1
|
Singla A, Gautam A, Goyal A, Dalia T. Paradoxical septic embolism in an Ebstein's anomaly patient leading to brain abscess: A case report. J Cardiol Cases 2024; 29:161-164. [PMID: 38646075 PMCID: PMC11031666 DOI: 10.1016/j.jccase.2023.12.001] [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: 07/09/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 04/23/2024] Open
Abstract
Ebstein's anomaly (EA), a congenital cardiac anomaly, is characterized by apical displacement of the tricuspid valve leaflet(s) into the right ventricle. We present the case of a 61-year-old female with a history of EA, Wolff-Parkinson-White syndrome, and patent foramen ovale (PFO), who presented with worsening hypoxia and confusion, in the setting of left lower extremity cellulitis and abscess. The computed tomography (CT) scan of the head showed a cerebellar infarct with hemorrhagic conversion. Magnetic resonance imaging of the head showed a satellite lesion raising concern for the embolic nature of infarcts. After ruling out cardioembolic causes of cerebellar infarction, her presenting symptoms were attributed to paradoxical septic emboli from the left leg abscess (demonstrated on CT scan of the leg). She was deemed a poor candidate for surgical closure of PFO due to contraindication to use heparin (due to the presence of hemorrhagic stroke) and underlying comorbidities. Septic embolization is a rare but dreaded complication in EA patients with PFO. Learning objective •Paradoxical emboli can occur in patients with Ebstein's anomaly (EA) and patent foramen ovale (PFO).•The mainstay of management in case of paradoxical embolism lies with the identification and treatment of the underlying cause, such as infective endocarditis, deep vein thrombosis, or infectious source, as in the present case.•The surgical correction of PFO in EA patients should be considered when the patient becomes symptomatic with cyanosis, hypoxia, or manifestations of paradoxical emboli.
Collapse
Affiliation(s)
- Ankur Singla
- Dayanand Medical College and Hospital, Ludhiana, India
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Archana Gautam
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
2
|
Yarrarapu SNS, Goyal A, Venkata VS, Panchal V, Sivasubramanian BP, Du DT, Jakulla RS, Pamulapati H, Afaq MA, Owens S, Dalia T. Comprehensive review of statin-intolerance and the practical application of Bempedoic Acid. J Cardiol 2024:S0914-5087(24)00045-5. [PMID: 38521120 DOI: 10.1016/j.jjcc.2024.03.006] [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] [Received: 11/14/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
Statin-intolerance (SI) has prevalence between 8.0 % and 10 %, and muscular complaints are the most common reason for discontinuation. Bempedoic acid (BA), an ATP citrate lyase inhibitor, decreases hepatic generation of cholesterol, upregulates low-density lipoprotein (LDL) receptor expression in the liver, and eventually clears circulating LDL-cholesterol from the blood. Multiple randomized clinical trials studying BA demonstrate a reduction in LDL levels by 17-28 % in SI. The CLEAR OUTCOME trial established significant cardiovascular benefits with BA. A dose of 180 mg/day of BA showed promising results. BA alone or in combination with ezetimibe is US Food and Drug Administration-approved for use in adults with heterozygous familial hypercholesterolemia and/or established atherosclerotic cardiovascular disease. BA reduced HbA1c by 0.12 % (p < 0.0001) in patients with diabetes. Adverse events of BA include myalgia (4.7 %), anemia (3.4 %), and increased aminotransferases (0.3 %). BA can cause up to four times higher risk of gout in those with a previous gout diagnosis or high serum uric acid levels. Reports of increased blood urea nitrogen and serum creatinine were noted. Current evidence does not demonstrate a reduction in deaths from cardiovascular causes. More studies that include a diverse population and patients with both high and low LDL levels should be conducted. We recommend that providers consider BA as an adjunct to statin therapy in patients with a maximally tolerated dosage to specifically target LDL levels.
Collapse
Affiliation(s)
- Siva Naga S Yarrarapu
- Department of Internal Medicine, Rutgers/Monmouth Medical Center, Long Branch, NJ, USA
| | - Amandeep Goyal
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Viraj Panchal
- Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | | | - Doantrang T Du
- Department of Internal Medicine, Rutgers/Monmouth Medical Center, Long Branch, NJ, USA
| | - Roopesh Sai Jakulla
- Department of Internal Medicine, University of Missouri, Kansas City, MO, USA
| | - Hema Pamulapati
- Department of Cardiology, Hays Medical Center, Hays, KS, USA
| | - Mazhar A Afaq
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Steven Owens
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA.
| |
Collapse
|
3
|
Cox ZL, Dalia T, Goyal A, Fritzlen J, Gupta B, Shah Z, Sauer AJ, Haglund NA. Novel Nebulized Milrinone Formulation for the Treatment of Acute Heart Failure Requiring Inotropic Therapy: A Phase 1 Study. J Card Fail 2024; 30:329-336. [PMID: 37871843 DOI: 10.1016/j.cardfail.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Nonintravenous inotropic-delivery options are needed for patients with inotropic-dependent heart failure (HF) to reduce the costs, infections and thrombotic risks associated with chronic central venous catheters and home infusion services. METHODS We developed a novel, concentrated formulation of nebulized milrinone for inhalation and evaluated the feasibility, safety and pharmacokinetic profile in a prospective, single-arm, phase I clinical trial. We enrolled 10 patients with stage D HF requiring inotropic therapy during a hospital admission for acute HF. Milrinone 60 mg/4 mL was inhaled via nebulization 3 times daily for 48 hours. The coprimary outcomes were adverse events and pharmacokinetic profiles of inhaled milrinone. Acute changes in hemodynamic parameters were secondary outcomes. RESULTS A concentrated nebulized milrinone formulation was well tolerated, without hypotensive events, arrhythmias or inhalation-related adverse events requiring discontinuation. Nebulized milrinone produced serum concentrations in the goal therapeutic range with a median plasma milrinone trough concentration of 39 (17-66) ng/mL and a median peak concentration of 207 (134-293) ng/mL. There were no serious adverse events. From baseline to 24 hours, mean pulmonary artery saturation increased (60% ± 7%-65 ± 5%; P = 0.001), and mean cardiac index increased (2.0 ± 0.5 mL/min/1.73m2-2.5 ± 0.1 mL/min/1.73m2; P = 0.001) with nebulized milrinone. CONCLUSIONS In a proof-of-concept study, a concentrated, nebulized milrinone formulation for inhalation was safe and produced therapeutic serum milrinone concentrations. Nebulized milrinone was associated with improved hemodynamic parameters of cardiac output in a population with advanced HF. These promising results require further investigation in a longer-term trial in patients with inotrope-dependent advanced HF.
