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Hennawi HA, Ashraf MT, Zohaib M, Khan MK, Khan IA, Muhammadzai HZU, Siddiqi A, Roomi S. Polypill Therapy in Cardiovascular Disease: A Meta-analysis of Randomized Controlled Trials. Curr Probl Cardiol 2023; 48:101735. [PMID: 37044270 DOI: 10.1016/j.cpcardiol.2023.101735] [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: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The effectiveness of polypill therapy in the prevention and treatment of cardiovascular disorders is still unclear. This meta-analysis aimed to assess the efficacy of polypill therapy in reducing cardiovascular risk factors. METHODS We conducted a systematic search of PubMed, Cochrane CENTRAL, SCOPUS, and Google Scholar for randomized controlled trials (RCTs) that evaluated polypill therapy for cardiovascular diseases, hypertension, or dyslipidemia. We included 18 RCTs with a total of 20,463 participants in our analysis. Pooled effect estimates were reported as Odds ratios (ORs) with a 95% confidence interval (CI) using a random-effects model. RESULTS Polypill therapy was associated with a statistically significant reduction in systolic blood pressure (SBP) [OR: -0.33, 95% CI (-0.64, -0.03); P-value= 0.03], diastolic blood pressure (DBP) [OR: -0.70, 95% CI (-1.20, -0.21); P-value= 0.005], and total cholesterol level [OR: -1.25, 95% CI (-1.82, -0.68); P-value < 0.0001]. Polypill therapy also showed improved adherence [OR 2.18, 95% CI (1.47, 3.24); P-value= 0.0001]. However, there was no statistically significant benefit in the reduction of all-cause mortality, major cardiovascular events, and LDL-c levels. CONCLUSIONS The use of polypill therapy is associated with a statistically significant reduction in SBP, DBP, and total cholesterol levels, as well as improved adherence. Further research is needed to determine its impact on hard clinical outcomes such as mortality and major cardiovascular events.
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Affiliation(s)
- Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA.
| | - Muhammad Talal Ashraf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Zohaib
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ibrahim Ahmed Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ali Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohaib Roomi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA
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Ullah W, Warner E, Khandait H, Sachdeva S, Abdalla AS, Shafique M, Khan MA, Roomi S, Khattak F, Alraies MC. Septal myectomy or alcohol ablation for hypertrophic cardiomyopathy: A nationwide inpatient sample (NIS) database analysis. Cardiovasc Revasc Med 2023; 50:54-58. [PMID: 36737383 DOI: 10.1016/j.carrev.2023.01.013] [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: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Comparison of the real-world cohort on the relative safety of alcohol septal ablation (ASA) vs. septal myectomy (SM) for the management of hypertrophic cardiomyopathy (HCM) has been lacking. METHODS The National Inpatient Sample (NIS) (2012-2019) was used to select all cases of HCM. The safety of ASA vs. SM was compared using a one:many propensity score matched (PSM) analysis. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were computed. RESULTS A total of 6208 HCM patients (ASA 3106 vs. SM 3102) were included using a PSM analysis. Post-procedural bleeding (aOR 0.18, 95 % CI 0.11-0.32, p < 0.0001) and the need for an intra-aortic balloon pump (aOR 0.51, 95 % CI, 0.28-0.96, p = 0.037) were significantly lower while permanent pacemaker (PPM) implantation was significantly higher in ASA group as compared with SM group (aOR 1.72, 95 % CI, 1.43-2.06, p < 0.0001). The total in-hospital mean adjusted cost and length of stay were also significantly lower in the ASA group. However, there were no significant differences in adjusted odds of all-cause mortality (aOR 0.91, 95 % CI 0.62-1.33, p = 0.61), stroke (aOR 0.91, 95 % CI, 0.59-1.4, p = 0.66), and major bleeding (aOR 1.0, 95 % CI 7.8-1.29, p = 0.99) between the two comparison groups. CONCLUSION In patients with hypertrophic cardiomyopathy, alcohol septal ablation appears to be an acceptable alternative to septal myectomy due to a lower risk of post-procedural bleeding and the need for an intra-aortic balloon pump. However, ASA confers a higher risk of PPM placement.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
| | - Eric Warner
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Ullah W, Zahid S, Zaidi SR, Sarvepalli D, Haq S, Roomi S, Mukhtar M, Khan MA, Gowda SN, Ruggiero N, Vishnevsky A, Fischman DL. Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020906. [PMID: 34259045 PMCID: PMC8483489 DOI: 10.1161/jaha.121.020906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals Philadelphia PA
| | | | | | | | | | | | - Maryam Mukhtar
- University Hospitals of Leicester NHS Trust Leicester UK
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Sabiha B, Bhatti A, Roomi S, John P, Ali J. In silico analysis of non-synonymous missense SNPs (nsSNPs) in CPE, GNAS genes and experimental validation in type II diabetes mellitus through Next Generation Sequencing. Genomics 2021; 113:2426-2440. [PMID: 34029697 DOI: 10.1016/j.ygeno.2021.05.022] [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: 05/13/2020] [Revised: 12/11/2020] [Accepted: 05/19/2021] [Indexed: 12/12/2022]
Abstract
Non-synonymous missense SNPs (nsSNPs) in CPE and GNAS genes were investigated computationally. In silico identified nsSNPs were experimentally validated in type II diabetes mellitus (T2DM) in Pakistani Pathan population using next generation sequencing (NGS). Sixty two high-risk nsSNPs in CPE and 44 in GNAS were identified. Only 12 in GNAS were clinically significant. Thirty six high-risk nsSNPs in CPE and 08 clinically significant nsSNPs in GNAS lies in the most conserved regions. I-mutant predicted that nsSNPs decrease the proteins stability and ModPred predicted 20 and 12 post-translational modification sites in CPE and GNAS proteins respectively. Ramachandran plot showed 88.7% residues are in the most favored region of protein models. By experimentation, none of the nsSNPs were found to be associated with T2DM. In conclusion, this study differentiates the deleterious nsSNPs from the neutral ones. Although nsSNPs are not associated with T2DM, they can be targeted in other CPE and GNAS genes related disorders.
