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Almohtasib Y, Fancher AJ, Sawalha K. Emerging Trends in Atherosclerosis: Time to Address Atherosclerosis From a Younger Age. Cureus 2024; 16:e56635. [PMID: 38646335 PMCID: PMC11032087 DOI: 10.7759/cureus.56635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Over the past two decades, research efforts into cardiovascular disease (CVD) have uncovered findings that fundamentally challenge our understanding of CVD, particularly atherosclerosis. Atherosclerosis was primarily attributed to the well-described abnormal lipid accumulation theory, involving plaque growth with subsequent plaque hemorrhage resulting in acute vessel thrombosis that may or may not rupture. This perspective has now evolved to encompass more complex pathways, wherein the accumulation of abnormal products of oxidation and inflammation is the most likely factor mediating atherosclerotic plaque growth. Furthermore, atherosclerosis was traditionally thought of as a disease in patients aged 40 and older. However, mounting evidence has demonstrated that significant atherosclerosis and CVD events are more prevalent in younger patients than previously realized and accelerating in incidence. With this alarming trend among younger individuals, our review sought to explore why this trend may be happening and what can be done about this developing problem.
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Affiliation(s)
- Yazan Almohtasib
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Andrew J Fancher
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Khalid Sawalha
- Cardiometabolic Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
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2
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Sawalha K, Asad O, Tadisina S, Alalawi L, Mahmood M, Alkhatib D, Alexander T. Obesity-Induced Hyperglycemia and Heart Failure Preserved Ejection Fraction: Uncharted Territories to Remission. Cureus 2023; 15:e49178. [PMID: 38130527 PMCID: PMC10734663 DOI: 10.7759/cureus.49178] [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] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Until the end of World War II, food security was a global challenge. Consequently, in 1948, type 2 diabetes was relatively uncommon, with the majority of cases being type 1 diabetes requiring insulin therapy. Since then, food has become increasingly palatable and readily available, leading to a rise in obesity across all age groups. Understanding the impact of obesity on our health has become crucial for optimizing healthcare. In this context, we draw attention to two significant, yet relatively uncharted pathogenic effects associated with obesity: Hyperglycemia and Heart Failure with Preserved Ejection Fraction (HFpEF). Thorough pathophysiologic, hemodynamic, and echocardiographic characterization have revealed the existence of a distinct phenotype known as "obese HFpEF" within the broader HFpEF population, and "obesity-induced hyperglycemia" within the diabetes population. In these phenotypes, patients often present with higher Body Mass Index and experience clinical symptoms decades earlier. Recent insights have enhanced our understanding of the mechanisms underlying obesity-mediated heart failure preserved ejection fraction and hyperglycemia. Early detection offers the potential for reversibility of many pathologies associated with obesity through adequate weight reduction. The objective of this review is to provide a deeper insight into these uncharted territories and explore the potential for improved outcomes by reframing these two narratives toward achieving remission. Such a shift has the potential to positively impact individual engagement with healthier lifestyles.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Osama Asad
- Internal Medicine, Jordan University of Science and Technology, Irbid, JOR
| | - Shourya Tadisina
- Endocrinology, Diabetes and Metabolism, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Luay Alalawi
- Cardiology, Corpus Christi Medical Center Bay Area, Corpus Christi, USA
| | - Maria Mahmood
- Marvin Baker Middle School, N/A, Corpus Christi, USA
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Sawalha K, Tripathi V, Alkhatib D, Alalawi L, Mahmood A, Alexander T. Our Hidden Enemy: Ultra-Processed Foods, Inflammation, and the Battle for Heart Health. Cureus 2023; 15:e47484. [PMID: 38022349 PMCID: PMC10663139 DOI: 10.7759/cureus.47484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Over the past few decades, we have witnessed unprecedented growth in new data that has fundamentally changed our traditional understanding of the progression of atherosclerotic plaques, as well as our strategies for preventing cardiovascular diseases, especially atherosclerosis. It was once believed that atherosclerosis was primarily caused by abnormal lipid buildup in the vessel intima, leading to plaque growth and luminal stenosis, with or without rupture. This perspective has now evolved to encompass more complex pathways, wherein the accumulation of abnormal products of oxidation and inflammation are the most likely factors mediating the growth of atherosclerotic plaques. The review aims to provide a comprehensive and detailed exploration of the relationship between ultra-processed foods, chronic inflammation, cardiovascular diseases, obesity, insulin resistance, and the role of the gut microbiota. It touches on several important aspects of modern diet and health.