Collapse
Affiliation(s)
- Zachary L Cox
- Department of Pharmacy Practice and Pharmaceutical Science, Lipscomb University College of Pharmacy, Nashville, TN; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN.
| | - Tarun Dalia
- The Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS
| | - Amandeep Goyal
- The Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS
| | - John Fritzlen
- The Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS
| | - Bhanu Gupta
- The Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS
| | - Zubair Shah
- The Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Nicholas A Haglund
- Minneapolis Heart Institute, Allina Health at Abbott Northwestern Hospital, Minneapolis, MN
| |
Collapse
|
4
|
Agrawal A, Romics L, Thekkinkattil D, Soliman M, Kaushik M, Barmpounakis P, Mortimer C, Courtney CA, Goyal A, Garreffa E, Carmichael A, Lane RA, Rutherford C, Kim B, Achuthan R, Pitsinis V, Goh S, Ray B, Grover K, Vidya R, Murphy J. 'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps. Breast 2023; 71:82-88. [PMID: 37544090 PMCID: PMC10430575 DOI: 10.1016/j.breast.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
Collapse
Affiliation(s)
- A Agrawal
- Cambridge University Hospitals, Cambridge, UK.
| | - L Romics
- New Victoria Hospital, Glasgow, UK.
| | | | - M Soliman
- Cambridge University Hospitals, Cambridge, UK; Mansoura University, Egypt.
| | - M Kaushik
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - P Barmpounakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece.
| | | | | | - A Goyal
- Royal Derby Hospital, Derby, UK.
| | | | - A Carmichael
- University Hospital of Derby and Burton, Belvedere Road, Burton on Trent, UK.
| | - R A Lane
- Cambridge University Hospitals, Cambridge, UK.
| | | | - B Kim
- St. James's University Hospital, Leeds, UK.
| | - R Achuthan
- St. James's University Hospital, Leeds, UK.
| | | | - S Goh
- Peterborough Hospital, Peterborough, UK.
| | - B Ray
- Harrogate NHS Trust, Harrogate, UK.
| | | | - R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | - J Murphy
- Manchester University Hospital, Manchester, UK.
| |
Collapse
|
5
|
Hennayake S, Goyal A, Cserni T, Bianchi A. Correspondence; 'Transformation of the female genitalia in congenital adrenal hyperplasia: MRI study'. J Pediatr Urol 2023; 19:596-597. [PMID: 37263835 DOI: 10.1016/j.jpurol.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Affiliation(s)
- S Hennayake
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - A Goyal
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - T Cserni
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Bianchi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| |
Collapse
|
6
|
Mancuso J, Dalia T, Goyal A, Elliott DRF, Shah Z, Vidic A. Cytomegalovirus infection in heart transplant patient presenting as appendicitis. J Cardiol Cases 2023; 28:113-115. [PMID: 37671257 PMCID: PMC10477039 DOI: 10.1016/j.jccase.2023.04.013] [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: 11/02/2022] [Revised: 03/30/2023] [Accepted: 04/23/2023] [Indexed: 09/07/2023] Open
Abstract
Cytomegalovirus (CMV) may manifest in various ways. While immunocompetent hosts may be asymptomatic or present with a mononucleosis-like illness, immunocompromised patients can have organ-specific disease capable of significant morbidity and mortality. CMV appendicitis is a particularly rare presentation. A 22-year-old female with a history of orthotopic heart transplantation presented to our hospital with a three-day history of worsening abdominal pain. A computed tomography scan of her abdomen was consistent with acute uncomplicated appendicitis, and she underwent laparoscopic appendectomy. Pathology revealed acute appendicitis with numerous large cells with intranuclear "owl's eye" inclusions characteristic of CMV. Her CMV viral load was elevated at 327,018 IU/ml. She was started on ganciclovir which resulted in improvement of her CMV level to 30,118 IU/ml within three weeks. CMV is a frequent cause of opportunistic infection in solid organ transplant patients and commonly involves the gastrointestinal tract. Acute appendicitis is a rarely reported complication to consider in the differential diagnosis of abdominal pain in immunocompromised patients. Learning objective Heart transplant recipients are at increased risk for opportunistic infections. Cytomegalovirus (CMV) is a frequent culprit and can present with a broad range of disease. A particularly rare presentation is that of acute appendicitis. We describe a case of a young woman with CMV appendicitis following orthotopic heart transplant.
Collapse
Affiliation(s)
- Joseph Mancuso
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA
| | - Amandeep Goyal
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Zubair Shah
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrija Vidic
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
7
|
Dalia T, Pothuru S, Chan WC, Mehta H, Goyal A, Farhoud H, Boda I, Malhotra A, Vidic A, Rali AS, Hanff TC, Gupta K, Fang JC, Shah Z. Trends and Outcomes of Cardiogenic Shock in Patients With End-Stage Renal Disease: Insights From USRDS Database. Circ Heart Fail 2023; 16:e010462. [PMID: 37503601 DOI: 10.1161/circheartfailure.122.010462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND There is a paucity of data regarding epidemiology, temporal trends, and outcomes of patients with cardiogenic shock (CS) and end-stage renal disease (chronic kidney disease stage V on hemodialysis). METHODS This is a retrospective cohort study using the United States Renal Data System database from January 1, 2006 to December 31, 2019. We analyzed trends of CS, percutaneous mechanical support (intraaortic balloon pump, percutaneous ventricular assist device [Impella and Tandemheart], and extracorporeal membrane oxygenation) utilization, index mortality, 30-day mortality, and 1-year all-cause mortality in end-stage renal disease patients. RESULTS A total of 43 825 end-stage renal disease patients were hospitalized with CS (median age, 67.8 years [IQR, 59.4-75.8] and 59.1% men). From 2006 to 2019, the incidence of CS increased from 275 to 578 per 100 000 patients (Ptrend<0.001). The index mortality rate declined from 54.1% in 2006 to 40.8% in 2019 (Ptrend=0.44), and the 1-year all-cause mortality decreased from 63% in 2006 to 61.8% in 2018 (Ptrend=0.73), but neither trend was statistically significant. There was a significantly decreased utilization of intra-aortic balloon pumps from 17 832 to 7992 (Ptrend<0.001), increased utilization of percutaneous ventricular assist device from 137 to 5201 (Ptrend<0.001) and increase in extracorporeal membrane oxygenation use from 69 to 904 per 100 000 patients (Ptrend<0.001). After adjusting for covariates, there was no significant difference in index mortality between CS patients requiring percutaneous mechanical support versus those not requiring percutaneous mechanical support (odds ratio, 0.97 [CI, 0.91-1.02]; P=0.22). On multivariable regression analysis, older age, peripheral vascular disease, diabetes, and time on dialysis were independent predictors of higher index mortality. CONCLUSIONS The incidence of CS in end-stage renal disease patients has doubled without significant change in the trend of index mortality despite the use of percutaneous mechanical support.