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Affiliation(s)
- Bibi Sabiha
- Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), H-12 Islamabad, Pakistan
| | - Attya Bhatti
- Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), H-12 Islamabad, Pakistan.
| | - Sohaib Roomi
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Peter John
- Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), H-12 Islamabad, Pakistan
| | - Johar Ali
- Center for Genome Sciences, Rehman Medical College, Phase-V, Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Ullah W, Zahid S, Zaidi R, Haq S, Roomi S, Sarvepalli D, Mukhtar M, Khan A, Gowda SN, Ruggiero N, Vishnevsky A, Fischman D. PREDICTORS OF PERMANENT PACEMAKER IMPLANTATION IN PATIENTS UNDERGOING TRANSCATHER AORTIC VALVE REPLACEMENT - A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02340-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ullah W, Roomi S, Nadeem N, Saeed R, Tariq S, Ellithi M, Haq S, Arslan A, Madara J, Boigon M, Haas DC, Fischman DL. Impact of Body Mass Index on COVID-19-Related In-Hospital Outcomes and Mortality. J Clin Med Res 2021; 13:230-236. [PMID: 34007361 PMCID: PMC8110221 DOI: 10.14740/jocmr4239] [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: 05/28/2020] [Accepted: 02/03/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. METHODS A retrospective cohort study was performed to determine the association of basal metabolic index (body mass index (BMI)) with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively. RESULTS A total of 176 consecutive patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% being male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the seventh day of hospitalization (35 vs. 30 kg/m2, P = 0.022). Similarly, patients requiring IMV had a higher BMI (33 vs. 29, P = 0.002) compared to non-intubated patients. The unadjusted OR for patients with a higher BMI requiring IMV (56% vs. 28%, OR: 3.3, 95% CI: 1.6 - 7.0, P = 0.002) and upgrade to ICU (46% vs. 28%, OR; 2.2, 1.07 - 4.6, P = 0.04) were significantly higher compared to patients with a lower BMI. Similarly, patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR: 3.2, 95% CI: 1.3 - 8.2, P = 0.01) compared to patients with a normal BMI. Despite a numerical advantage in the lower BMI group, there was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR: 3.8, 13% vs. 4%, 1.1 - 14.1, P = 0.07). aORs controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. CONCLUSIONS In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for IMV.
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Affiliation(s)
- Waqas Ullah
- Abington Jefferson Health, Abington, PA, USA
| | | | | | - Rehan Saeed
- University of South Dakota, Vermillion, SD, USA
| | | | | | - Shujaul Haq
- Abington Jefferson Health, Abington, PA, USA
| | | | - John Madara
- Abington Jefferson Health, Abington, PA, USA
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Roomi S, Shah SO, Ullah W, Abedin SU, Butler K, Schiers K, Kohl B, Yoo E, Vibbert M, Jallo J. Declining Intensive Care Unit Mortality of COVID-19: A Multi-Center Study. J Clin Med Res 2021; 13:184-190. [PMID: 33854659 PMCID: PMC8016522 DOI: 10.14740/jocmr4452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) mortality has waned significantly over time; however, factors contributing towards this reduction largely remain unidentified. The purpose of this study was to evaluate the trend in mortality at our large tertiary academic health system and factors contributing to this trend. Methods This is a retrospective cohort study of intensive care unit (ICU) patients diagnosed with COVID-19 between March and August 2020 admitted across 14 hospitals in the Philadelphia area. Collected data included demographics, comorbidities, admission risk of mortality score, laboratory values, medical interventions, survival outcomes, hospital and ICU length of stay (LOS) and discharge disposition. Chi-square (χ2) test, Fisher exact test, Cochran-Mantel-Haenszel method, multinomial logistic regression models, independent sample t-test, Mann-Whitney U test and one-way analysis of variance (ANOVA) were used. Results A total of 1,204 patients were included. Overall mortality was 39%. Mortality declined significantly from 46% in March to 14% in August 2020 (P < 0.05). The most common underlying comorbidities were hypertension (60.2%), diabetes mellitus (44.7%), dyslipidemia (31.6%) and congestive heart failure (14.7%). Hydroxychloroquine (HCQ) use was more commonly associated with the patients who died, while the use of remdesivir, tocilizumab, steroids and duration of these medications were not significantly different. Peak values of ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer levels were significantly higher in patients who died (P < 0.05). The mean hospital LOS was significantly longer in the patients who survived compared to the patients who died (18 vs. 12, P < 0.05). Conclusions The mortality of patients admitted to our ICU system significantly decreased over time. Factors that may have contributed to this may be the result of a better understanding of COVID-19 pathophysiology and treatments. Further research is needed to elucidate the factors contributing to a reduction in the mortality rate for this patient population.
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Affiliation(s)
- Sohaib Roomi
- Department of Medicine, Abington Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Syed Omar Shah
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Waqas Ullah
- Department of Medicine, Abington Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Shan Ul Abedin
- Department of Medicine, Abington Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Karyn Butler
- Department of Surgery, Division of Surgical Critical Care, Abington Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Kelly Schiers
- Department of Medicine, Jefferson Health New Jersey, Washington Township, NJ, USA
| | - Benjamin Kohl
- Department of Anesthesiology, Aria-Jefferson Health, Philadelphia, PA, USA
| | - Erika Yoo
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Vibbert
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jack Jallo
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
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Ullah W, Thalambedu N, Zahid S, Zia Khan M, Mir T, Roomi S, Fischman DL, Virani SS, Alam M. Percutaneous coronary intervention in patients with cardiac allograft vasculopathy: a Nationwide Inpatient Sample (NIS) database analysis. Expert Rev Cardiovasc Ther 2021; 19:269-276. [PMID: 33507114 DOI: 10.1080/14779072.2021.1882851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure and mortality. The role of percutaneous coronary intervention (PCI) in these patients remains unknown.Methods: The National Inpatient Sample (NIS) (2015-2017) was queried to identify all cases of CAV. The merits of PCI were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for in-hospital complications were calculated.Results: A total of 2,380 patients (PCI 185, no-PCI 21,95) with CAV were included in the analysis. There was no significant difference in the odds of major bleeding (OR 1.87, 95% CI 0.94-3.7, P = 0.11), post-procedure bleeding (P = 0.37), cardiogenic shock (OR 0.87, 95% CI 0.45-1.69, P = 0.80), acute kidney injury (uOR 0.92, 95% CI 0.68-1.24, P = 0.64), cardiopulmonary arrest (OR 0.84, 95% CI 0.34-2.11, P = 0.88), and in-hospital mortality (OR 1.59, 95% CI 0.91-2.79, P = 0.14) between patients undergoing PCI compared to those treated conservatively. A propensity-matched analysis closely followed the results of unadjusted crude analysis.Conclusion: PCI in CAV may be associated with increased in-hospital complications and higher resource utilization.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | | | - Salman Zahid