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Affiliation(s)
- Khalid Sawalha
- Department of Cardiometabolic Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Vyomesh Tripathi
- Department of Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Deya Alkhatib
- Department of Cardiology, Yale School of Medicine, New Haven, USA
| | - Luay Alalawi
- Department of Cardiology, Corpus Christi Medical Center Bay Area, Corpus Christi , USA
| | - Ahmed Mahmood
- Department of Cardiology, Corpus Christi Medical Center Bay Area, Corpus Christi , USA
| | - Thomas Alexander
- Department of Cardiology, Corpus Christi Medical Center Bay Area, Corpus Christi, USA
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Battisha A, Sawalha K, Obeidat Y, Patel B. Role of Cardiac Biomarkers in Monitoring Cardiotoxicity in Chemotherapy Patients. Crit Pathw Cardiol 2023; 22:83-87. [PMID: 37607037 DOI: 10.1097/hpc.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE This review aims to highlight the different types of chemotherapy-induced cardiotoxicity and will discuss the evidence base behind the use of different cardiac biomarkers to predict cardiovascular complications. Additionally, we will review the use of cardiac biomarkers to monitor cardiac outcomes and the role of cardioprotective medications in reducing cardiovascular side effects. RECENT FINDINGS Chemotherapy has been linked to an increased risk of cardiotoxicity and heart failure. Currently, patients receiving chemotherapy undergo echocardiogram before starting chemotherapy and every 6 months to monitor for any decline in cardiac function. We reviewed the current evidence and practice guidelines of monitoring chemotherapy cardiotoxicity. SUMMARY Cardio-oncology is a rapidly evolving subspecialty in cardiology, especially with the advent of new chemotherapeutic agents, which have cardiovascular side effects. Early detection of these effects is crucial to prevent life-threatening and irreversible cardiovascular outcomes. Monitoring troponin, pro-brain natriuretic peptide, and other cardiac biomarkers during chemotherapy will help to early detect cardiotoxicity.
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Affiliation(s)
- Ayman Battisha
- From the Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Khalid Sawalha
- From the Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Yasin Obeidat
- From the Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Brijesh Patel
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV
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Lopez-Candales A, Monte S, Sawalha K, Norgard NB. Time to revisit the true role of metformin in type 2 diabetes mellitus. Postgrad Med 2023; 135:539-542. [PMID: 37294638 DOI: 10.1080/00325481.2023.2224036] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/06/2023] [Indexed: 06/11/2023]
Affiliation(s)
- Angel Lopez-Candales
- Cardiovascular Medicine Division, University Health Truman Medical Center, University of Missouri-Kansas City, Missouri-Kansas, MO, USA
| | - Scott Monte
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, NY, USA
| | - Khalid Sawalha
- Nutrition and Metabolism, Department of Medicine, University of Missouri-Kansas City, Kansas, MO, USA
| | - Nicholas B Norgard
- Department of Medicine, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas, MO, USA
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Sawalha K, Norgard NB, Drees BM, López-Candales A. Growth Differentiation Factor 15 (GDF-15), a New Biomarker in Heart Failure Management. Curr Heart Fail Rep 2023; 20:287-299. [PMID: 37289373 DOI: 10.1007/s11897-023-00610-4] [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] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
The emergence of biomarkers across medicine's subspecialties continues to evolve. In essence, a biomarker is a biological observation that clearly substitutes a clinical endpoint or intermediate outcome not only are more difficult to observe but also, biomarkers are easier, less expensive and could be measured over shorter periods. In general, biomarkers are versatile and not only used for disease screening and diagnosis but, most importantly, for disease characterization, monitoring, and determination of prognosis as well as individualized therapeutic responses. Obviously, heart failure (HF) is no exception to the use of biomarkers. Currently, natriuretic peptides are the most used biomarkers for both diagnosis and prognostication, while their role in the monitoring of treatment is still debatable. Although several other new biomarkers are currently under investigation regarding diagnosis and determination of prognosis, none of them are specific for HF, and none are recommended for routine clinical use at present. However, among these emerging biomarkers, we would like to highlight the potential for growth differentiation factor (GDF)-15 as a plausible new biomarker that could be helpful in providing prognostic information regarding HF morbidity and mortality.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Medicine Fellowship, University of Missouri-Kansas City, Kansas City, MO, USA.
