the timing of revascularization for non-IRA in cases of MVD is uncertain. METHODS This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023472652). Databases were searched for relevant articles published before 10 November 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. RESULTS Out of 640 studies evaluated, there were 13 RCTs with 5144 patients with AMI with MVD. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44-0.83) and target-vessel revascularization (OR 0.72; CI 0.53-0.97) . Although there is a favorable trend for major adverse cardiovascular and cerebrovascular events (MACCE), nonfatal AMI, cerebrovascular events, and major bleeding in the immediate non-culprit artery (-ies) PCI, those were statistically non-significant. Similarly, all-cause mortality, cardiovascular mortality, stent thrombosis, and acute renal insufficiency did not show significant differences between two groups. CONCLUSION Among hemodynamically stable patients with multivessel AMI, the immediate PCI strategy was superior to the multistage PCI strategy for the unplanned ischemia-driven PCI and target-vessel revascularization while odds are favorable in terms of MACCE, nonfatal AMI, cerebrovascular events, and major bleeding at longest follow-up.
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Affiliation(s)
- Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Karnali province, Nepal
| | | | - Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Laxmi Regmi
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Karnali province, Nepal
| | - Kailash Pant
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Illinois College of Medicine, OSF Healthcare, Peoria, Illinois
| | - Bishesh Shrestha
- Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel H Katz
- Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY
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Udemgba C, Bravo-Jaimes K, Mejia MO, Oli PR, Shrestha DB, Dawadi S, Kadariya D, Velarde G. Differences in clinical presentation and outcomes in pregnancy-associated Takotsubo Syndrome- A scoping review of the literature: Outcomes in pregnancy-associated Takotsubo. Curr Probl Cardiol 2024; 49:102175. [PMID: 37913927 DOI: 10.1016/j.cpcardiol.2023.102175] [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] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TS) during pregnancy and postpartum is rare but may lead to significant maternal and fetal morbidity. We compared clinical characteristics and prognosis according to [a] timing of presentation (pregnancy vs post-partum) and [b] modes of delivery (cesarean section vs vaginal delivery). METHODS Systematic review of articles published in PubMed, Scopus, Embase, and Medline databases from inception to July 30, 2023. Patient demographics, obstetric, electrocardiographic, laboratory, echocardiographic characteristics, and prognosis were summarized descriptively. RESULTS An initial database search identified 2162 articles, of which 81 studies were included in this review. TS during pregnancy can have emotional, obstetric, and metabolic triggers and has a higher proportion of adverse fetal outcomes when compared with women who developed TS postpartum. Women with TS after cesarean section had an earlier onset and higher proportion of anesthesia use when compared with those who developed TS after vaginal delivery. There were no differences regarding the degree of systolic dysfunction or the need for advanced therapies, including ventilator support, intra-aortic balloon pump, and extracorporeal membrane oxygenation among groups. CONCLUSIONS TS is associated with various triggers and adverse fetal outcomes when it develops during pregnancy than in the postpartum period. TS occurs more rapidly and with a more aggressive course after cesarean section than after vaginal delivery.
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Affiliation(s)
- Chinelo Udemgba
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | | | - Miluska O Mejia
- Division of Cardiology, Rochester General Hospital, Rochester, NY
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Nepal
| | | | - Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Dinesh Kadariya
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | - Gladys Velarde
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL.