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Zia Khan
- Department of Medicine, University of West Virginia, Morgantown, WV, USA
| | - Tanveer Mir
- Department of Cardiovascular Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - David L Fischman
- Department of Cardiovascular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Roomi S, Madara J. PULMONARY EMBOLISM AND RIGHT HEART STRAIN PATTERN IN COVID-19: AN INCIDENTAL FINDING OR A PERSISTENT PATTERN? Chest 2020. [PMCID: PMC7548722 DOI: 10.1016/j.chest.2020.08.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ullah W, Mukhtar M, Al-Mukhtar A, Roomi S, Saeed R, Boigon M, Haas D, Rame E. Safety and Efficacy of Soluble Guanylate Cyclase Stimulators in Patients with Heart Failure: A Systematic Review and Meta-analysis. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.078] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Roomi S, Talib U, Farooq S, Chohan A, Siddique M, Saeed R, Kumar R. TRACHEOESOPHAGEAL FISTULA: A RARE COMPLICATION OF PROLONGED INTUBATION IN COVID-19. Chest 2020. [PMCID: PMC7548594 DOI: 10.1016/j.chest.2020.09.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Roomi S, Ullah W, Haq S, Farooq S, Madara J. UTERINE RHABDOMYOSARCOMA METASTASIZING TO HEART: A RARE CAUSE OF ARRHYTHMIAS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.256] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ullah W, Meizinger C, Roomi S, Saeed R, Boigon M, Haas D, Rame E. Impact of Left Ventricular Assist Device on Pulmonary Functions and Pulmonary Hemodynamics: A Meta-analysis. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.412] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S, Roomi S, Madara J, Boigon M, Haas DC, Fischman DL. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J Community Hosp Intern Med Perspect 2020; 10:402-408. [PMID: 33235672 PMCID: PMC7671719 DOI: 10.1080/20009666.2020.1798141] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the C-reactive protein (CRP) and D-Dimer levels for predicting in-hospital outcomes in COVID-19. Methods A retrospective cohort study was performed to determine the association of CRP and D-Dimer with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results A total of 176 patients with confirmed COVID-19 diagnosis were included. On presentation, the unadjusted odds for the need of IMV (OR 2.5, 95% CI 1.3-4.8, p = 0.012) and upgrade to ICU (OR 3.2, 95% CI 1.6-6.5, p = 0.002) were significantly higher for patients with CRP (>101 mg/dl). Similarly, the unadjusted odds of in-hospital mortality were significantly higher in patients with high CRP (>101 mg/dl) and high D-Dimer (>501 ng/ml), compared to corresponding low CRP (<100 mg/dl) and low D-Dimer (<500 ng/ml) groups on day-7 (OR 3.5, 95% CI 1.2-10.5, p = 0.03 and OR 10.0, 95% CI 1.2-77.9, p = 0.02), respectively. Both high D-Dimer (>501 ng/ml) and high CRP (>101 mg/dl) were associated with increased need for upgrade to the ICU and higher requirement for IMV on day-7 of hospitalization. A multivariate regression model mirrored the overall unadjusted trends except that adjusted odds for IMV were high in the high CRP group on day 7 (aOR 2.5, 95% CI 1.05-6.0, p = 0.04). Conclusion CRP value greater than 100 mg/dL and D-dimer levels higher than 500 ng/ml during hospitalization might predict higher odds of in-hospital mortality. Higher levels at presentation might indicate impending clinical deterioration and the need for IMV.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Nishanth Thalambedu
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA.,Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shujaul Haq
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Rehan Saeed
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Shristi Khanal
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Shafaq Tariq
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - John Madara
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Margot Boigon
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Donald C Haas
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - David L Fischman
- Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Roomi S, Ullah W, Ahmed F, Farooq S, Sadiq U, Chohan A, Jafar M, Saddique M, Khanal S, Watson R, Boigon M. Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review. J Med Internet Res 2020; 22:e21758. [PMID: 32784192 PMCID: PMC7470234 DOI: 10.2196/21758] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. OBJECTIVE The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. METHODS A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. RESULTS The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. CONCLUSIONS In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.
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Affiliation(s)
- Sohaib Roomi
- Jefferson Health Abington, Abington, PA, United States
| | - Waqas Ullah
- Jefferson Health Abington, Abington, PA, United States
| | - Faizan Ahmed
- Jefferson Health Abington, Abington, PA, United States
| | - Soban Farooq
- King Edward Medical University, Lahore, Pakistan
| | - Usama Sadiq
- Jefferson Health Abington, Abington, PA, United States
| | - Asad Chohan
- Newark Beth Israel Medical Center, Newark, NJ, United States
| | - Munnam Jafar
- Jefferson Health Abington, Abington, PA, United States
| | | | | | - Robert Watson
- Jefferson Health Abington, Abington, PA, United States
| | - Margot Boigon
- Jefferson Health Abington, Abington, PA, United States
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18
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Abstract
Falsely elevated potassium levels are common in routine laboratory tests and should be differentiated from true hyperkalemia. If the patient is inappropriately treated for hyperkalemia, the resulting hypokalemia can lead to life-threatening cardiac arrhythmias. We present the case of a 67-year-old woman with a past medical history of stable chronic lymphocytic leukemia, who presented for chest pain and had an elevated potassium level of 5.8 mEq/L, which, upon repeat laboratory testing, was then 6.7 mEq/L. She was initially treated for hyperkalemia. Laboratory test results showed creatine kinase levels at 43 U/L, lactate dehydrogenase levels at 177 U/L, phosphorus levels at 4.5 mg/dL, and uric acid levels at 6.4 mg/dL, indicating no evidence of tumor lysis syndrome. The patient was later diagnosed with reverse pseudohyperkalemia, indicated by falsely elevated plasma potassium levels in the presence of serum potassium levels within normal limits and venous blood gas samples.
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Roomi S, Ullah W, Farooq S, Saeed R, Haq S, Ashfaq AA. Is therapeutic anticoagulation improving renal outcomes in COVID-19? J Community Hosp Intern Med Perspect 2020; 10:306-309. [PMID: 32850085 PMCID: PMC7427433 DOI: 10.1080/20009666.2020.1785995] [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: 05/02/2020] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
We present three patients with COVID-19 who developed acute renal failure during hospitalization and were seen to have an improvement in their kidney function after being started on therapeutic anticoagulation with heparin (Target PTT 58-93 seconds) for varying indications (atrial fibrillation, popliteal vein thrombosis and a pulmonary embolism). Their kidney functions improved significantly following anticoagulation with a clear temporal relationship between the former and latter. Anticoagulation was held for one patient due to concern of gastrointestinal bleeding and his kidney functions worsened a day after stopping anticoagulation. D-dimer levels also improved with anticoagulation but the trend of other inflammatory markers remained unpredictable.