Collapse
Affiliation(s)
- Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - Suveenkrishna Pothuru
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - Hassan Farhoud
- Medical Student, Class of 2023, University of Kansas Medical Center (H.F.)
| | - Ilham Boda
- Department of Internal Medicine, University of Kansas Health System (I.B., A.M.)
| | - Anureet Malhotra
- Department of Internal Medicine, University of Kansas Health System (I.B., A.M.)
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - Aniket S Rali
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (A.S.R.)
| | - Thomas C Hanff
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City (T.C.H., J.C.F.)
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| | - James C Fang
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City (T.C.H., J.C.F.)
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Health System (T.D., S.P., W.-C.C., H.M., A.G., A.V., K.G., Z.S.)
| |
Collapse
|
8
|
Hennayake S, Cervellione R, Goyal A, Keene D, Cserni T, De Silva A, Rossi A, Bianchi A. Commentary: Symptomatic corpus spongiosum defect in adolescents and young adults who underwent distal hypospadias repair during childhood. J Pediatr Urol 2023:S1477-5131(23)00148-1. [PMID: 37147141 DOI: 10.1016/j.jpurol.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/07/2023]
Affiliation(s)
- S Hennayake
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - R Cervellione
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Goyal
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - D Keene
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - T Cserni
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A De Silva
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Rossi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Bianchi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| |
Collapse
|
9
|
Alahmad MM, Dalia T, Goyal A, Bhyan P, Shah Z. Endomyocardial Biopsy Utilization and Outcomes Among Patients with Myocarditis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.436] [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: 04/05/2023] Open
|
10
|
Goyal A, Dalia T, Ranka S, Sauer AJ, Hu J, Cernik C, Nuqali A, Chandler J, Parimi N, Dennis K, Majmundar M, Tayeb T, Haglund J, Shah Z, Vidic A, Gupta B, Haglund NA. Impact of Biopsy Proven Liver Fibrosis on Patients Undergoing Evaluation and Treatment for Advanced Heart Failure Surgical Therapies. Am J Cardiol 2023; 194:46-55. [PMID: 36947946 DOI: 10.1016/j.amjcard.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
There is a paucity of data regarding the impact of liver fibrosis on patients with stage D heart failure (HF). We conducted a retrospective study (January 1, 2017 to December 12, 2020) in patients with stage D HF who underwent liver biopsy as part of their advanced HF therapy evaluation. Baseline characteristics and 1-year outcomes were compared between no- or mild-to-moderate-fibrosis (grade 0 to 2) and advanced-fibrosis (grade 3 to 4) groups. Of 519 patients with stage D HF, 136 who underwent liver biopsy (113 [83%] no or mild-to-moderate fibrosis and 23 [17%] advanced fibrosis) were included. A total of 71 patients (52%) received advanced HF therapies (23 heart transplantation, 48 left ventricular assist devices). One-year mortality was higher among patients with advanced fibrosis (52% vs 18%, p <0.001). Further subgroup analysis suggested a trend toward increased 1-year mortality among patients with advanced fibrosis who underwent advanced therapies (37% vs 13%, p = 0.09). There was a trend of lower likelihood of receiving advanced HF therapies in the advanced-fibrosis group, only 1 heart transplantation and 7 left ventricular assist devices, but it did not reach statistical significance (35% vs 56%, p = 0.06). After adjustment for confounders, degree of liver fibrosis was an independent predictor of mortality (odds ratio 6.2; 95% 1.27 to 30.29, p = 0.02). We conclude that advanced liver fibrosis is common among patients with stage D HF who undergo evaluation for advanced HF surgical therapies and significantly increases 1-year mortality. Further larger studies are needed to support our findings.
Collapse
Affiliation(s)
- Amandeep Goyal
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Tarun Dalia
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Sagar Ranka
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Andrew J Sauer
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jinxiang Hu
- Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas
| | - Colin Cernik
- Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas
| | - Abdulelah Nuqali
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jonathan Chandler
- Departments of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Nikhil Parimi
- Departments of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Katie Dennis
- Departments of Pathology, The University of Kansas Health System, Kansas City, Kansas
| | - Monil Majmundar
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Taher Tayeb
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jennifer Haglund
- Departments of Gastroenterology and Hepatology, The University of Kansas Health System, Kansas City, Kansas
| | - Zubair Shah
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Andrija Vidic
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Bhanu Gupta
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Nicholas A Haglund
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas.
| |
Collapse
|
11
|
Bhyan P, Mehta A, Goyal A, Dalia T, Bhyan P, Gahona CT, Rosamond TL. AN UNREPAIRED, UNRUPTURED GIGANTIC LEFT VENTRICLE PSEUDOANEURYSM. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
12
|
Boda I, Farhoud H, Dalia T, Goyal A, Shah Z, Vidic A. Early and aggressive presentation of wild-type transthyretin amyloid cardiomyopathy: A case report. World J Cardiol 2022; 14:657-664. [PMID: 36605423 PMCID: PMC9808025 DOI: 10.4330/wjc.v14.i12.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Wild-type transthyretin amyloidosis (ATTRwt) is the most common form of transthyretin amyloid cardiomyopathy, occurring mostly over age of 60 years (mean age of 80 years). Mean survival without treatment is 3.6 years, making early detection imperative. We report an unusual case of a 58-year-old patient with ATTRwt cardiomyopathy requiring heart transplantation.
CASE SUMMARY A 58-year-old male presented with progressive fatigue, shortness of breath, weight gain, leg swelling, orthopnoea, and paroxysmal nocturnal dyspnoea for several months. Approximately ten months before this clinical presentation, the patient had first received a diagnosis of heart failure with reduced ejection fraction (EF) of 15% to 20%. The patient was started on appropriate guideline-directed medical therapy with only mild improvement in his EF. Upon further investigation, echocardiogram, technetium pyrophosphate scan (Tc PYP), and cardiac magnetic resonance imaging (cMRI) suggested a diagnosis of amyloidosis, and ATTRwt was subsequently confirmed with native heart tissue biopsy, congo red staining, liquid chromatography-tandem mass spectrometry, and genetic testing. The patient was successfully treated with heart transplantation and is doing well post-transplant.
CONCLUSION Wild-type ATTR amyloidosis should be kept on differentials in all patients (even less than 60 years old) with non-ischemic cardiomyopathy, especially in the setting of increased ventricular wall thickness and other classic echocardiogram, cMRI, and Tc PYP findings. Early diagnosis and management can be consequential in improving patient outcomes.