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA.
| | - Nicholas B Norgard
- Department of Medicine, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Betty M Drees
- Department(s) of Internal Medicine, Biomedical and Health Informatics, Section of Endocrinology, UMKC School of Medicine, Kansas City, MO, USA
| | - Angel López-Candales
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA
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Lopez-Candales A, Asif T, Sawalha K, Norgard NB. Heart Failure with Preserved Left Ventricular Ejection Fraction: A Complex Conundrum Simply Not Limited to Diastolic Dysfunction. Cardiovasc Ther 2023; 2023:1552826. [PMID: 37496726 PMCID: PMC10368509 DOI: 10.1155/2023/1552826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023] Open
Abstract
Over the last two decades, the changing paradigm of heart failure with preserved ejection fraction (HFpEF) has transformed our understanding not only of the pathophysiology of this clinical entity but also the diagnostic and therapeutic approaches aimed at treating this complex patient population. No longer HFpEF should be seen as simply left ventricular diastolic dysfunction but as a group of that in addition of having small and thick left ventricles with abnormal diastolic filling patterns as their main pathophysiologic abnormality; they also have whole host of different abnormalities. In fact, this heterogeneous clinical entity embodies numerous mechanisms and is linked to multiorgan dysfunction, with hypertension and obesity playing a major role. Although we have gained an enormous amount of understanding not only on the causes but also the downstream effects of HFpEF, there is still much to be learned before we can fully comprehend this complex clinical entity. It is the main intention of this review to synthesize the most recent attributes, mechanism, diagnostic tools, and most useful therapeutic alternatives to be considered when evaluating patients either complaining of dyspnea on exertion as well as exercise intolerance or those recently admitted with HF symptoms but with normal LVEF in the absence of any other valvular abnormalities.
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Affiliation(s)
- Angel Lopez-Candales
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Talal Asif
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Khalid Sawalha
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Nicholas B. Norgard
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
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Al-Khadra Y, Salih M, Al-Akchar M, Sawalha K, DeMartini T, Hafiz AM. National Trends of Percutaneous Mechanical Support Utilization During Percutaneous Coronary Interventions in Chronic Total Occlusion. Am J Cardiol 2023; 200:215-222. [PMID: 37390576 DOI: 10.1016/j.amjcard.2023.05.029] [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: 02/26/2023] [Revised: 04/22/2023] [Accepted: 05/07/2023] [Indexed: 07/02/2023]
Abstract
Coronary chronic total occlusion (CTO) is common in patients with multivessel coronary artery disease. Percutaneous coronary artery (PCI) interventions have shown favorable outcomes in patients with CTO. Nevertheless, the data regarding the utilization of mechanical circulatory support in CTO PCIs is not well established. We sought to investigate the trends in utilization and periprocedural complications in this population. Using the National Inpatient Sample database from 2011 to 2019, we identified patients diagnosed with CTO who underwent PCI. We investigated the presence of a linear trend in the utilization of mechanical circulatory support (MCS) during those procedures and the associated periprocedural complications using the Cochran-Armitage method. A total of 208,123 patients who were diagnosed with CTO and underwent PCI from 2011 to 2019, of which in 6,319 patients MCS was used during the procedure. Patients in the MCS group were older (67.4 vs 66.4 years), less likely to be women (24.0% vs 26.4%), and equally likely to be African-American (9.4% vs 8.8%) with a higher burden of co-morbidities in terms of coronary artery disease, congestive heart failure, and atrial fibrillation (p <0.001 for all). Using the Cochrane-Armitage method, we found a statistically significant linear uptrend in the utilization of MCS from 269 (1.4%) to 990 cases (7.0%) from 2011 to 2019. Using multivariable logistic regression, female gender, renal failure, alcohol abuse, coagulopathy, and fluid and electrolyte disorders were identified as independent predictors of mortality in CTO PCI procedures assisted with MCS (p ≤0.007). In conclusion, the utilization of MCS in CTO PCI procedures has been increasing over the years. Female gender and renal failure are independently associated with a higher mortality risk.
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Affiliation(s)
- Yasser Al-Khadra
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Mohsin Salih
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mohammad Al-Akchar
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Khalid Sawalha
- Department of Internal Medicine, UMass Chan Medical School-Baystate campus, Springfield, Massachusetts
| | - Tony DeMartini
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Abdul Moiz Hafiz
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, Illinois
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Sawalha K, Gupta S, López-Candales A. Early repolarization: Electrocardiographic cues to distinguish benign from malignant variants. Am J Med Sci 2023:S0002-9629(23)01172-2. [PMID: 37156459 DOI: 10.1016/j.amjms.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Historically, early repolarization (ER) has been considered a marker of good health as it is more prevalent in athletes, younger persons, and at slower heart rates. However, contemporary reports, largely based on data from resuscitated sudden cardiac arrest patients, suggest an association between ER and an increased risk for sudden cardiac death and the development of malignant ventricular arrhythmias. Therefore, after we present a brief-case presentation, we intend to review a challenging topic in recognition of malignant variants and propose a four-step comprehensive approach to simplify ECG discrimination when assessing ER changes.