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Affiliation(s)
- Sohaib Roomi
- Department of Internal Medicine, Jefferson Health Abington, Abington, PA, USA
| | - Waqas Ullah
- Department of Internal Medicine, Jefferson Health Abington, Abington, PA, USA
| | - Soban Farooq
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Rehan Saeed
- Department of Internal Medicine, Jefferson Health Abington, Abington, PA, USA
| | - Shujaul Haq
- Department of Internal Medicine, Jefferson Health Abington, Abington, PA, USA
| | - Ammar Ali Ashfaq
- Department of Internal Medicine, Jefferson Health Abington, Abington, PA, USA
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20
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Sattar Y, Ullah W, Roomi S, Rauf H, Mukhtar M, Ahmad A, Ali Z, Abedin MSU, Alraies MC. Complications of leadless vs conventional (lead) artificial pacemakers - a retrospective review. J Community Hosp Intern Med Perspect 2020; 10:328-333. [PMID: 32850090 PMCID: PMC7427453 DOI: 10.1080/20009666.2020.1786901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Leadless pacemakers (LPM) are introduced in cardiovascular market with a goal to avoid lead- and pocket-associated complications due to conventional artificial pacemakers (CPM). The comparison of LPM and CPM complications is not well studied at a case by case level. Methods: Comprehensive literature was searched on multiple databases performed from inception to December 2019 and revealed 204 cases that received LPM with a comparison of CPM. The data of complications were extracted, screened by independent authors and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Armonk, NY: IBM Corp.). Results: The complications of CPM were high in comparison to LPM in terms of electrode dislodgement (56% vs 7% of cases, p-value < .0001), pocket site infection rate (16% vs 3.4%, p-value = 0.02), and a lead fracture rate (8% vs 0%, p-value = 0.04). LPMs had a statistically non-significant two-times high risk of pericardial effusion (8%) compared to CPMs (4%) with a p-value = 0.8. Conclusion: LPMs appear to have a better safety profile than CPMs. There was a low pocket site and lead-related infections in LPM as compared to CPM. However, LPM can have twice the risk of pericardial effusion than CPMs, but this was not statistically significant.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, New York, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Hiba Rauf
- Internal Medicine, Dow University Health Sciences, Karachi, Pakistan
| | - Maryam Mukhtar
- Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Asrar Ahmad
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Zain Ali
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | | | - M Chadi Alraies
- Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
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21
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Ullah W, M. Abdullah H, Roomi S, Sattar Y, Almas T, Narayana Gowda S, Saeed R, Mukhtar M, Ahmad A, Oliver T, Alraies MC, Haas DC, Fischman DL. Safety and Efficacy of Hydroxychloroquine in COVID-19: A Systematic Review and Meta-Analysis. J Clin Med Res 2020; 12:483-491. [PMID: 32849936 PMCID: PMC7430873 DOI: 10.14740/jocmr4233] [Citation(s) in RCA: 8] [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: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND During the initial phases of the coronavirus disease 2019 (COVID-19) epidemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ); however, recently, the Centers for Disease Control and Prevention (CDC) has recommended against routine use of HCQ outside of study protocols citing possible adverse outcomes. METHODS Multiple databases were searched to identify articles on COVID-19. An unadjusted odds ratio (OR) was used to calculate the safety and efficacy of HCQ on a random effect model. RESULTS Twelve studies comprising 3,912 patients (HCQ 2,512 and control 1400) were included. The odds of all-cause mortality (OR: 2.23, 95% confidence interval (CI): 1.58 - 3.13, P value < 0.00001) were significantly higher in patients on HCQ compared to patients on control agent. The response to therapy assessed by negative repeat polymerase chain reaction (PCR) (OR: 1.83, 95% CI: 0.50 - 6.75, P = 0.36), radiological resolution (OR: 1.98, 95% CI: 0.47 - 8.36, P value = 0.36) and the need for invasive mechanical ventilation (IMV) (OR: 1.21, 95% CI: 0.34 - 4.33, P value = 0.76) were identical between the two groups. Overall, four times higher odds of net adverse events (NAEs) were observed in the HCQ group (OR: 4.59, 95% CI 1.73 - 12.20, P value = 0.02). The measures for individual safety endpoints were also numerically lower in the control arm; however, none of these values reached the level of statistical significance. CONCLUSIONS HCQ might offer no benefits in terms of decreasing the viral load and radiological improvement in patients with COVID-19. HCQ appears to be associated with higher odds of all-cause mortality and NAEs.
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Affiliation(s)
- Waqas Ullah
- Abington Jefferson Health, Abington, PA 19001, USA
| | | | - Sohaib Roomi
- Abington Jefferson Health, Abington, PA 19001, USA
| | | | | | | | - Rehan Saeed
- Abington Jefferson Health, Abington, PA 19001, USA
| | - Maryam Mukhtar
- Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Tony Oliver
- University of South Dakota, Vermillion, SD 57069, USA
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22
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Rauf H, Ullah W, Roomi S, Ahmad A, Sattar Y, Ali Z, Gopisetti N. An unusual case of fungal ball on implantable cardioverter defibrillator wire and literature review. J Community Hosp Intern Med Perspect 2020; 10:340-342. [PMID: 32850093 PMCID: PMC7427435 DOI: 10.1080/20009666.2020.1772669] [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] [Indexed: 11/04/2022] Open
Abstract
Cardiac Implantable Electronic Device (CIED) includes pacemakers and implantable cardioverter defibrillators (ICD). The device infection is classified into pocket and systemic infection. We present a case of candida fungemia secondary to dissemination from the fungal ball found on an ICD. Patient was successfully managed with IV fluconazole, ICD explantation and reimplantation. The purpose of this report is to highlight rare complications of ICD implantation and guide its clinical course and management.
