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Sperry BW, Vuppala S. Sequential 18F-fluorodeoxyglucose positron emission tomography imaging in cardiac sarcoidosis. J Nucl Cardiol 2024; 35:101860. [PMID: 38583507 DOI: 10.1016/j.nuclcard.2024.101860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
| | - Suchith Vuppala
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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Li M, Haque W, Vuppala S, Tobias E. Rare presentation of multisystem inflammatory syndrome in an adult associated with SARS-CoV-2 infection: unilateral neck swelling. BMJ Case Rep 2021; 14:14/5/e242392. [PMID: 33980565 PMCID: PMC8118037 DOI: 10.1136/bcr-2021-242392] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a rare but often severe complication of SARS-CoV-2 infection. While several case reports about MIS-A in the setting of COVID-19 have been published since the term was first coined in June 2020, a clear description of the underlying pathophysiology and guideline-based recommendations on the diagnostic and therapeutic approach are lacking. What has been reported is that in the absence of severe respiratory illness, MIS-A can present with hypotension or shock, high-grade fever, abdominal pain, diarrhoea and severe weakness days to weeks after SARS-CoV-2 infection. Here, we present a case of a 28-year-old man who presented with a rarely described initial symptom: unilateral neck swelling. His presentation, disease progression and treatment course provide further information about MIS-A as a complication and in formulating diagnostic guidelines.
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Affiliation(s)
- Mozhu Li
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Waqas Haque
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Suchith Vuppala
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ethan Tobias
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Haque W, Alvarenga M, Vuppala S, Reddy M, Sarode R. Retrospective analysis of bleeding events after central venous catheter placement in thrombotic thrombocytopenic purpura. Transfus Apher Sci 2021; 60:103120. [PMID: 33736954 DOI: 10.1016/j.transci.2021.103120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a thrombotic disorder caused by severe deficiency of ADAMTS13. Platelets are transfused prophylactically in non-TTP patients for central venous catheter (CVC) with a count <20 × 109/L to prevent bleeding. However, transfusing platelets in TTP prior to CVC placement remains controversial due to concern for arterial thrombosis and mortality. At our center, platelet transfusion is contraindicated in TTP, therefore, we analyzed data for bleeding complications following CVC placement. STUDY DESIGN AND METHODS 95 acute episodes of TTP were identified. Twenty-six episodes were excluded for insufficient documentation or no CVC placement. The charts of 69 remaining episodes were reviewed. RESULTS Of 69 TTP episodes, nine (13 %) had bleeding after a CVC placement. Of these, seven bleeds were minor, and the two were major related to the technical issues during femoral venous access causing arterial bleeds. Median platelet count before the CVC placement among those experiencing bleeding complications was 12 × 109/L (range 3-44) as compared to median count of 15 × 109/L (range 4-257) in those who did not bleed (p = 0.258). Among 44 episodes with a platelet count <20 × 109/L, seven (16 %) had bleeds. CONCLUSION Major bleeding complications following CVC placement in TTP is uncommon and most likely related to technical challenges. Median platelet count was similar in patients who bled versus those who did not, suggesting that platelet transfusion is unnecessary to correct platelet count prior to a CVC placement in TTP.
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Affiliation(s)
- Waqas Haque
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States.