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Affiliation(s)
- Khalid Sawalha
- University of Missouri-Kansas City, Nutrition and Metabolism Fellowship, Kansas City, MO, USA
| | - Sanjaya Gupta
- Electrophysiology Division, Saint Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Saint Luke's Blvd, MO, USA
| | - Angel López-Candales
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA.
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10
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López-Candales A, Sawalha K, Vila LM. Inflammasomes as potential mediators of adverse cardiovascular events in diabetes and lupus: more questions than answers. J Cardiovasc Med (Hagerstown) 2023; 24:279-282. [PMID: 37016797 DOI: 10.2459/jcm.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Angel López-Candales
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City
| | - Khalid Sawalha
- University of Missouri-Kansas City, Nutrition and Metabolism Fellowship, Kansas City, Missouri, USA
| | - Luis M Vila
- Division of Rheumatology, Allergy, and Immunology, University of Puerto Rico Medical School, San Juan, Puerto Rico
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11
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Abstract
Cardiovascular disease (CVD), specifically coronary atherosclerosis, is regulated by an interplay between genetic and lifestyle factors. Most recently, a factor getting much attention is the role epigenetics play in atherosclerosis; particularly the development of coronary artery disease. Furthermore, it is important to understand the intricate interaction between the environment and each individual genetic material and how this interaction affects gene expression and consequently influences the development of atherosclerosis. Our main goal is to discuss epigenetic regulations; particularly, the factors contributing to coronary atherosclerosis and their role in aging and longevity. We reviewed the current literature and provided a simplified yet structured and reasonable appraisal of this topic. This role has also been recently linked to longevity and aging. Epigenetic regulations (modifications) whether through histone modifications or DNA or RNA methylation have been shown to be regulated by environmental factors such as social stress, smoking, chemical contaminants, and diet. These sensitive interactions are further aggravated by racial health disparities that ultimately impact cardiovascular disease outcomes through epigenetic interactions. Certainly, limiting our exposure to such causative events at younger ages seems our "golden opportunity" to tackle the incidence of coronary atherosclerosis and probably the answer to longevity.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Diseases, Truman Medical Centers - University of Missouri Kansas City, Kansas City, USA
| | - Nicholas Norgard
- Pharmacology and Therapeutics, Truman Medical Centers - University of Missouri Kansas City, Kansas City, USA
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Sawalha K, Asad R, Habash F, López-Candales A. Profiling Cardiometabolic Health in Jordan: A Call to Action to Improve Cardiovascular Health. Cureus 2023; 15:e38488. [PMID: 37273358 PMCID: PMC10237340 DOI: 10.7759/cureus.38488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/06/2023] Open
Abstract
Over the past decades, Jordan has witnessed unprecedented growth in the prevalence of cardiometabolic diseases, with a crude prevalence of 48.2% in 2020, up from 38% in 2009. This is slightly higher than the reported prevalence of 40% in the US population. According to the latest World Health Organization report published in 2020, Jordan's leading cause of mortality is cardiovascular diseases with a cause-specific mortality rate of 18.6%. Since the advancement of the healthcare system in Jordan took place in the early 2000s, Jordan has witnessed a major epidemiologic transition where the burden of infectious disease has decreased, but on the other hand, the burden of cardiometabolic disease has increased as well. For such a country with limited resources and healthcare infrastructure where two-thirds of its population is below the age of 30, this is alarming. This growth can be attributed to a complex interplay between genetic and lifestyle factors. Smoking, physical inactivity, obesity, and unhealthy diet are considered major public health problems in Jordan, as reported in 2007 by the Jordanian Behavioral Risk Factor Surveillance. We attempt to raise awareness through this review article, so healthcare providers in Jordan understand the magnitude of the issue, and appropriate steps are taken to reestablish screening and management guidelines pertaining to cardiometabolic diseases in Jordan.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Medicine, University of Missouri Kansas City, Kansas City, USA
| | - Reda Asad
- Endocrinology, Diabetes and Metabolism, University of Missouri Kansas City, Kansas City, USA
| | - Fuad Habash
- Cardiac Electrophysiology, Baylor Heart and Vascular Hospital, Dallas, USA
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13
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López-Candales A, Sawalha K. Improving diagnostic assessments in the ever-changing landscape of atherosclerosis. J Cardiovasc Med (Hagerstown) 2023; 24:221-229. [PMID: 36952387 DOI: 10.2459/jcm.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagnostic approaches. Emerging data have recently challenged our basic understanding in linking ischemia to its adverse outcomes as well as the need for invasive testing for both diagnosis and treatment. The advent of coronary computed tomography in providing improved visualization of coronary arteries has led to the identification of both subclinical atherosclerosis and high-risk coronary lesions. Recognition of asymptomatic coronary artery disease (CAD) with objective localization of subclinical coronary atherosclerosis improves atherosclerotic cardiovascular risk assessment and allows healthcare providers to take effective primary prevention measures. Therefore, reshaping the diagnostic landscape in proposing new testing modalities would be highly dependent on local resource availability and the reading expertise of each clinical practice and medical institution. The main objective of this Review is to propose a potentially new diagnostic approach of simply using noninvasive stress testing or coronary angiography in the routine assessment of CAD.