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Affiliation(s)
- Hiba Rauf
- Internal Medicine, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Hospital, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Hospital, Abington, PA, USA
| | - Asrar Ahmad
- Internal Medicine, Abington Jefferson Hospital, Abington, PA, USA
- Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, New York, NY, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, New York, NY, USA
| | - Zain Ali
- Internal Medicine, Abington Jefferson Hospital, Abington, PA, USA
| | - Neethu Gopisetti
- Internal Medicine, Abington Jefferson Hospital, Abington, PA, USA
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23
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Ullah W, Basyal B, Tariq S, Almas T, Saeed R, Roomi S, Haq S, Madara J, Boigon M, Haas DC, Fischman DL. Lymphocyte-to-C-Reactive Protein Ratio: A Novel Predictor of Adverse Outcomes in COVID-19. J Clin Med Res 2020; 12:415-422. [PMID: 32655735 PMCID: PMC7331862 DOI: 10.14740/jocmr4227] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the validity and clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric carcinoma prognostication, versus the neutrophil-to-lymphocyte ratio (NLR) for predicting in-hospital outcomes in COVID-19. Methods A retrospective cohort study was performed to determine the association of LCR and NLR with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively. Results The mean age for NLR patients was 63.6 versus 61.6, and for LCR groups, it was 62.6 versus 63.7 years, respectively. The baseline comorbidities across all groups were comparable except that the higher LCR group had female predominance. The mean NLR was significantly higher for patients who died during hospitalization (19 vs. 7, P ≤ 0.001) and those requiring IMV (12 vs. 7, P = 0.01). Compared to alive patients, a significantly lower mean LCR was observed in patients who did not survive hospitalization (1,011 vs. 632, P = 0.04). For patients with a higher NLR (> 10), the unadjusted odds of mortality (odds ratios (ORs) 11.0, 3.6 - 33.0, P < 0.0001) and need for IMV (OR 3.3, 95% CI 1.4 - 7.7, P = 0.008) were significantly higher compared to patients with lower NLR. By contrast, for patients with lower LCR (< 100), the odds of in-hospital all-cause mortality were significantly higher compared to patients with a higher LCR (OR 0.2, 0.06 - 0.47, P = 0.001). The aORs controlled for baseline comorbidities and medications mirrored the overall results, indicating a genuinely significant correlation between these biomarkers and outcomes. Conclusions A high NLR and decreased LCR value predict higher odds of in-hospital mortality. A high LCR at presentation might indicate impending clinical deterioration and the need for IMV.
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Affiliation(s)
- Waqas Ullah
- Abington Jefferson Health, Abington, PA, USA
| | | | | | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rehan Saeed
- Abington Jefferson Health, Abington, PA, USA
| | | | - Shujaul Haq
- Abington Jefferson Health, Abington, PA, USA
| | - John Madara
- Abington Jefferson Health, Abington, PA, USA
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24
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Abstract
Loperamide is a widely available, over-the-counter medication. The advent of the opioid epidemic has seen cases of loperamide overdose being reported. The common side effects of the medication can be relatively benign, but at high doses, loperamide can precipitate life-threatening arrhythmias. Our case highlights rare side effects of loperamide overdose inducing ventricular tachycardia, with unfavorable consequences. This case emphasizes that the distribution and availability of this medication should be restricted, to be a prescription drug, to prevent overdose and adverse outcomes.
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Affiliation(s)
- Zain Ali
- Physician, Internal Medicine, Abington Memorial Hospital, Abington, PA, USA
| | - Umer Shoukat
- Physician, Internal Medicine, Abington Memorial Hospital, Abington, PA, USA
| | - Mariya Khan
- Civil Hospital, Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohaib Roomi
- Resident Physician, Internal Medicine, Abington Memorial Hospital, Abington, PA, USA
| | - Waqas Ullah
- Physician, Internal Medicine, Abington Memorial Hospital, Abington, PA, USA.,Civil Hospital, Karachi, Dow University of Health Sciences, Karachi, Pakistan.,Resident Physician, Internal Medicine, Abington Memorial Hospital, Abington, PA, USA
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25
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Roomi S, Sherazi MF, Ullah W, Khan OA, Minalyan A, Atiq M, Thalambedu N. Rhabdomyosarcoma from uterus to heart. J Community Hosp Intern Med Perspect 2020; 10:245-249. [PMID: 32850073 PMCID: PMC7426992 DOI: 10.1080/20009666.2020.1760465] [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] [Indexed: 11/29/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a malignant soft tissue tumor of the pediatric population which is  rarely seen in adults. Metastatic rhabdomyosarcoma is even rarer. We present an unusual case of a 49 year old female presenting with palpitations and uterine bleeding. An Echo-cardiogram revealed a large oval mass on the posterior mitral leaflet and a Computerized Tomography (CT) scan of the abdomen revealed a uterine growth. Surgical excision of the cardiac mass was done and histological analysis of cardiac lesion confirmed it to be rhabdomyosarcoma with a primary source in the uterus. The patient became asymptomatic from a cardiac standpoint after excision of the mass and was scheduled for chemo/radiation therapy for the primary uterine malignancy. Metastatic cardiac rhabdomyosarcoma can be confused with a myxoma or any other primary or secondary cardiac tumors resulting in delayed diagnosis. However, its aggressive nature makes it a life-threatening tumor that requires an early diagnosis to prevent fatal consequences.
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Affiliation(s)
- Sohaib Roomi
- Internal Medicine, Resident Physician Jefferson Health - Abington
| | | | - Waqas Ullah
- Internal Medicine, Resident Physician Jefferson Health - Abington
| | - Omair Ali Khan
- Foundation University Medical College, Rawalpindi, Pakistan
| | - Artem Minalyan
- Internal Medicine, Resident Physician Jefferson Health - Abington
| | - Muhammad Atiq
- Internal Medicine, Resident Physician Jefferson Health - Abington
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26
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Ullah W, Roomi S, Abdullah HM, Mukhtar M, Ali Z, Ye P, Haas DC, Figueredo VM. Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis. Cardiol Res 2020; 11:145-154. [PMID: 32494324 PMCID: PMC7239594 DOI: 10.14740/cr1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR. Methods Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (RevMan) 5.3 and Stata software. Results A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR thresholds, higher sensitivity and specificity (both 90%) were noted with the higher cutoff (0.75) and lower cutoff (0.8), respectively. At the vessel level, sensitivity and specificity at the lower FFR threshold were significantly higher at 88% and 89%, compared to the corresponding values for higher cutoff at 0.75. Similarly, meta-regression analysis of SCMR at higher (3T) resolution showed a higher sensitivity of 87% at the patient level and higher specificity of 90% at the vessel level. The highest sensitivity and specificity of SCMR (92% and 94%, respectively) were noted in studies with CAD prevalence greater than 60%. Conclusions SCMR has high diagnostic accuracy for CAD comparable to FFR at a spatial resolution of 3T and an FFR cut-off of 0.80. An increase in CAD prevalence further improved the specificity of SCMR.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Hafez M Abdullah
- Internal Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Maryam Mukhtar
- Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Zain Ali
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Ping Ye
- Internal Medicine, University of South Dakota, Sioux Falls, SD, USA.,Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Donald C Haas
- Abington Hospital-Jefferson Health, Abington, PA, USA
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27
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Ullah W, Roomi S, Cheema MA, Haas D. LONG FORGOTTEN COMPLICATIONS OF CARDIAC CATHETER ABLATION: RARE BUT FATAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Ullah W, Roomi S, Abdullah HM, Haas D, Figueredo VM. DIAGNOSTIC ACCURACY OF CARDIAC MAGNETIC RESONANCE VERSUS FRACTIONAL FLOW RESERVE FOR CORONARY ARTERY DISEASE SEVERITY: A META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31979-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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29
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Ullah W, Rauf H, Roomi S, Inayat F, Haas D. CANDIDA INDUCED TRICUSPID VALVE ENDOCARDITIS: AN UNUSUAL PRESENTATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ullah W, Sattar Y, Roomi S, Humayun W, Shaukat M, Haas D. SAFETY AND EFFICACY OF ANTICOAGULANT MONO-THERAPY IN STABLE CORONARY ARTERY DISEASE AND ATRIAL FIBRILLATION: A META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30980-3] [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: 10/24/2022]
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31
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Roomi S, Haq S, Ullah W, Jafar MS, Sherazi M. Cardiac Tamponade Due to Inferior Vena Cava Filter Removal: A Case Report and Review of Literature. Cureus 2020; 12:e6996. [PMID: 32206460 PMCID: PMC7079764 DOI: 10.7759/cureus.6996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiac tamponade is a condition characterized by the accumulation of pericardial fluid, compromising the hemodynamics of the circulation. It has several known causes, including traumatic injury to the pericardium, idiopathic, neoplastic or purulent pericarditis, and, rarely, iatrogenic etiology. Inferior vena cava (IVC) filter removal can lead to multiple complications including but not limited to IVC perforation, air embolism, pneumothorax or filter migration. Here, we present a case of a middle-aged woman presenting with cardiac tamponade after IVC filter removal. She was successfully managed with pericardiocentesis followed by pericardial window placement. As this case and literature review illustrates, cardiac tamponade is a rare but potentially devastating complication of IVC filter manipulation.