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Shrestha DB, Sedhai YR, Oli PR, Proskuriakova E, Adelkhanova A, Shtembari J, Khan TMA, Singh K, Ahmed MA, Waheed I, Kazimuddin N, Steff R, Acharya R, Patel NK. Prior Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers and Clinical Outcomes of Sepsis and Septic Shock: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2024; 83:16-22. [PMID: 37815234 DOI: 10.1097/fjc.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
ABSTRACT Sepsis and septic shock are life-threatening conditions that are associated with high mortality and considerable health care costs. The association between prior angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) use and outcomes after sepsis is elusive. The aim of this study was to evaluate the role of the prior use of ACEi or ARBs and outcomes after sepsis and septic shock. A relevant literature review was performed in 4 databases from inception until July 2022. Independent reviewers first screened the title, abstract, and full text, and then, data extraction and analysis were performed. One post hoc analysis of a trial and 6 retrospective cohort studies were included in this review. There were 22% lower odds of in-hospital/30-day mortality among patients who have used ACEi/ARBs in the past [23.83% vs. 37.20%; odds ratio (OR), 0.78, 95% confidence interval (CI), 0.64-0.96], and reduced 90-day mortality (OR, 0.80, 95% CI, 0.69-0.92). ACEi/ARBs users were found to have 31% lesser odds of developing acute kidney injury as compared with nonusers (OR, 0.69, 95% CI, 0.63-0.76). There was no significant difference in the length of hospital stay (MD 1.26, 95% CI, ‒7.89 to 10.42), need for renal replacement therapy (OR, 0.71, 95% CI, 0.13-3.92), mechanical ventilation (OR, 1.10, 95% CI, 0.88-1.37) or use of vasopressors (OR, 1.21, 95% CI, 0.91-1.61). Based on this analysis, prior use of ACEi/ARBs lowers the risk of mortality and adverse renal events in patients with sepsis and septic shock.
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Affiliation(s)
| | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Nepal
| | | | - Alla Adelkhanova
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL
| | - Tahir Muhammad Abdullah Khan
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Karan Singh
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Muhammad Altaf Ahmed
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Irfan Waheed
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Nisarfathima Kazimuddin
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Rodney Steff
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Roshan Acharya
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, School of Medicine, Richmond, VA
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Oli PR, Shrestha DB, Shtembari J, Gyawali P, Regmi L, Bhandari A, Dhungel S, Mattumpuram J, Pant K, Mungee S. Bivalirudin versus heparin in STEMI after BRIGHT-4 trial: an updated meta-analysis. Coron Artery Dis 2023; 34:562-579. [PMID: 37865864 DOI: 10.1097/mca.0000000000001289] [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: 10/23/2023]
Abstract
BACKGROUND The use of bivalirudin-based anticoagulation over heparin-based anticoagulation for coronary percutaneous intervention has been debated for a long time. Multiple trials have shown promising benefits of bivalirudin over heparin therapy with the most recent addition being the BRIGHT-4 trial. We performed a meta-analysis to assess evidence from these trials, focusing on the coronary intervention of the STEMI population. METHODS This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023394701). Databases were searched for relevant articles published before January 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. RESULTS Out of 2375 studies evaluated, 13 randomized control trials with 24 360 acute ST-elevation myocardial infarction patients were included for analysis. The bivalirudin-based anticoagulation reduced the net clinical events (OR 0.75, CI 0.61-0.92), major adverse cardiac or cerebral events (OR 0.85, CI 0.74-0.98), any bleeding (OR 0.61, CI 0.45-0.83), major bleeding (OR 0.54, CI 0.39-0.75), all-cause mortality (OR 0.79, CI 0.67-0.92) and cardiac mortality (OR 0.78, CI 0.65-0.93) significantly without increasing the risk of any stent thrombosis (OR 0.92, 95% CI 0.52-1.61), definite stent thrombosis (OR 1.17, 95% CI 0.62-2.22) and acute stent thrombosis (OR 2.06, 95% CI 0.69-6.09) significantly at 30 days. CONCLUSION Based on this meta-analysis, bivalirudin plus a post-PCI high-dose infusion-based anticoagulation during STEMI PCI has significant benefits over heparin therapy for cardiovascular outcomes without a significant increase in the risk of thrombotic outcomes.