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Affiliation(s)
| | - Khalid Sawalha
- Nutrition and Metabolism Fellowship, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Kadado AJ, Gobeil K, Pervaiz A, Pundlik S, Pritham R, Obeidat Y, Fatima A, Sawalha K, Chalhoub F. Same-Day Discharge After Left Bundle Area Pacing. Crit Pathw Cardiol 2023; 22:5-7. [PMID: 36812337 DOI: 10.1097/hpc.0000000000000306] [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: 02/24/2023]
Abstract
BACKGROUND Left bundle area pacing (LBAP) has emerged as an area that appears to be an attractive alternative to other forms of physiological pacing owing to its ease and favorable pacing parameters. Same-day discharge after conventional pacemakers, implantable cardioverter defibrillators, and more recently leadless pacemakers have become routine, especially after the COVID-19 pandemic. With the advent of LBAP, the safety and feasibility of same-day discharge remain unclear. METHODS This is a retrospective, observational case series of consecutive, sequential patients undergoing LBAP at Baystate Medical Center, an academic teaching hospital. We included all patients who underwent LBAP and were discharged on the same day of procedure completion. Safety parameters included any procedure-related complications including pneumothorax, cardiac tamponade, septal perforation, and lead dislodgement. Pacemaker parameters included pacing threshold, R-wave amplitude, and lead impedance pre-discharge the following day of implantation and up to 6 months of follow-up. RESULTS A total of 11 patients were included in our analysis, the average age was 70.3 ± 6.74 years. The most common indication for pacemaker insertion was AV block (73%). No complications were seen in any of the patients. The average time between the procedure and discharge was 5.6 hours. Pacemaker and lead parameters were stable after 6 months of follow-up. CONCLUSIONS In this case series, we find that same-day discharge after LBAP for any indication is a safe and feasible option. As this mode of pacing becomes increasingly more common, larger prospective studies evaluating the safety and feasibility of early discharge after LBAP will be needed.
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Affiliation(s)
- Anis John Kadado
- From the Department of Cardiology, UMass Chan Medical School - Baystate, Springfield MA
| | - Kyle Gobeil
- Department of Cardiology, Yale University School of Medicine, New Haven CT
| | - Abdullah Pervaiz
- From the Department of Cardiology, UMass Chan Medical School - Baystate, Springfield MA
| | - Shayal Pundlik
- Department of Medicine, UMass Chan Medical School - Baystate, Springfield MA
| | - Ryan Pritham
- Department of Medicine, UMass Chan Medical School - Baystate, Springfield MA
| | - Yasin Obeidat
- Department of Medicine, UMass Chan Medical School - Baystate, Springfield MA
| | - Anum Fatima
- Department of Medicine, UMass Chan Medical School - Baystate, Springfield MA
| | - Khalid Sawalha
- Department of Medicine, UMass Chan Medical School - Baystate, Springfield MA
| | - Fadi Chalhoub
- From the Department of Cardiology, UMass Chan Medical School - Baystate, Springfield MA.,Department of Cardiology, Division of Cardiac Electrophysiology, UMass Chan Medical School - Baystate, Springfield MA
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Amghaiab IA, Ghiblawi A, Fitzpatrick J, Brewer L, Chandler GG, El-Rifai A, Sawalha K, Hackett M, Adams LP, Alderman T, Ward B, Malik FS, Ali FI. IMPACT OF LVEDP ON RESPONSE AND SAFETY OF HIGH-DOSE HYDRATION POLICY TO PREVENT AKI POST-PCI : A SINGLE-CENTER 4-YEAR EXPERIENCE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ali FI, Fitzpatrick J, Byram M, Hanna L, Smart K, Sawalha K, Jefferson BK, Gage A, Gentry JL, Horr S, Amghaiab IA, Brewer L, El-Rifai A, Hackett M, Adams LP, Cobb D, Nur SA, Stabile M, Van Decar T. IMPACT OF USING HIGH-SENSITIVITY CARDIAC TROPONIN ASSAY ON DISPOSITION OF PATIENTS WITH CHEST PAIN IN THE ED IN A COMMUNITY HOSPITAL SETTING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01570-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Lopez-Candales A, Sawalha K, Drees BM, Norgard NB. In search of mechanisms to explain the unquestionable benefit derived from sodium-glucose cotransporter-2 (SGLT-2) inhibitors use in heart failure patients. Postgrad Med 2023; 135:323-326. [PMID: 36787777 DOI: 10.1080/00325481.2023.2181537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Angel Lopez-Candales
- Division of Cardiovascular Diseases, University Health Truman Medical Center, Hospital Hill, and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Khalid Sawalha
- Nutrition and Metabolism, Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Betty M Drees
- Department(s) of Internal Medicine, Biomedical and Health Informatics and Division of Endocrinology Truman Medical Center, Hospital Hill, and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nicholas B Norgard