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32
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Zafar Y, Sattar Y, Ullah W, Roomi S, Rashid MU, Khan MS, Schmidt L. Proprotein convertase subtilisin/Kexin type-9 (PCSK-9) inhibitors induced liver injury - a retrospective analysis. J Community Hosp Intern Med Perspect 2020; 10:32-37. [PMID: 32128056 PMCID: PMC7034434 DOI: 10.1080/20009666.2019.1710952] [Citation(s) in RCA: 4] [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: 08/11/2019] [Accepted: 12/17/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Proprotein convertase subtilisin/Kexin type 9 (PCSK-9) inhibitors induced liver dysfunction in patients with or without previous liver injury, and this is not well discussed in the previous literature. Methods: A total sample of 202 patients were retrospectively reviewed at the University of Missouri, Kansas City, from the year 2015 to 2018 based on predefined selection criteria. Inclusion criteria involved patients with dyslipidemia, with or without PCSK-9 inhibitors, liver function tests and lipid profile at baseline and at a mean of 6-month follow-up. The variables, including age, gender, and confounding factors like other medications (statin, oral antidiabetic, and antihypertensive) induced, or chronic secondary liver diseases causing liver injury were taken into consideration. Exclusion criteria included patients without dyslipidemia. Results: The mean age of the study population was 64 ± 11 years (63% males and 37% females). The lipid profile including triglyceride and cholesterol levels during 6-month follow-up visit showed a mean of 184 ± 260 and 163 ± 50 mg/dL as compared to that at baseline of 227 ± 603 and 181 ± 70 mg/dL, respectively. In terms of clinical efficacy, a 6-month follows-up showed a drop in triglyceride and cholesterol levels by 38 and 15 mg/dL, respectively. A liver function test at 6 months in patients taking PCSK-9 inhibitors showed an increase in alanine transaminase (ALT) and aspartate transaminase (AST) by 5.8 mg/dL (p = 0.037) and 6.2 mg/dL (p = 0.008), respectively, from baseline values. Conclusion: PCSK-9 inhibitors should be used cautiously with a follow-up liver function test.
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Affiliation(s)
- Yousuf Zafar
- Internal Medicine, University of Missouri, Kansas City, MO, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, New York, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington - Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington - Jefferson Health, Abington, PA, USA
| | | | | | - Laura Schmidt
- Cardiology, University of Missouri, Kansas City, MO, USA
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Abstract
Cor triatriatum is a rare congenital cardiac condition characterized by the division of one atrium into two chambers by a fibromuscular membrane, resulting in three atrial chambers. The goal of this study was to determine the associations of cor triatriatum with cyanosis, atrial fibrillation (AF), and stroke. MEDLINE (PubMed, Ovid), Embase, and Cochrane databases were searched on April 25, 2019, for relevant articles on cor triatriatum. After initial screening and removal of duplicates, 235 articles were selected. Data were extracted from these articles, including types, presentations, diagnostic findings, management, and outcomes of patients with cor triatriatum. Approximately 83% of patients with cor triatriatum had cor triatriatum sinistrum (CTS) and 17% had cor triatriatum dextrum (CTD). The mean age of all patients was 29±23 years. Mean ages at diagnosis differed significantly in patients with CTS and CTD (31±23 years vs. 21±20 years, p=0.02). CTS showed a significantly greater association with AF (14.65% vs. 12.5%, p=0.036) and had a substantially higher risk of stroke (7.9% vs. 5.0%, p=0.04) than CTD. CTS also had a numerically higher association with atrial septal defects (15.13% vs. 15.6%), but this difference was not statistically significant (p=0.89). In contrast, cyanosis at presentation was significantly more frequent in patients with CTD than CTS (5.5% vs. 5.3%, p=0.05). Management did not differ significantly between these groups (p=0.29). The overall mortality rate was 16%, with no significant difference between patients with CTS and CTD (p=0.33). The higher likelihood of AF and stroke in CTS than in CTD patients warrants treatment of the former with anticoagulation agents, irrespective of their CHA₂DS₂-VASc scores (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex category). Patients with CTS usually present at an older age due to their lower risk of cyanosis and asymptomatic AF.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hiba Rauf
- Internal Medicine, Dow Medical College, Karachi, PAK
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
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Haq S, Roomi S, Lashari BH, Khan MAA. Non-Sustained Ventricular Tachycardia as a Sign of Lung Cancer. Cureus 2019; 11:e6090. [PMID: 31857922 PMCID: PMC6897347 DOI: 10.7759/cureus.6090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The leading cause of death due to malignancy in the USA is lung cancers. They can be divided into small cell lung cancer and non-small cell lung cancer. Of the latter, adenocarcinoma comprises the majority of lung cancers. Manifestations of lung cancer can be divided into thoracic, extra-thoracic and paraneoplastic syndromes. We describe a case of ventricular tachycardia in a patient who presented with dysphagia, ultimately found to have a non-small cell lung cancer invading the esophagus and heart.