Collapse
Affiliation(s)
- Ilham Boda
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Hassan Farhoud
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| |
Collapse
|
13
|
Goyal A, Bhyan P, Dalia T, Mufarrih SM, Gujrati R, Pothuru S, Chhabra L. Pacemaker Malfunction Due to Electric Blanket: A Rare Case of Electromagnetic Interference. Kans J Med 2022; 15:446-448. [PMID: 36578459 PMCID: PMC9778785 DOI: 10.17161/kjm.vol15.18549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Poonam Bhyan
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | | | - Rahul Gujrati
- Department of Medicine, University of Florida Health, Jacksonville, FL
| | | | - Lovely Chhabra
- Department of Cardiology, Westchester Medical Center, New York Medical Center, Valhalla, NY
| |
Collapse
|
14
|
Sami F, Acharya P, Noonan G, Maurides S, Al-Masry AA, Bajwa S, Parimi N, Boda I, Tran C, Goyal A, Mastoris I, Dalia T, Sauer A, Bakel AVAN, Shah Z. Palliative Inotropes in Advanced Heart Failure: Comparing Outcomes Between Milrinone and Dobutamine. J Card Fail 2022; 28:1683-1691. [PMID: 36122816 DOI: 10.1016/j.cardfail.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND We sought to describe and compare outcomes among advanced patients with heart failure (not candidates for orthotopic heart transplant/left ventricular assist device) on long-term milrinone or dobutamine, which are not well-studied in the contemporary era. METHODS AND RESULTS We included adults with refractory stage D heart failure who were not candidates for orthotopic heart transplant or left ventricular assist device and discharged on palliative dobutamine or milrinone. The primary outcome was 1-year survival. A 6-month predictor of survival analysis was conducted. A total of 248 patients (133 on milrinone, 115 on dobutamine) were included. There were no differences in baseline comorbidities between milrinone and dobutamine cohorts, except for the prevalence of chronic kidney disease, which was higher in the dobutamine group. On discharge, the proportion of patients on beta-blockers and mineralocorticoid antagonists was higher in milrinone group. Overall, the 1-year mortality rate was 70%. The dobutamine cohort had a significantly higher 1-year mortality rate (84% vs 58%, P <0.001). The type of inotrope did not predict survival at 6 months when adjusted for discharge medications and comorbidities. Beta-blockers and angiotensin-converting enzyme/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor continued at discharge predicted survival at 6 months. CONCLUSIONS The 1-year mortality from palliative inotropes remains high. Compared with dobutamine, use of milrinone was associated with improved survival owing to better optimization of guideline-directed medical therapy, primarily beta-blocker therapy.
Collapse
Affiliation(s)
- Farhad Sami
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas; University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Prakash Acharya
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Grace Noonan
- Medical Student, University of Kansas Medical Center, Kansas City, Kansas
| | - Steven Maurides
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Anas Abudan Al-Masry
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas; University of Arizona, Phoenix, Arizona
| | - Suhaib Bajwa
- Medical Student, University of Kansas Medical Center, Kansas City, Kansas
| | - Nikhil Parimi
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ilham Boda
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Christina Tran
- Medical Student, University of Kansas Medical Center, Kansas City, Kansas
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew Sauer
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Adrian VAN Bakel
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
| |
Collapse
|
15
|
Tansir G, Rastogi S, Dubasi S, Lavu R, Chitikela S, Barwad A, Goyal A. 414P Lessons learnt from clinico-genomic profiling of families with Li Fraumeni Syndrome: The largest case series from the Indian setting. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.445] [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: 12/07/2022] Open
|
16
|
Mohamad Alahmad M, Goyal A, Mohammed M. Validity of CHA2DS2-VASc score in patients with malignancies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Anticoagulation for patients with atrial fibrillation/flutter (AF) after risk stratification based on CHA2DS2-VASc score (congestive heart failure, hypertension, age group, Diabetes Mellitus, prior stroke, transient ischemic attack or thromboembolism, prior heart attack, peripheral artery disease or aortic plaque and patient's gender) has been the gold standard practice to prevent cerebrovascular accidents (CVA).
Purpose
Since patients with malignancies are at increased risk of thrombophilia, we tried to study if cancer patients with atrial fibrillation are at increased risk for CVA beyond what should be expected based on their comorbidities.
Methods
We used the Nationwide Readmissions Database (NRD) database for the years 2016–2019. First, we extracted all cases with a diagnosis of atrial fibrillation/flutter. Exclusion criteria included patients younger than 18-year-old. We studied the comorbidities and calculated CHA2DS2-VASc score. Then, we compared the risk for admission with an acute CVA in patients with and without any diagnosis of malignancies (solid cancer, leukemia, lymphoma or metastatic disease). Patients with carcinoma in situ were considered non-cancer patients. Corrected logistic regression and Chi-square tests using survey procedures in SAS 8.1 were applied to accommodate for complex sampling (Rao-Scott design).
Results
We identified 1,748,619 weighted admissions with AF equally distributed across the years. 5% were patients with malignancies. The mean age was 74-year-old for cancer patients and 71-year-old for non-cancer patients with quite equal gender distribution (43–49% were female). Patients with a diagnosis of cancer has high inpatient mortality (13%). Every additional point in CHA2DS2-VASc score was associated with increased odds of admission with CVA. Having a diagnosis of cancer was not associated with increased odds of admission with CVA (odd ratio for 95% confidence interval 1.0 [0.95–1.1]). Patients with history of VTE (assuming they are on anticoagulation) or who are on chronic anticoagulation have lower risk of admission with acute CVA if they have AF.
Conclusions
Although malignancies is associated with hypercoagulable status including higher risk for stroke, deep venous thrombosis and pulmonary embolism, our cross-sectional study indicates that CHA2DS2-VASc score is still a reliable tool for risk stratification in patients with atrial fibrillation. More longitudinal studies are needed.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Mohamad Alahmad
- University of Kansas Medical Center , Kansas City , United States of America
| | - A Goyal
- University of Kansas Medical Center , Kansas City , United States of America
| | - M Mohammed
- Rochester Regional Health, Cardiology , Rochester , United States of America
| |
Collapse
|
17
|
Goyal A, Dalia T, Bhyan P, Farhoud H, Shah Z, Vidic A. Rare case of chronic Q fever myocarditis in end stage heart failure patient: A case report. World J Cardiol 2022; 14:508-513. [PMID: 36187426 PMCID: PMC9523269 DOI: 10.4330/wjc.v14.i9.508] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Q fever myocarditis is a rare disease manifestation of Q fever infection caused by Coxiella burnetii. It is associated with significant morbidity and mortality if left untreated. Prior studies have reported myocarditis in patients with acute Q fever. We present the first case of chronic myocarditis in an end-stage heart failure patient with chronic Q fever infection.
CASE SUMMARY A 69-year-old male was admitted with dyspnea on exertion, hypotension and bilateral lower extremity edema for a few months. He has a past medical history of ischemic cardiomyopathy with left ventricular ejection fraction of 25%, implantable cardioverter defibrillator in place, bioprosthetic aortic valve and mitral valve replacement. He continued to have shortness of breath despite diuresis along with low grade fevers. Initial infectious work up came back negative. On further questioning, the patient was found to have close contact with farm animals and the recurrent fevers prompted the work-up for Q fever. Q fever serologies and cardiac positron emission tomography confirmed the diagnosis of chronic Q fever myocarditis. He was then successfully treated with doxycycline and hydroxychloroquine for 18 mo.