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Sawalha K, Shatla I, Mosinska M, Lopez-Candales A. Prevalence and most commonly encountered QRS fragmentation morphology on routine ECG tracings on admissions at the height of the COVID-19 pandemic. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00018-6] [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: 01/28/2023]
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Sawalha K, Shatla I, Mosinska M, Lopez-Candales A. Fragmentation of QRS complexes during SARS-CoV-2 infection: close analysis of routinely obtained electrocardiograms. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00110-6] [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: 01/28/2023]
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20
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Chrisler O, Sawalha K, López-Candales A. Vasospastic Angina With ST-Segment Elevation Seen During Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring. J Investig Med High Impact Case Rep 2023; 11:23247096231166677. [PMID: 37056197 PMCID: PMC10108419 DOI: 10.1177/23247096231166677] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
A 54-year-old man presented with significant ST-segment elevations noted on both channels displayed on the mobile cardiac outpatient telemetry (MCOT). Pertinent cardiac history was remarkable for syncope and episodes of atypical chest pain. The latter were described as infrequent and not associated with exercise intolerance. His syncopal episodes were described as occurring mostly in the mornings after the use of the restroom. Episodes happen 1 or 2 times a year since 2015. Patient had undergone thorough investigation with no significant findings. An MCOT was prescribed since frequency of symptoms has recently increased. Significant ST-segment elevations were noted. The patient described atypical chest pain and a sensation of presyncope during these recordings. He was urgently admitted, and a coronary angiogram revealed no epicardial luminal stenosis. However, the presence of sluggish coronary flow was suggestive of possible vasospastic angina. No ST-segment changes were noted during his coronary angiogram. The remarkable element portrayed by this case hinges in showing the unique utility of MCOT, as the most uncharacteristic diagnostic tool, in identifying transient ST-segment elevations that finally led to the diagnosis.
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Medling T, Gobeil K, Sawalha K, Abozenah M, Tavares P, Friedmann P, Naimi T, Pack Q. Relation of Patient's Opinion of Alcohol's Health Effects and Drinking Habits Among Hospitalized Patients With Cardiovascular Disease. Am J Cardiol 2022; 179:31-38. [PMID: 35914974 PMCID: PMC10061998 DOI: 10.1016/j.amjcard.2022.06.033] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
Media reports frequently cite observational studies and meta-analyses to promote the reputed cardiovascular benefits of moderate alcohol consumption; however, it is unclear whether public opinion or drinking behavior align with these reports. We administered an anonymous, single-center, 35-question, cross-sectional survey among patients hospitalized for acute cardiac illnesses from June to September 2019, who were eligible for cardiac rehabilitation. We assessed patient opinions toward alcohol use, perceptions of alcohol's health impact, and role of media in forming these beliefs. We hypothesized that drinking habits are associated with beliefs about the health benefits of alcohol consumption. Of 300 patients approached, 290 completed the survey (97%). Most (69%) reported having heard moderate alcohol use is heart healthy from 1 or more sources including: TV (61%), family/friends (33%), newspapers (21%), and the internet (10%); although, only 19% reported believing these reports. In total, 12 patients (4%) reported intentionally increasing alcohol intake because of the reported beneficial health effects. There was a strong association between binge drinking and increasing alcohol used to improve cardiac health (odds ratio 8.8, 95% confidence interval 2.7, 29). Given the known cardiotoxic effects of alcohol, particularly in large doses, strategies aimed at population-based education regarding the unhealthy cardiovascular impact of alcohol use is needed, especially among binge drinkers.
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Affiliation(s)
- Theodore Medling
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kyle Gobeil
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, Massachusetts
| | - Khalid Sawalha
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Mohammed Abozenah
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, Massachusetts
| | - Paolo Tavares
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Peter Friedmann
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts
| | - Timothy Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Quinn Pack
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts.