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Affiliation(s)
- Shujaul Haq
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Bilal H Lashari
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
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Ahmed A, Ullah W, Hussain I, Roomi S, Sattar Y, Ahmed F, Saeed R, Ashfaq A. Atrial fibrillation: a leading cause of heart failure-related hospitalizations; a dual epidemic. Am J Cardiovasc Dis 2019; 9:109-115. [PMID: 31763062 PMCID: PMC6872464] [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] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Atrial fibrillation (AF), and heart failure (HF) are a major cardiovascular epidemic over the last decade. The prevalence and rehospitalization of heart failure are on rising edge, and many factors are responsible for these re-exacerbations of heart failure. In this study, we sought to determine an association of a risk factor for frequent rehospitalization of heart failure at our institute. We aimed to find the re-admission rate, heart rate, and rhythm of heart failure exacerbation. METHODS We performed a single-center retrospective study at the Abington Hospital - Jefferson health and 418 patients having a history of heart failure, and AF were selected. The heart failure readmission rate (days), heart rate, and rhythm were analyzed. RESULTS The mean age of the included population was 82.8 years SD ± 9.2. About 53% had AF with a mean heart rate 90 SD ± 21 bpm, and 47% had normal sinus rhythm (NSR) with a mean heart rate of 78 ± 16 bpm on re-admission. This difference was statistically significant (p=0.02). The mean re-admission rate for atrial fibrillation was 27.49 days SD ± 18.97, compared to 32.68 SD ± 20.26 days for NSR, statistically significant (p=0.007) and the Pearson Chi-square was also significant P = 0.006. CONCLUSION There is a significantly increased rate of re-admission in heart failure patients with atrial fibrillation with a rapid ventricular rate. Efforts should be taken to keep the patient in NSR or controlled AF to minimize the rehospitalization rate, and this, in turn, reduces the financial burden on patients and institutes.
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Affiliation(s)
- Asrar Ahmed
- Internal Medicine, Abington-Jefferson HealthAbington, USA
| | - Waqas Ullah
- Internal Medicine, Abington-Jefferson HealthAbington, USA
| | | | - Sohaib Roomi
- Internal Medicine, Abington-Jefferson HealthAbington, USA
| | - Yasar Sattar
- Internal Medicine, Abington-Jefferson HealthAbington, USA
- Internal Medicine, Icahn School of Medicine at Mount Sinai-Elmhurst HospitalNew York, USA
| | - Faizan Ahmed
- Internal Medicine, Abington-Jefferson HealthAbington, USA
| | - Rehan Saeed
- Internal Medicine, Abington-Jefferson HealthAbington, USA
| | - Ammar Ashfaq
- Internal Medicine, Abington-Jefferson HealthAbington, USA
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Abstract
A prominent coved or saddle-shaped ST-segment elevation followed by T wave changes in V1-V3 and in the absence of other identifiable cause is termed as Brugada pattern. This pattern in the presence of documented ventricular arrhythmias or its symptoms (syncope, seizure) or significant family for sudden cardiac death or abovementioned ECG changes is called Brugada syndrome. Here we present a comprehensive literature review on the precipitation factors of Brugada syndrome/pattern by various stimuli, its presentation, associations, management and outcomes. We are also presenting a unique case of Brugada pattern where the patient's Brugada pattern was unmasked at an extreme old age by infection.
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Affiliation(s)
- Hassan Abbas
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Asrar Ahmad
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Ganesh Gajanan
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
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Ullah W, Roomi S, Sattar Z, Ahmad A, Ali Z, Sarwar U, Figueredo V. Acupuncture related acute purulent pericarditis masquerading uremic pericarditis. J Community Hosp Intern Med Perspect 2019; 9:230-234. [PMID: 31258863 PMCID: PMC6586117 DOI: 10.1080/20009666.2019.1622380] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/13/2019] [Indexed: 10/31/2022] Open
Abstract
We are reporting a rare case of acupuncture-related acute pericarditis in an old-aged gentleman due to Staphylococcus aureus infection who was successfully managed with drainage of pericardial fluid and broad-spectrum antibiotics. We also reviewed the literature and found cardiac tamponade as the most common acupuncture-related cardiac complication, followed by infective endocarditis, bacterial abscess, and infected myxoma. There was no available literature on post-acupuncture acute pericarditis.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Hospital _ Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital _ Jefferson Health, Abington, PA, USA
| | - Zeeshan Sattar
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Asrar Ahmad
- Internal Medicine, Abington Hospital _ Jefferson Health, Abington, PA, USA
| | - Zain Ali
- Internal Medicine, Abington Hospital _ Jefferson Health, Abington, PA, USA
| | - Usman Sarwar
- Internal Medicine, Abington Hospital _ Jefferson Health, Abington, PA, USA
| | - Vincent Figueredo
- Department of Cardiology, St Mary Medical Center, Langhorne, PA, USA
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Roomi S, Ullah W, Iqbal I, Ahmad A, Saleem S, Sattar Z. Thyrotoxicosis factitia: a rare cause of junctional rhythm and cardiac arrest. J Community Hosp Intern Med Perspect 2019; 9:258-263. [PMID: 31258870 PMCID: PMC6586092 DOI: 10.1080/20009666.2019.1618668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/09/2019] [Indexed: 11/02/2022] Open
Abstract
Thyrotoxicosis factitia is a hyperthyroid state due to the accidental or deliberate thyroxine ingestion. It can have many complications depending upon the organ involved. We present a case of a heavy built athlete presenting with cardiac arrest, who was found to be abused the thyroxine hormone for bodybuilding. Electrocardiogram (EKG) was significant for junctional arrhythmias along with interval supraventricular tachycardia (SVT) and bradycardia. The patient ultimately expired due to a failed resuscitation. To our knowledge, this is the first reported case of junctional arrhythmias caused by exogenous thyroxine.