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Affiliation(s)
- Prakash Raj Oli
- Department of Internal Medicine, Karnali Province Hospital, Birendranagar, Nepal
| | | | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Pratik Gyawali
- Department of Internal Medicine, Om Saibaba Memorial Hospital, Kathmandu
| | - Laxmi Regmi
- Department of Internal Medicine, Karnali Province Hospital, Birendranagar
| | - Amit Bhandari
- Department of Internal Medicine, Sait Johns Hospital, HSHS Medical Group, Springfield
| | - Swati Dhungel
- Department of Internal Medicine, Division of Cardiovascular Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kailash Pant
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Illinois College of Medicine, OSF Healthcare, Peoria, Illinois, USA
| | - Sudhir Mungee
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Illinois College of Medicine, OSF Healthcare, Peoria, Illinois, USA
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Goit R, Oli PR, Le Q, Bhandari A. Paradoxical Vocal Fold Dysfunction Mimicking Bronchial Asthma in a Young Female Patient. Cureus 2023; 15:e41376. [PMID: 37546109 PMCID: PMC10400364 DOI: 10.7759/cureus.41376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Inducible laryngeal obstruction (ILO)/paradoxical vocal fold motion (PVFM) is a reversible narrowing of the larynx that results from vocal fold motion dysfunction. Distinguishing ILO from asthma can be challenging, as they can coexist, and standard tests may not be able to differentiate between the two. However, a flexible laryngoscopy can promptly diagnose ILO. Unfortunately, ILO is often overlooked as a potential cause when evaluating patients with sudden-onset breathing difficulties and respiratory distress. We present a case of a young female who sought frequent treatment at the emergency room (ER) with symptoms of shortness of breath (SOB), rapid heart rate, rapid breathing, and anxiety. Despite receiving treatment for acute asthma attacks, her symptoms persisted. During her most recent hospital admission, a flexible laryngoscopy revealed abnormal vocal fold movements, indicating paradoxical vocal fold dysfunction (PVFD) and muscle tension dysphonia (MTD). A comprehensive treatment approach involving speech therapy, pulmonology, and psychiatry led to significant clinical improvement. This case report highlights the importance of raising awareness among healthcare providers about ILO potentially mimicking bronchial asthma exacerbation.
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Affiliation(s)
- Raman Goit
- Internal Medicine, Kathmandu Medical College, Kathmandu, NPL
| | | | - Quang Le
- Hospital Medicine, University of Missouri School of Medicine, Columbia, USA
| | - Amit Bhandari
- Internal Medicine, St John's Hospital, Springfield, USA
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Shrestha DB, Shtembari J, Shehata K, Gondi H, Munagala A, Villegas Santamaria E, Oli PR, Kovacs D, Khosla S. Spontaneous Coronary Artery Dissection in Young Patients: A Case Series and Review of Current Management Algorithm. Cureus 2023; 15:e39393. [PMID: 37378181 PMCID: PMC10292098 DOI: 10.7759/cureus.39393] [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] [Received: 02/26/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized non-atherosclerotic cause of acute coronary syndrome. Common risk factors for SCAD are coronary atherosclerosis, female gender, peripartum period, systemic inflammatory conditions, and connective tissue disorders. It manifests as myocardial ischemia and infarction, arrhythmia, and sudden cardiac death. We present a case series of two young men and one young female with SCAD who had chest pain and were diagnosed with SCAD-associated ST-elevation myocardial infarction. Its diagnosis requires a high degree of clinical suspicion and its management is guided by the patient's clinical condition and the characteristics of the lesions.
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Affiliation(s)
- Dhan B Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Kerolus Shehata
- Department of Cardiology, Mount Sinai Hospital, Chicago, USA
| | - Harsha Gondi
- Department of Cardiology, Mount Sinai Hospital, Chicago, USA
| | - Anish Munagala
- Department of Cardiology, Mount Sinai Hospital, Chicago, USA
| | | | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Surkhet, NPL
| | - Daniela Kovacs
- Department of Cardiology, Mount Sinai Hospital, Chicago, USA
| | - Sandeep Khosla
- Department of Cardiology, Mount Sinai Hospital, Chicago, USA
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Prasai P, Shrestha D, Saad E, Trongtorsak A, Adhikari A, Gaire S, Adhikari P, Devkota A, Oli PR, Shtembari J, Sedhai YR, Akbar MS. ELECTRIC CARDIOVERSION VS PHARMACOLOGICAL THEN ELECTRIC CARDIOVERSION FOR NEW ONSET ATRIAL FIBRILLATION: A META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Prasai P, Shrestha DB, Saad E, Trongtorsak A, Adhikari A, Gaire S, Oli PR, Shtembari J, Adhikari P, Sedhai YR, Akbar MS, Elgendy IY, Shantha G. Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12031165. [PMID: 36769812 PMCID: PMC9918032 DOI: 10.3390/jcm12031165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED). METHODS A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events. RESULTS A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35-3.71; n = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04-0.27: n = 727). CONCLUSION This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.