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22
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Sawalha K, Kamdar HA, Gullo T, Okere S, Hamed M, Hinduja A, Hussein O. Cardiovascular Predictors of Intracerebral Hematoma Expansion. J Stroke Cerebrovasc Dis 2022; 31:106527. [PMID: 35523053 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106527] [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: 12/10/2021] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is limited evidence on the effect and relevance of cardiovascular parameters on the cerebrovascular system when an intracerebral hemorrhage (ICH) occurs. While recent studies evaluating this relationship are conflicting, one evaluating the effect of systolic cardiac function on clinical outcomes in ICH patients, found low cardiac ejection fractions to be associated with poor clinical outcomes. Our primary objective was to study such correlations and identify various cardiovascular disease states that may be associated with hematoma expansion. METHODS This is an IRB-approved single-center retrospective study utilizing our institutional "Get with the Guidelines"-Stroke registry between 2013 and 2017. Patients included were older than 18 years of age, admitted with an acute ICH, and had an echocardiogram during their hospitalization. Univariate and multivariate logistical regression analyses were used to identify cardiovascular predictors of hematoma expansion. RESULTS Two-hundred forty-nine patients were identified from our GWTG-S registry that met initial inclusion criteria. Of these patients, a history of peripheral arterial disease (PAD) (p = 0.015), presence of aortic stenosis (AS) on the echocardiogram (p = 0.025), and a positive spot sign on the CT-angiogram (CTA) of the head (p < 0.001) were found to be independently associated with ICH expansion. Both a history of hypertension and elevated blood pressure on presentation were not significant predictors. Additionally, patients with a history of congestive heart failure had decreased odds of hematoma expansion (p = 0.027). CONCLUSION This exploratory study highlights potential novel cardiac predictors of hematoma expansion, including PAD and AS, which warrant further study. Larger prospective studies are needed to further investigate such associations to ultimately optimize cardio-cerebral health.
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Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States
| | - Hera A Kamdar
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Terese Gullo
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Sheila Okere
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Mohammad Hamed
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Archana Hinduja
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Omar Hussein
- Department of Neurology, University of New Mexico Health Sciences Center, MSC10-5620, 1 UNM, 87111, Albuquerque, NM 87131, United States.
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Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has impacted the lives of physicians at all levels. The workloads and working hours have increased tremendously which affected the time spent on administrative and academic duties. The COVID-19 pandemic imposed a lot of challenges on academic institutions in term of providing quality of care to patients and maintaining the quality of education for trainee. Herein, we discuss the challenges and impact of the pandemic on residents training.
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Affiliation(s)
- Odalys Estefania Lara Garcia
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, United States
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, United States
| | - Mohammad Al-Akchar
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, Illinois, United States
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Pundlik S, Abozenah M, Fatima A, Pritham R, Obeidat Y, Sawalha K. A CASE OF VENTRICULAR TACHYCARDIA IN THE SETTING OF NON-EXERTIONAL HEATSTROKE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Sawalha K, Gupta K, Kadado AJ, Abozenah M, Battisha A, Salerno C, Khan A, Islam AM. In-hospital outcomes of transcatheter versus surgical mitral valve repair in patients with chronic liver disease. Int J Clin Pract 2021; 75:e14660. [PMID: 34322958 DOI: 10.1111/ijcp.14660] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair (TEER) using MitraClip is a treatment option for patients with moderate to severe mitral regurgitation who are not surgical candidate. Liver cirrhosis is associated with higher operative morbidity and mortality; however, it is not part of preoperative risk assessments calculators. We sought to evaluate the in-hospital outcomes in TEER and surgical mitral valve repair (SMVR) in liver cirrhosis. METHODS National Inpatient Database from 2013 to 2017 was used to obtain all patients with cirrhosis who underwent TEER or SMVR using ICD-9-CM and ICD-10-CM codes. The primary outcome is to compare inpatient mortality between TEER and SMVR. Secondary outcomes were assessed including length of stay (LOS) and rate of complications including cardiogenic shock, blood transfusion and prolonged ventilation. RESULTS A total of 875 patients with cirrhosis who underwent TEER (n = 123) or SMVR (n = 752) were identified in our analysis. Patients with TEER had significantly higher comorbidities such as congestive heart failure, coronary artery disease and chronic obstructive pulmonary disease. In-hospital mortality was lower in TEER group (8.2% vs 16%, P = .04). TEER was associated with lower rates of blood transfusion (30.3% vs 61.2%, P = .02) and reduced rates of prolonged mechanical ventilation (1.2% vs 17.2%, P = .042). In multivariate regression analysis, both blood transfusion and prolonged mechanical ventilation were significant predictors of mortality in liver cirrhosis. CONCLUSIONS TEER was associated with lower rate of in-hospital mortality, LOS, blood transfusion and prolonged mechanical ventilation in cirrhosis patients. TEER can be considered as a viable option for cirrhosis patient with severe mitral regurgitation.