CONCLUSION Chronic Q fever myocarditis, if left untreated, carries a poor prognosis. It should be kept in differentials, especially in patients with recurrent fevers and contact with farm animals.
Collapse
Affiliation(s)
- Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Poonam Bhyan
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC 28304, United States
| | - Hassan Farhoud
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| |
Collapse
|
18
|
Welliver M, Goyal A, Mo X, Dick S, Ma G, Bazan J, Brownstein J, Haglund K, Willimas T, DiCostanzo D, Grecula J, Addison D, Miller E. EP05.01-021 Radiation Dose to Cardiac Substructures and the Incidence of Cardiac Events in Patients with Stage III NSCLC Receiving CCRT. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.468] [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: 10/14/2022]
|
19
|
Affiliation(s)
- A Goyal
- From the Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Room No. 638, 6th floor, Superspeciality Block, Delhi 110029, India
| | - P Ish
- From the Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Room No. 638, 6th floor, Superspeciality Block, Delhi 110029, India
| |
Collapse
|
20
|
Pothuru S, Chan W, Goyal A, Dalia T, Mastoris I, Sauer A, Gupta K, Porter CB, Shah Z. Emergency department use and hospital admissions among adult orthotopic heart transplant patients. J Am Coll Emerg Physicians Open 2022; 3:e12718. [PMID: 35677288 PMCID: PMC9167054 DOI: 10.1002/emp2.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To study the demographics, clinical presentations, and outcomes of emergency department (ED) visits of patients with heart transplantation (HT) in the United States. Methods We performed a secondary analysis of the National Emergency Department Sample database from 2016 to 2018. All ED visits of patients with HT aged ≥ 18 years were identified using International Classification of Diseases, Tenth Revision codes. Results Out of a total 308,182,495 national ED visits, 55,583 were HT‐related visits. The median age was 61.07 years (interquartile range [IQR]: 46.91–69.38) and 69.44% were males. The hospital admission rate was 54.3% and median inpatient length of stay was 3.19 days (IQR: 1.63–5.92). The mortality rate during inpatient stay was 1.16%. Median inpatient and ED charges among admitted patients were $37,911 (IQR: $21,487–$71,262). The most common primary diagnosis of HT‐related ED visits was sepsis (4.3%) followed by acute kidney injury (3.57%) and chest pain (3%). Conclusion More than half of total ED visits among HT patients resulted in hospital admission. The most common cause for ED visit in these patients was sepsis followed by acute kidney injury and chest pain.
Collapse
Affiliation(s)
| | - Wan‐Chi Chan
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Amandeep Goyal
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Tarun Dalia
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Andrew Sauer
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Charles B. Porter
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| | - Zubair Shah
- Department of Cardiovascular Medicine The University of Kansas Health System University of Kansas School of Medicine Kansas City KS USA
| |
Collapse
|
21
|
Nabi Z, Butt R, Mir R, Hills J, Tsang Y, Wheatley D, Bhattacharya I, Ranger A, Cramp S, Hammonds N, Goyal A. PO-1835 A glimpse at breast internal mammary chain radiotherapy practice in the United Kingdom. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03798-7] [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: 10/18/2022]
|
22
|
Price H, Nabi Z, Butt R, Mir R, Diez P, Dodwell D, Sadiq S, Lewis M, Goyal A. PD-0335 Dosimetric differences between field and volume-based regional nodal RT in the POSNOC breast trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02828-6] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Butt R, Nabi Z, Mir R, Hills J, Wheatley D, Bhattacharya I, Ranger A, Cramp S, Hammonds N, Goyal A, Tsang Y. MO-0644 Practice patterns for outlining the axilla and IMC, findings of the RTQA for the ATNEC trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02402-1] [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: 10/18/2022]
|
24
|
Goyal A, Chandler J, Dalia T, Ranka S, Fritzlen J, Sami F, Mastoris I, Titterington J, Khashab ME, Haglund N, Gupta B, Vidic A, Danter M, Sauer A, Shah Z, Abicht T. Outcomes In Heartmate 3 (HM3) Vs Heartware (HVAD) Patients: A Single Center Experience. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Pothuru S, Chan WC, Goyal A, Dalia T, Gupta K, Shah Z. Emergency Department Use And Hospital Admissions Among Adult Orthotopic Heart Transplant Patients. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.178] [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: 11/25/2022]
|
26
|
Dalia T, Goyal A, Chan WC, Ranka S, Sami F, Weidling R, Pothuru S, Sauer A, Haglund N, Gupta K, Shah Z. Left Ventricular Assist Device Outcomes In Patients With Chronic Kidney Disease And End-stage Renal Disease. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.142] [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: 10/18/2022]
|
27
|
Hockney S, Santoiemma P, Goyal A, Kumar R, Ghafourian K, Stosor V. Mucormycosis After Heart Transplantation: A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1579] [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: 11/26/2022] Open
|
28
|
Sami F, Noonan G, Abudan A, Maurides S, Acharya P, Bajwa S, Goyal A, Dalia T, Parimi N, Tran C, Sauer A, Van Bakel A, Shah Z. Outcomes In Patients On Chronic Inotropic Support Who Are Not Candidates For Advanced Heart Failure Therapies. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.018] [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: 11/16/2022]
|
29
|
Goyal A, Hockney S, Kumar R, Harap R, Wilcox J, Pham D, Stosor V. Do VAD Infections Predict Post-Heart Transplant Infections or Mortality? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.683] [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: 11/25/2022] Open
|
30
|
Dalia T, Acharya P, Chan WC, Sauer A, Weidling R, Fritzlen J, Goyal A, Miller D, Porter C, Shah Z. Prognostic Role Of Cardiopulmonary Exercise Testing In Wild Type Transthyretin Amyloid Cardiomyopathy Patients Treated With Tafamidis. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.057] [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: 11/16/2022]
|
31
|
Nuqali A, Goyal A, Acharya P, Mastoris I, Dalia T, Sauer A, Shah Z. Thirty-day Readmissions Among Patients With Cardiogenic Shock Who Underwent Extracorporeal Membrane Oxygenation Support In The United States: Insights From The Nationwide Readmissions Database. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.104] [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: 10/18/2022]
|
32
|
Goyal A, Acosta NT, Shah Z, Henkel S, Dalia T, Abicht T. Acute Pump Thrombosis Within 1 Hour Of Heartmate 3 Implantation. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.180] [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: 11/25/2022]
|
33
|
Singh P, Arora S, Goyal A, Mittal N, Singh A, Sharma S, Shanthaiah D, Dardi I. INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Acta Endocrinol (Buchar) 2022; 18:174-180. [PMID: 36212268 PMCID: PMC9512378 DOI: 10.4183/aeb.2022.174] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide. AIMS The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus. METHODS We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications. RESULTS The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED. CONCLUSION Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.