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Affiliation(s)
- Sohaib Roomi
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Waqas Ullah
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Iqra Iqbal
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Asrar Ahmad
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
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Ullah W, Khanal S, Sattar Z, Roomi S, Ahmad A, Sarwar U, Ghani AR. "Singultus" uncloaking potentially fatal vascular dissections. J Community Hosp Intern Med Perspect 2019; 9:282-284. [PMID: 31258876 PMCID: PMC6586111 DOI: 10.1080/20009666.2019.1622379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022] Open
Abstract
Aortic dissection (AD) is a serious condition in which the intimal layer of aorta tears and blood surges in between the intimal and medial layers of aorta causing it to separate (dissect). It usually presents with excruciating pain radiating to the back. Here we present a unique presentation of AD where an old-aged Caucasian male presented with a chronic history of intractable hiccups. His computed tomography (CAT scan) revealed the dissection of the descending thoracic aorta. He was managed conservatively and was discharged home in stable condition. The purpose of this report is to highlight this unusual presentation of AD and unmask the possible etiology of hiccups in such cases.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington-Jefferson Health, Abington, USA
| | - Shristi Khanal
- Internal Medicine, Abington-Jefferson Health, Abington, USA
| | - Zeeshan Sattar
- Internal Medicine, SUNY Downstate Medical Center, Brooklyn, USA,CONTACT Zeeshan Sattar Internal Medicine, SUNY Downstate Medical Center, Brooklyn, USA
| | - Sohaib Roomi
- Internal Medicine, Abington-Jefferson Health, Abington, USA
| | - Asrar Ahmad
- Internal Medicine, Abington-Jefferson Health, Abington, USA
| | - Usman Sarwar
- Internal Medicine, Abington-Jefferson Health, Abington, USA
| | - Ali Raza Ghani
- Internal Medicine, Abington-Jefferson Health, Abington, USA
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Ullah W, Cheema MA, Abdullah HMA, Roomi S, Saeed R, Balaratna A. ST-Segment Elevation Myocardial Infaction Alert During the Night Shift, A Misfortune for the Patient or an Overstatement? Cardiol Res 2019; 10:150-156. [PMID: 31236177 PMCID: PMC6575109 DOI: 10.14740/cr862] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 11/11/2022] Open
Abstract
Background Conflicting data exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on intervention timings. It is believed that short staffing at night hours may lead to a lapse in the delivery of effective, efficient and timely medical intervention. Methods A retrospective single-center study was performed, and a total of 436 patients were randomized into two groups. Group A had 279 patients who had the heart catheterization done during the daytime (between 6 am and 6 pm), while group B had 157 patients who had the same intervention performed at night (between 6 pm and 6 am). Results Door to balloon (DTB) time during the day was about 16 min shorter than the DTB time at night (81.29 ± 3.26 vs. 97.30 ± 8.54) with no statistical difference (P = 0.051). The mean troponin rise during the day was 1.94 ± 10.60 SEM (95% confidence interval (CI): -22.70 to 18.90) higher than night troponin levels (71.75 ± 7.18 vs. 69.80 ± 7.18), but P value was 0.85. The left ventricular ejection fraction (LVEF) fall for daytime was 0.93% vs. 0.90% for night time patients (P = 0.94). Conclusion There is no significant difference in the mean DTB time, the rise in troponin, fall in LVEF, readmission rates, or mortality, and hence no negative effects on patient outcomes based on the patient's time of presentation between the two groups.
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Affiliation(s)
- Waqas Ullah
- Abington - Jefferson Health, Abington, PA, USA
| | | | | | | | - Rehan Saeed
- Abington - Jefferson Health, Abington, PA, USA
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Abstract
Methotrexate (MTX) was originally formulated as one of the first antitumour drugs due to its ability to alter folate metabolism, which renders it to be an antiproliferative agent. Classically, the higher dosage is administered via parenteral route, in a cyclical fashion, to achieve antitumour effects. Patients on high doses of MTX are prone to develop rare complications of myelosuppression and pancytopenia, in a dose-dependent fashion, secondary to altered folate metabolism. 1 Herein, we present a unique case of rheumatoid arthritis presented with pancytopenia due to low-dose MTX and doxycycline drug interaction. We also report the successful management of pancytopenia and oral ulcers with combination therapy of leucovorin and granulocyte colony-stimulating factor.
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Affiliation(s)
- Ahmad Arslan
- Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
| | | | | | - Waqas Ullah
- Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
| | - Sohaib Roomi
- Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
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Sattar Z, Abdullah HM, Roomi S, Ullah W, Khan A, Ghani A, Ahmad A. Tetralogy of Fallot with isolated levocardia in a young female. J Community Hosp Intern Med Perspect 2019; 9:275-278. [PMID: 31258874 PMCID: PMC6586116 DOI: 10.1080/20009666.2019.1601980] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Zeeshan Sattar
- Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Hafez Muhammad Abdullah
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, Pennsylvania, USA
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, Pennsylvania, USA
| | - Adnan Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Ali Ghani
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, Pennsylvania, USA
| | - Asrar Ahmad
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, Pennsylvania, USA
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Roomi S, Masi A, Conselvan GB, Trevisan S, Quaggiotti S, Pivato M, Arrigoni G, Yasmin T, Carletti P. Protein Profiling of Arabidopsis Roots Treated With Humic Substances: Insights Into the Metabolic and Interactome Networks. Front Plant Sci 2018; 9:1812. [PMID: 30619394 PMCID: PMC6299182 DOI: 10.3389/fpls.2018.01812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/21/2018] [Indexed: 05/06/2023]
Abstract
Background and Aim: Humic substances (HSs) influence the chemical and physical properties of the soil, and are also known to affect plant physiology and nutrient uptake. This study aimed to elucidate plant metabolic pathways and physiological processes influenced by HS activity. Methods: Arabidopsis roots were treated with HS for 8 h. Quantitative mass spectrometry-based proteomics analysis of root proteins was performed using the iTRAQ (Isobaric Tag for Relative and Absolute Quantification) technique. Out of 902 protein families identified and quantified for HS treated vs. untreated roots, 92 proteins had different relative content. Bioinformatic tools such as STRING, KEGG, IIS and Cytoscape were used to interpret the biological function, pathway analysis and visualization of network amongst the identified proteins. Results: From this analysis it was possible to evaluate that all of the identified proteins were functionally classified into several categories, mainly redox homeostasis, response to inorganic substances, energy metabolism, protein synthesis, cell trafficking, and division. Conclusion: In the present study an overview of the metabolic pathways most modified by HS biological activity is provided. Activation of enzymes of the glycolytic pathway and up regulation of ribosomal protein indicated a stimulation in energy metabolism and protein synthesis. Regulation of the enzymes involved in redox homeostasis suggest a pivotal role of reactive oxygen species in the signaling and modulation of HS-induced responses.
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Affiliation(s)
- Sohaib Roomi
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Antonio Masi
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padua, Padua, Italy
| | | | - Sara Trevisan
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padua, Padua, Italy
| | - Silvia Quaggiotti
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padua, Padua, Italy
| | - Micaela Pivato
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padua, Padua, Italy
| | - Giorgio Arrigoni
- Proteomics Center, University of Padua and Azienda Ospedaliera di Padova, Padua, Italy
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Tayyaba Yasmin
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Paolo Carletti
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padua, Padua, Italy
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Siddiqui S, Khurshid A, Roomi S, Karamat F, Khan AM, Shaheen H, Yasmin T. Comparative analysis of hyoscine in wild-type and in vitro grown Datura innoxia by high performance liquid chromatography. TROP J PHARM RES 2017. [DOI: 10.4314/tjpr.v16i7.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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