| | - Maria Alvarenga
- UT Rio Grande Valley School of Medicine, 1201 W University Dr, Edinburg, TX, 78539, United States
| | - Suchith Vuppala
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States
| | - Manasa Reddy
- Division of Transfusion Medicine and Hemostasis, Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Ravi Sarode
- Division of Transfusion Medicine and Hemostasis, Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, United States; Division of Hematology/Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, 75390, United States
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Kabir R, Vuppala S, Liu Y, Tejani I, Weideman R, Banerjee A, Tsai S, Huffman L, Niazi K, Brilakis ES, Shishehbor MH, Banerjee S. Clinical outcomes of patients with and without chronic kidney disease undergoing endovascular revascularization of infrainguinal peripheral artery disease: Insights from the XLPAD registry. Catheter Cardiovasc Interv 2021; 98:310-316. [PMID: 33527684 DOI: 10.1002/ccd.29491] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The purpose of the present study was to define clinical outcomes of chronic kidney disease (CKD) patients undergoing endovascular revascularization of infrainguinal peripheral artery disease (PAD). BACKGROUND CKD is an established predictor of advanced PAD. However, clinical outcomes for these patients following endovascular revascularization remain inadequately defined. METHODS Using the ongoing multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851), we analyzed all-cause death, target limb amputation, and need for repeat revascularization for patients with and without CKD undergoing infrainguinal endovascular revascularization between the years 2005 and 2018. RESULTS Of 3,699 patients, 15.1% (n = 559) had baseline CKD. CKD patients had significantly higher incidence of heavily calcified lesions (48.4% vs. 38.1%, p < .001) and diffuse disease (66.9% vs. 61.5%, p = .007). Kaplan-Meier analysis showed significant differences between CKD and non-CKD patient outcomes at 12 months for freedom from target limb amputation (79.9% vs. 92.7%, p < .001) and all-cause death (90.1% vs. 97.6%, p < .001). However, freedom from target vessel revascularization was similar between the groups. After adjusting for baseline comorbidities in the CKD and non-CKD groups, the hazard ratios for target limb amputation and death at 12 months were 2.28 (95% confidence interval or CI 1.25-4.17, p < .001) and 4.38 (95% CI 2.58-7.45, p < .001), respectively. CONCLUSIONS Following endovascular revascularization for infrainguinal PAD, CKD was an independent predictor of all-cause death and target limb amputation at 12 months.
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Affiliation(s)
- Ryan Kabir
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Suchith Vuppala
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yulun Liu
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ishita Tejani
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rick Weideman
- Pharmacy Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Avantika Banerjee
- Department of Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA
| | - Shirling Tsai
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Pharmacy Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Lynn Huffman
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Khusrow Niazi
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Emmanouil S Brilakis
- Department of Medicine, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mehdi H Shishehbor
- Department of Medicine, Case Western Reserve University and University Hospitals, Cleveland, Ohio, USA
| | - Subhash Banerjee
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Pharmacy Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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Abstract
PURPOSE OF REVIEW To review literature from 2016 to 2019 on clinical decision support (CDS) for diagnosis and management of hypertension in children and adults. RECENT FINDINGS Ten studies described hypertension CDS systems. Novel advances included the integration of patient-collected blood pressure data, automated information retrieval and management support, and use of CDS in low-resource/developing-world settings and in pediatrics. Findings suggest that CDS increases hypertension detection/control, yet many children and adults with hypertension remain undetected or undercontrolled. CDS challenges included poor usability (from lack of health record integration, excessive data entry requests, and wireless connectivity challenges) and lack of clinician trust in blood pressure measures. Hypertension CDS has improved but not closed gaps in the detection and control of hypertension in children and adults. The studies reviewed indicate that the usability of CDS and the system where CDS is deployed (e.g., commitment to high-quality blood pressure measurement/infrastructure) may impact CDS's ability to increase hypertension detection and control.
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Affiliation(s)
- Suchith Vuppala
- Department of Medicine, University of Texas Southwestern (UTSW) Medical School, Dallas, TX USA
| | - Christy B. Turer
- Departments of Pediatrics and Medicine, UTSW and Children’s Health, 5323 Harry Hines Blvd., Dallas, TX 75390-9063 USA
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Vuppala S, Jeon-Slaughter H, Grodin J, Abdullah SM, Khalili H, Brilakis E, Banerjee S. CRT-100.01 Chronic Kidney Disease Effect on the Long-term Cardiovascular Outcomes of Stented Percutaneous Coronary Interventions (PCI) Among Veterans: Veterans Administration National Data 2005-2010. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.040] [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: 11/30/2022]
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