Collapse
Affiliation(s)
- P. Singh
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - S. Arora
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - A. Goyal
- Dayanand Medical College and Hospital, Dept. of Urology
| | - N. Mittal
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - A. Singh
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - S. Sharma
- Dayanand Medical College and Hospital, Dept. of social and preventive medicine, Ludhiana, Punjab
| | - D.M. Shanthaiah
- Institute of Medical Sciences, Dept. of Endocrinology and Metabolism, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - I.K. Dardi
- Columbia Asia Hospital, Patiala, Punjab, India
| |
Collapse
|
34
|
Goyal A, Mehta H, Bhyan P, Dalia T, Patel N, Acharya P, Pothuru S, Sauer A, Danter M, Vidic A, Abicht T, Shah Z. THIRTY-DAY READMISSION RATES AND CAUSES AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: INSIGHTS FROM THE NATIONWIDE READMISSIONS DATABASE: 2016-2018. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01390-0] [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: 10/18/2022]
|
35
|
Truyen TTTT, Vu P, Tran N, Le HN, Nguyen HD, Bui A, Tran N, Nguyen T, Nguyen C, Goyal A, Nguyen AT, Mai T, Tran P. GIANT LEFT ATRIAL MYXOMA WITH FUNCTIONAL SEVERE MITRAL VALVE STENOSIS: EARLY SURGICAL INTERVENTION IS CRITICALLY NEEDED. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04038-4] [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: 11/28/2022]
|
36
|
Truyen TTTT, Dang H, Tran S, Vu P, Le TTB, Nguyen HD, Truong DN, Tran H, Nguyen DNC, Pham HN, Goyal A, Ngo K, Tran P. VENTRICULAR SEPTAL PERFORATION IN THE SETTING OF TAKOTSUBO SYNDROME: LEARNING HOW TO IMPROVE MORTALITY RATE THROUGH EARLY RECOGNITION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03658-0] [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: 11/29/2022]
|
37
|
Patel N, Ghosh B, Hajra A, Bandyopadhyay D, Chakraborty S, Amgai B, Goyal A, Dalia T. THE BURDEN OF CHRONIC CARDIOVASCULAR COMORBIDITIES IN SEXUAL MINORITY POPULATIONS: ANALYSIS FROM THE NATIONWIDE INPATIENT SAMPLE DATABASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Goyal A, Patel N, Dalia T, Sauer A, Porter CB, Shah Z. CHARACTERISTICS AND OUTCOMES IN PATIENTS ADMITTED WITH HEART FAILURE WITH UNDERLYING AMYLOIDOSIS: INSIGHTS FROM THE NATIONWIDE READMISSION DATABASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01354-7] [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: 10/18/2022]
|
39
|
Kumar A, Goyal A, Gauba K, Kapur A, Singh SK, Mehta SK. An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: An in-situ and in-vitro study. Eur Arch Paediatr Dent 2022; 23:79-87. [PMID: 34057698 DOI: 10.1007/s40368-021-00630-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/12/2020] [Accepted: 05/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Molar incisor hypomineralization (MIH) affected teeth have enamel with altered mineral content like decreased calcium and phosphorus and increased carbon content leading to porous enamel and subsequent post-eruptive breakdown. AIM An in situ study was conducted to evaluate and compare the effects of a Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-based cream and fluoride varnish on the remineralization of MIH affected teeth. METHODS Enamel slabs were prepared from MIH affected teeth that had been extracted for various reasons and inserted in appliances of 30 participants who were undergoing interceptive orthodontic therapy. They were randomly divided into two groups using block randomization technique: Group A-daily single application of CPP-ACP cream (n = 15); Group B-professional application of fluoride varnishes every 3 months (n = 15). After 6 months of regular wear of the appliance, the enamel slabs were placed under Field Emission Scanning Microscope (FESEM) and Energy-Dispersive Spectroscopy (EDS) for evaluation of ultra structure and mineral content, respectively. RESULTS A significant increase in calcium and phosphorus content, and a decrease in carbon content was observed within the 6 months period, suggesting remineralization in both the groups. On comparing the Ca:P and Ca:C ratios, a significant increase in the Ca:C ratio was evident in the two groups. No significant difference was seen in the Ca:P ratio in the CPP-ACP group at six months. The inter-group comparison did not reveal any significant difference between the two groups either at baseline or at 6 months post-intervention. CONCLUSION Remineralization can be achieved in MIH affected teeth with the use of remineralizing agents.
Collapse
Affiliation(s)
- A Kumar
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Singh
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - S K Mehta
- Punjab University, Chandigarh, India
| |
Collapse
|
40
|
Singh SK, Goyal A, Gauba K, Bhandari S, Kaur S. Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial. Eur Arch Paediatr Dent 2022; 23:147-158. [PMID: 34398412 DOI: 10.1007/s40368-021-00657-8] [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: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. AIM To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs). METHODS 60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months. RESULTS After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups. CONCLUSION Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.
Collapse
Affiliation(s)
- S K Singh
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Bhandari
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kaur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
41
|
Mukhtar U, Goyal A, Luthra-Guptasarma M, Gauba K, Kapur A, Thakur AK. Label-free quantitative proteomics reveals molecular correlates of altered biomechanical properties in molar incisor hypomineralization (MIH): an in vitro study. Eur Arch Paediatr Dent 2022; 23:179-191. [PMID: 35013981 DOI: 10.1007/s40368-021-00687-2] [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: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Molar-incisor hypomineralization (MIH) is a qualitative developmental defect of enamel that affects first permanent molars with or without affecting permanent incisors. We aimed to carry out a quantitative proteomics-based study to compare and evaluate proteins in sound and MIH-affected enamel. MATERIALS AND METHODS Ten blocks each of the MIH-affected enamel and sound enamel were processed and prepared for LC-MS/MS analysis. Label-free quantitation was carried out to evaluate the differentially expressed proteins in the two groups of samples. RESULTS A significant increase in the number of proteins in MIH-affected enamel (50.3 ± 29.6) was observed compared to the sound enamel (21.4 ± 3.2). While proteins like collagens, α1-anti-trypsin, kallikrein-4 (KLK4), matrix metalloprotease-20 (MMP-20), alpha-2-macroglobulin, and alpha-2-HS-glycoprotein were upregulated in sound enamel, there was over-expression of albumin, calcium-binding proteins, anti-thrombin III, and dentin sialophosphoprotein (DSPP), along with proteins implicated in stress response and inflammatory processes in MIH. CONCLUSION We propose that altered biomechanical properties of the enamel in MIH samples arise due to (i) down-regulation of proteins contributing to collagen biosynthesis and fibril formation; (ii) an overall imbalance in required levels of proteases (KLK4 and MMP-20) and anti-proteases (anti-thrombin-III which inhibits KLK-4), essential for optimal mineralization; (iii) very low levels of alpha-2-macroglobulin with important consequences in enamel mineralization and amelogenesis; and (iv) increased albumin in MIH, preventing proper growth of hydroxyapatite crystals. Increased inflammatory component was also seen in MIH; however, whether inflammation is a cause or consequence of the poor mineralization process needs to be assessed.