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Affiliation(s)
- Paritosh Prasai
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
- Correspondence: (P.P.); (D.B.S.)
| | - Dhan Bahadur Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
- Correspondence: (P.P.); (D.B.S.)
| | - Eltaib Saad
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Aarya Adhikari
- Department of Internal Medicine, Chitwan Medical College, Chitwan 44200, Nepal
| | - Suman Gaire
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar 21700, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Pabitra Adhikari
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY 42101, USA
| | - Muhammad Sikander Akbar
- Department of Internal Medicine, Division of Cardiology, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Islam Y. Elgendy
- Division of Cardiology, University of Kentucky, Lexington, KY 40506, USA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Bhusal L, Deep Pathak B, Dhakal B, Simkhada N, Sharma N, Upadhaya Remi B, Adhikari S, Oli PR, Neupane S, Limbu B, Shrestha DB. Determination of level of self‐reported adherence of antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center. J Clin Hypertens (Greenwich) 2022; 24:1444-1450. [DOI: 10.1111/jch.14592] [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] [Received: 08/01/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Bishal Dhakal
- Nepalese Army Institute of Health and Sciences Nepal
| | | | - Neeraj Sharma
- Nepalese Army Institute of Health and Sciences Nepal
| | | | | | - Prakash Raj Oli
- Karnali Care International Hospital and Research Center Pvt. Ltd. Surkhet Nepal
| | | | - Binod Limbu
- Nepalese Army Institute of Health and Sciences Nepal
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Pangeni RP, Timilsina B, Oli PR, Khadka S, Regmi PR. A multidisciplinary approach to accidental inhalational ammonia injury: A case report. Ann Med Surg (Lond) 2022; 82:104741. [PMID: 36268428 PMCID: PMC9577859 DOI: 10.1016/j.amsu.2022.104741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Ammonia is a highly toxic irritant gas, and its toxicity usually occurs from occupational exposure. Most are unintentional toxicity. It causes tissue damage via exothermic reaction with body tissues causing liquefactive necrosis. Presentation depends on the level and duration of exposure. Management is supportive and its antidote is not available yet. Presentation of case We report a case of a 22-year-old male with accidental workplace exposure from coolant damage and leakage. He had altered mental status with visible injury to the nasal cavity, and ulcerated laryngeal mucosa with asymmetric vocal cords on bronchoscopy. Computed tomography showed right lower lobe consolidations. A muti-disciplinary approach and prompt management with respiratory support along with inhaled steroids and bronchodilators, antibiotics, electrolyte replacement, analgesics, and supportive eye and oral treatments were initiated. He had to be managed with a high-flow nasal cannula with subsequent tapering of the oxygen supplementation with titration. Discussion Inhalation injury due to ammonia toxicity can have varied presentations from mild to severe life-threatening respiratory distress and neurological deterioration. Complications can range from upper airway edema to pulmonary edema. Most of these are usual findings except for the presence of pneumothorax. It could be due to the pre-existing lung status or oxygen therapy but the literature is inadequate. Conclusion Ammonia inhalational injury may be associated with pneumothorax. It is important to have a multi-disciplinary approach and in-hospital management of ammonia toxicity as well as to raise awareness regarding the work environment and timely recognition of the possible occupational health hazards. Pneumothorax in a case of inhalation ammonia injury. Early recognition and a multispecialty approach are vital for the outcome of the toxicity. Awareness of occupational safety measures in the workplace can help minimize the associated health hazards.