Collapse
Affiliation(s)
- U Mukhtar
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - M Luthra-Guptasarma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Thakur
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
42
|
Taduru SS, Goyal A, Dalia T, Mastoris I, Rali AS, Acharya P, Weidling R, Sauer A, Haglund N, Shah Z. Inpatient Characteristics, Complications, and Outcomes of Patients with Cardiac Sarcoidosis: A Study from The National Inpatient Sample. Indian Heart J 2022; 74:148-150. [PMID: 35104459 PMCID: PMC9039686 DOI: 10.1016/j.ihj.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Although seen in ∼5% of sarcoidosis patients, cardiac sarcoidosis (CS) accounts for nearly 25% of disease-related deaths. This study aimed to describe characteristics and outcomes among CS patients. Patients diagnosed with CS in 2016-2017 in the US National Inpatient Sample Database were evaluated to study patient characteristics, reasons ascribed to admission, in-hospital outcomes, and complications. A total of 2420 patients (median age 56 years) were included in the analysis. Most admissions occurred due to ventricular tachycardia (12.8%), followed by myocarditis (9.9%) with a mean length of stay of 7±7 days. The overall incidence of in-hospital mortality was 2.5%.
Collapse
Affiliation(s)
- Siva S Taduru
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Aniket S Rali
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Robert Weidling
- Department of Internal Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Andrew Sauer
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nicholas Haglund
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA.
| |
Collapse
|
43
|
Patel N, Ranka S, Hajra A, Bandyopadhyay D, Amgai B, Chakraborty S, Khalid M, Goyal A, Dalia T, Reddy YM, Shani J. Gender-Specific Outcomes after Percutaneous Left Atrial Appendage Closure - A Nationwide Readmission Database Analysis. J Cardiovasc Electrophysiol 2022; 33:430-436. [PMID: 35023251 DOI: 10.1111/jce.15359] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thromboembolism-associated stroke is the most feared complication of Atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can't tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients. METHODS Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results. RESULT 28,819 patients were included in our study. Among them 11,946 (41.5%) were women and 16,873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~ 1 year older than men. The overall rate of complications was higher in women (8.6% vs 6.6%, P<0.001), primarily driven by bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI: 1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97, p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014). Women had two times higher peri-procedural ischemic stroke. There was no difference in peri-procedural mortality. Women remained at 20% and 13% higher risk for readmission at 30 days and 6 months of discharge. CONCLUSION Women had higher peri-procedural complications and were at higher risk of readmissions at 30 days and six months. However, there was no difference in mortality during the index hospitalization. Further studies are necessary to determine causality. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Neel Patel
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Sagar Ranka
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | | | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Y Madhu Reddy
- University of Kansas Medical Center, Kansas City, KS, USA
| | | |
Collapse
|
44
|
Nuqali A, Goyal A, Acharya P, Mastoris I, Dalia T, Chan WC, Sauer A, Haglund N, Vidic A, Abicht T, Danter M, Gupta K, Tonna JE, Shah Z. Thirty-day readmissions among patients with cardiogenic shock who underwent extracorporeal membrane oxygenation support in the United States: Insights from the nationwide readmissions database. Am Heart J Plus 2022; 13:100076. [PMID: 38560058 PMCID: PMC10978167 DOI: 10.1016/j.ahjo.2021.100076] [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] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 04/04/2024]
Abstract
Background There is a paucity of data on readmission rates and predictors of readmissions in cardiogenic shock patients after contemporary Extracorporeal Membrane Oxygenation (ECMO) use. Methods Using the Nationwide Readmission Database, we included adult patients (≥18 years old) hospitalized between January to November 2016-2018 for cardiogenic shock requiring ECMO support. Thirty-day readmission rates, associated variables, and predictors of readmission were assessed. Results A total of 10,723 patients underwent ECMO for cardiogenic shock. After excluding patients who died (n = 5602; 52%) and who underwent LVAD or OHT during index admission (n = 892; 8%), 4229 patients discharged alive were included. Of those, 694 (16.4%) were readmitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR = 1.77; 95% CI 1.32-2.37), chronic liver disease (OR = 1.35; 95% CI 1.03-1.77), and prolonged LOS (≥30 days; OR = 1.38; 95% CI 1.05-1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50-0.95) and short-term hospital post-discharge care (OR = 0.53; 95% CI 0.28-0.99) conferred a lower risk. Sepsis, followed by congestive heart failure, was the most common readmission diagnoses. Conclusions Patients with CS requiring ECMO support have high mortality and high 30-day readmission rates, with sepsis being the leading cause of readmissions followed by heart failure.
Collapse
Affiliation(s)
- Abdulelah Nuqali
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Andrew Sauer
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Nicholas Haglund
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Andrija Vidic
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Travis Abicht
- Department of Cardiothoracic Surgery, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Matthew Danter
- Department of Cardiothoracic Surgery, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Kamal Gupta
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, United States of America
- Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, United States of America
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, United States of America
| |
Collapse
|
45
|
Dhaliwal HS, Singh R, Abraham AM, Sharma R, Goyal NK, Soloman R, Bansal P, Goyal A. Perception of Illness and Its Association with Treatment Willingness in Patients with Newly Diagnosed Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2021; 66:4197-4207. [PMID: 33409801 DOI: 10.1007/s10620-020-06794-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease of immense public health relevance. Understanding illness perceptions in the NAFLD population will provide sound scientific evidence for planning high-quality patient-centered care and implementing effective interventions. The Brief Illness Perception Questionnaire (BIPQ) is a robust psychometric tool to systematically assess the dimensions of illness perceptions in various chronic ailments. METHODS In a cross-sectional study enrolling patients with newly diagnosed NAFLD, the sociodemographic, anthropometric, biochemical, and radiological determinants of enhanced illness perceptions (measured by the BIPQ score) were investigated using univariate and multivariable binary logistic regression analyses. Finally, the association between individual domains of the BIPQ and willingness to participate in comprehensive medical management was explored. RESULTS In total, 264 patients (mean age 53 ± 11.9 years, 59.8% males) were enrolled in the final analysis. The mean and median BIPQ scores in the study population were 30.3 ± 12.8 and 31.0 (IQR, 22.0-40.0), respectively. The variables having a significant independent association with heightened perceptions (BIPQ > 31) were family history of liver disease (aOR, 5.93; 95% CI, 1.42-24.74), obesity (aOR, 3.33; 95% CI, 1.57-7.05), diabetes mellitus (aOR, 2.35; 95% CI, 1.01-5.49), and transaminitis (aOR, 2.85; 95% CI, 1.42-5.69). Patients with a higher level of illness perceptions (31.6 ± 12.9 vs 27.8 ± 12.3, p = 0.022) were more likely to express a willingness to participate in the comprehensive management plan, with 3 of the 8 domains (consequence, identity, and treatment control) mainly affecting willingness. CONCLUSION A family history of liver disease, obesity, diabetes, and transaminitis were independently associated with increased illness perceptions. A belief in serious consequences, a strong illness identity, and higher perceived treatment control were significantly associated with the willingness to undergo comprehensive care for NAFLD.
Collapse
Affiliation(s)
- Harpal S Dhaliwal
- Department of Gastroenterology, GTBS (C) Hospital, Ludhiana, Punjab, 141002, India.
| | - Ripudaman Singh
- Department of Gastroenterology, GTBS (C) Hospital, Ludhiana, Punjab, 141002, India
| | - Abin M Abraham
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajan Sharma
- Department of Internal Medicine, GTBS (C) Hospital, Ludhiana, Punjab, India
| | - N K Goyal
- Department of Psychiatry, GTBS (C) Hospital, Ludhiana, Punjab, India
| | - Rajat Soloman
- Department of Psychiatry, Government Medical College, Rajnandgaon, Chhattisgarh, India
| | - Pankaj Bansal
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Medicine and Science, Eau Claire, WI, 54702, USA
| | - Amandeep Goyal
- Department of Internal Medicine, Marietta Memorial Hospital, Marietta, OH, 45750, USA
| |
Collapse
|
46
|
Goyal A, Bansal P. Reply to letter to editor by McCullough. Ann Med 2021; 53:335-336. [PMID: 33511888 PMCID: PMC7877975 DOI: 10.1080/07853890.2021.1878273] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | | |
Collapse
|
47
|
Bansal P, Goyal A, Cusick A, Lahan S, Dhaliwal HS, Bhyan P, Bhattad PB, Aslam F, Ranka S, Dalia T, Chhabra L, Sanghavi D, Sonani B, Davis JM. Hydroxychloroquine: a comprehensive review and its controversial role in coronavirus disease 2019. Ann Med 2021; 53:117-134. [PMID: 33095083 PMCID: PMC7880079 DOI: 10.1080/07853890.2020.1839959] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022] Open
Abstract
Hydroxychloroquine, initially used as an antimalarial, is used as an immunomodulatory and anti-inflammatory agent for the management of autoimmune and rheumatic diseases such as systemic lupus erythematosus. Lately, there has been interest in its potential efficacy against severe acute respiratory syndrome coronavirus 2, with several speculated mechanisms. The purpose of this review is to elaborate on the mechanisms surrounding hydroxychloroquine. The review is an in-depth analysis of the antimalarial, immunomodulatory, and antiviral mechanisms of hydroxychloroquine, with detailed and novel pictorial explanations. The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for coronavirus disease 2019 (COVID-19). Finally, current literature associated with hydroxychloroquine and COVID-19 has been analyzed to interrelate the mechanisms, adverse effects, and use of hydroxychloroquine in the current pandemic. Currently, there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19. KEY MESSAGES HCQ, initially an antimalarial agent, is used as an immunomodulatory agent for managing several autoimmune diseases, for which its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions. HCQ is generally well-tolerated although severe life-threatening adverse effects including cardiomyopathy and conduction defects have been reported. HCQ use in COVID-19 should be discouraged outside clinical trials under strict medical supervision.
Collapse
Affiliation(s)
| | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Austin Cusick
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | | | - Poonam Bhyan
- Cape Fear Valley Hospital, Fayetteville, NC, USA
| | | | | | - Sagar Ranka
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Lovely Chhabra
- Heartland Regional Medical Center, Southern IL University, Carbondale, IL, USA
| | | | | | | |
Collapse
|
48
|
Mishra R, Kapur A, Goyal A, Gauba K, Trehan A. Salivary parameters and their correlation with neutrophil counts in children with acute lymphoblastic leukemia. Eur Arch Paediatr Dent 2021; 23:281-287. [PMID: 34843095 DOI: 10.1007/s40368-021-00679-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chemotherapy for Acute Lymphoblastic Leukemia (ALL) is known to render children immuno-deficient. A concomitant suppression of local defence mechanisms, such as saliva may further aggravate the adverse consequences of chemotherapy. The present study was conducted to evaluate alterations in salivary flow rate, pH and buffering capacity and to correlate these parameters with Absolute Neutrophil Counts (ANC). METHODS A cohort of 43 patients, aged 3-12 years were evaluated for the aforementioned parameters at baseline, post-induction and post-consolidation phases. Salivary collection was done and ANC was measured from routine haematological reports. RESULTS A decrease in the salivary parameters was observed at the end of Induction phase as compared to baseline, with a statistically significant decrease in unstimulated salivary flow rates (p < 0.01). Statistically significant positive correlations were found between ANC and salivary flow rate (p = 0.005), pH (p < 0.00) and buffering capacity (p < 0.00). On testing the significance of these correlations, all the values for these parameters were found to be statistically significant. CONCLUSION Salivary parameters showed derangements over the phases of chemotherapy, with maximum decrease at the end of induction phase. The positive correlations of salivary parameters with ANC of the subjects may be considered indicative of a concomitant immunological compromise in these children.
Collapse
Affiliation(s)
- R Mishra
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Trehan
- Unit of Hematology and Oncology, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
49
|
Wong S, Sehgal R, Birks T, Allen D, Goyal A, Kucheria R, Ajayi L, Ellis G. 1191 The Use of CT Urography to Diagnose Upper Tract Urothelial Carcinomas (UTUC); Managing Surgical Resources During The COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Upper tract urothelial carcinomas (UTUC) account for 5-10% of urothelial malignancies. Rapid diagnosis is essential as 60% are invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre.
Method
A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database.
Results
57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis.
Conclusions
A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
Collapse
Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - T Birks
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - R Kucheria
- Royal Free Hospital, London, United Kingdom
| | - L Ajayi
- Royal Free Hospital, London, United Kingdom
| | - G Ellis
- Royal Free Hospital, London, United Kingdom
| |
Collapse
|
50
|
Wong S, Sehgal R, Goyal A, Allen D. 1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents.
Method
A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up.
Results
Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%.
Conclusions
Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.
Collapse
Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
| |
Collapse
|