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Regmi DR, Dangal G, Silwal A, Shrestha DB, Oli PR, Budhathoki P. Repeat Cesarean Section among Pregnant Women in a Tertiary Center of Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:6-11. [PMID: 35199680 PMCID: PMC9157665 DOI: 10.31729/jnma.6597] [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] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/17/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction: Cesarean Section is the most common obstetrics surgery done for both maternal and fetal indications. There is a rising trend of cesarean section rates which is associated with increased maternal morbidities. This study aims to find out the prevalence of repeat Cesarean Section among women with previous cesarean sections done in a tertiary centre.
Methods: This was a descriptive cross-sectional study conducted in a tertiary care hospital of Nepal from August 2020 to January 2021. Pregnant women with previous Cesarean Section status without other pelvic surgery and medical comorbidities were included and data were collected regarding intraoperative findings. Ethical approval was taken from the Institutional Review Committee (Reference Number: 14). A convenience sampling technique was used. Data were analysed using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage.
Results: Out of 1315 patients undergoing Cesarean Section, the prevalence of Repeat Cesarean Section was found to be 184 (13.99%) (12.11-15.86 at 95% Confidence Interval).
Conclusions: The prevalence of Repeat Cesarean Cection from our study was similar to other studies done in similar settings. Repeat Cesarean Cection confers peri-operative morbidities which adversely affect postoperative recovery. Repeat Cesarean Cection continues to contribute to morbidity over subsequent pregnancies and serious maternal morbidity.
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Affiliation(s)
- Dharma Raj Regmi
- Department of Obstetrics and Gynecology, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal
- Correspondence: Dr. Dharma Raj Regmi, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal. , Phone: +977-9842173483
| | - Ganesh Dangal
- Department of Obstetrics and Gynecology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Ashmita Silwal
- Bir Hospital Nursing Campus, National Academy of Medical Sciences, Kathmandu, Nepal
| | | | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Surkhet, Nepal
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr. Iwamura Memorial Hospital, Bhaktapur, Nepal
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14
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Katuwal N, Shrestha DB, Adhikari SP, Oli PR, Budhathoki P, Amatya R, Pradhan M, Adhikari B. Study on prevalence of suicidal ideation and risk factors of suicide among patients visiting psychiatric OPD at Shree Birendra Hospital, Kathmandu Nepal. PLoS One 2021; 16:e0254728. [PMID: 34283849 PMCID: PMC8291667 DOI: 10.1371/journal.pone.0254728] [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] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Suicide is a global public health issue. Several environmental, psychosocial, behavioral factors along with physical, sexual, and emotional abuse have been associated with suicidal ideation and attempts. Childhood physical, sexual abuse, and health risk behaviors are also associated with suicidal attempts. The suicidal ideation prevalence varied from 1 to 20% and it varied with study population, geography, age group, gender, and other factors. The Beck suicidal ideation scale is an effective tool for assessing the major suicidal ideation with a six cut-off score. MATERIALS AND METHOD 160 patients who met the inclusion criteria were enrolled into this cross-sectional study after random sampling among the patients visiting the Psychiatric OPD of Shree Birendra Hospital, Kathmandu, Nepal. The Semi-Structured Interview Schedule (SSIS), Beck Scale for Suicide Ideation (BSS), and Kuppuswamy's Scale were used to collect the data from the patients enrolled in the study. The Chi-square test and binary logistic regression analyses were used to identify and differentiate the factors associated with high suicidal risk. RESULTS Out of total 160 patients, 65% (n = 104) were female, 92.5% (n = 148) were married, 61.9% (n = 99) were residing in urban area, 93.1% (n = 148) were Hindus, 74.4% (n = 119) patients were living in the nuclear family, 5% (n = 8) patients had family history of psychiatric illness and 10.6% (n = 17) patients were using the substance of abuse. In the Beck scale for suicidal ideation questionnaire, 87.5% (n = 140) patients had moderate to strong wish to live, 89.4% (n = 143) patients responded as they would take precautions to save a life, 88.8% (n = 142) patients had such ideation/wish for brief, 96.3% (n = 154) had not considered for specificity/planning of contemplated suicidal attempt, 91.9% (n = 147) patients stated that they would not attempt active suicide because of a deterrent example from family, religion, irreversibility of the act and 98.1% (n = 157) patients had revealed ideas of deception/concealment of contemplated suicide openly. 16.9% (n = 27) of participants were categorized as high risk for suicide while 83.1% (n = 133) patients were as a low-risk category for suicide based on the Beck scale for suicidal ideation scoring. CONCLUSION In conclusion, this study found that most of the suicidal attempts were done as an act of impulse and it is higher among female and married individuals residing in the urban areas. This study did not establish any statistically significant association or differences among independent variables with the higher risk scoring in the Beck suicidal ideation scale.
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Affiliation(s)
- Nagendra Katuwal
- Department of Neuropsychiatry, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | | | - Suman Prasad Adhikari
- Department of Neuropsychiatry, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Prakash Raj Oli
- Department of Internal Medicine, Province hospital, Surkhet, Nepal
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr. Iwamura Memorial Hospital, Bhaktapur, Nepal
| | - Richa Amatya
- Department of Neuropsychiatry, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Monalisha Pradhan
- Department of Neuropsychiatry, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Bibhuti Adhikari
- Department of Internal Medicine, Amda Hospital, Damak, Jhapa, Nepal
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Shrestha DB, Khatri R, Oli PR, Malla R, Shrestha C, Khatiwada R, Silwal P, Shah PB. Cesarean Section in a Maternity Unit of a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:322-326. [PMID: 34508541 PMCID: PMC8369590 DOI: 10.31729/jnma.5150] [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: 06/29/2020] [Accepted: 05/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Cesarean section is a common obstetric procedure which is done to reduce complications in high risk pregnancies. The aim of study was to find out the prevalence of cesarean section in a maternity unit of a tertiary care center. Methods: A descriptive cross-sectional study was conducted among 497 pregnant women presenting in a maternity unit of a tertiary center of Kathmandu, Nepal over a period of six months from March to August 2017 after taking ethical approval from Institutional Review Committee (Ref. 24). In this study, the prevalence of cesarean section, perinatal outcome, maternal and neonatal complications if any were observed. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: The prevalence of cesarean section was 171 (34.4%) at 95% Confidence interval (30.2-38.7). Most common indication for cesarean section was fetal distress 53 (31%). The maternal complications developed in 11 (6.4%) among those who delivered via cesarean delivery; Surgical Site Infection being the most common maternal complication. The neonatal intensive care unit admission rate among the newborns via cesarean section delivery was 48 (27.43%) and neonatal sepsis 14 (8%) was most common adverse neonatal outcome. Conclusions: The cesarean rate at the study center is higher than standard target rate of World Health Organization. Neonatal and maternal adverse outcome in current study were comparable with existing literatures.
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Affiliation(s)
- Dhan Bahadur Shrestha
- Department of Gynaecology and Obstetrics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Ratna Khatri
- Department of Gynaecology and Obstetrics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | | | - Rosy Malla
- Department of Gynaecology and Obstetrics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Cimona Shrestha
- Department of Gynaecology and Obstetrics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Roshan Khatiwada
- Department of Gynaecology and Obstetrics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Pratik Silwal
- Department of Gynaecology and Obstetrics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Prajwol Bikram Shah
- Department of Internal Medicine, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal
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Oli PR, Malla RV, Karmacharya K. A Case of Peritoneal-Pelvic Tuberculosis With Elevated CA-125; An Enigma as Ovarian Cancer. Med J Shree Birendra Hosp 2019. [DOI: 10.3126/mjsbh.v18i2.22390] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Peritoneal-pelvic tuberculosis is a rare form of extrapulmonary-TB mainly affecting women of 20-40 years, especially in TB endemic countries. It classically presents with abdominal pain, menstrual irregularities, adnexal mass, and elevated serum CA-125 level, creating confusion with genital malignancy, especially ovarian one leading to difficulty in its management and often leads to devastating surgeries. Here's a case of peritoneal-pelvic TB, a young lady with abdominal pain, radiologic associates and adnexal mass, and elevated serum CA-125 level is presented. So, it should always be one of the differential diagnosis of ovarian cancer especially among young women in TB endemic countries.
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