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Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
- Department of Public Health Practice, School of Public Health and Health Sciences, University of New England, Biddeford, Maine, USA
| | - Kamesh Gupta
- Department of Internal Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Anis John Kadado
- Department of Cardiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Mohammed Abozenah
- Department of Internal Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Colby Salerno
- Department of Cardiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Ahmad Khan
- Department of Internal Medicine, West Virginia University, Charleston, West Virginia, USA
| | - Ashequl M Islam
- Department of Cardiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts, USA
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Sawalha K, Desikan S, Kamoga GR. Oh wait … It isn't MUDPILES! Acute toxic encephalopathy with an interesting anion gap metabolic acidosis resulting in prolonged invasive mechanical ventilation. J Community Hosp Intern Med Perspect 2021; 11:670-672. [PMID: 34567461 PMCID: PMC8462857 DOI: 10.1080/20009666.2021.1942670] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 70-year-old white female patient with past medical history of migraine, fibromyalgia, diverticulitis, and hypothyroidism presented to the emergency department accompanied by her husband for one day of altered mentation, nausea and vomiting. Laboratory testing showed oligo-anuric acute kidney injury with a severely high anion gap metabolic acidosis. Urine drug screen was negative. Brain imaging and lumbar puncture were negative for acute findings. We report this unique case by going through the differential for anion gap metabolic acidosis secondary to Celecoxib as well as a unique drug–drug interaction between Celecoxib and Gabapentin.
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Affiliation(s)
- Khalid Sawalha
- Internal Medicine Division, White River Health System, Batesville, AR, USA
| | - Sai Desikan
- Internal Medicine Division, White River Health System, Batesville, AR, USA
| | - Gilbert-Roy Kamoga
- Internal Medicine Division, White River Health System, Batesville, AR, USA
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Gobeil K, Medling T, Tavares P, Sawalha K, Abozenah M, Friedmann PD, Naimi T, Pack QR. Frequency of Hazardous and Binge Drinking Alcohol Among Hospitalized Cardiovascular Patients. Am J Cardiol 2021; 153:119-124. [PMID: 34210505 PMCID: PMC8316379 DOI: 10.1016/j.amjcard.2021.05.026] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022]
Abstract
Excessive alcohol use is a risk factor for most cardiac diseases. The prevalence of unhealthy alcohol use among hospitalized cardiac patients is uncertain as is the frequency with which it is addressed. We performed a single center, patient-level anonymous survey among hospitalized cardiac patients eligible for cardiac rehabilitation. Hazardous drinking was defined as an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or greater. Binge drinking was defined as 5+ drinks for men or 4+ for women on ≥1 occasion within the past 30 days. Unhealthy drinking was defined as either hazardous or binge drinking. Of 300 patients approached, 290 (96.7%) completed the survey. Mean ( ± SD) age was 69 ± 11 years; 70% were male and 31% were cardiac surgical patients. The proportion (95% CI) of hazardous, binge, and unhealthy drinking was 12% (9 to 16), 16% (12 to 20), and 18% (14-23), respectively. Overall, 58% of subjects reported being screened for alcohol use, mostly by nurses (56%). Those with unhealthy drinking reported being counseled more frequently about their alcohol use compared to non-unhealthy drinkers (11% versus 3%, p = 0.03), but the large majority (89%) of unhealthy drinkers reported receiving no advice about their alcohol use while admitted. In conclusion, almost one-fifth of hospitalized cardiac patients reported unhealthy drinking, these patients were only screened about half of the time, and were rarely counseled about their alcohol use.
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Affiliation(s)
- Kyle Gobeil
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Department of Cardiovascular Disease, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Theodore Medling
- University of Massachusetts Medical School, Worcester Massachusetts
| | - Paolo Tavares
- University of Massachusetts Medical School, Worcester Massachusetts
| | - Khalid Sawalha
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Mohammed Abozenah
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Timothy Naimi
- Department of Medicine, Boston University School of Medicine, Boston Massachusetts
| | - Quinn R Pack
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Department of Cardiovascular Disease, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield Massachusetts.
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Sawalha K, Kunnumpurath A, Singh S, Kamoga GR. It Is Just a Rash They Said! Acute Skin Manifestation in a Patient With Vasculitis in Rural Hospitals. J Investig Med High Impact Case Rep 2021; 8:2324709620966446. [PMID: 33090049 PMCID: PMC7585880 DOI: 10.1177/2324709620966446] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 76-year-old Caucasian male with a history of rheumatoid arthritis, Raynaud’s phenomenon, pulmonary embolism on warfarin, and a previous amputation of his left partial ring and fifth finger presented with acute onset of rash in bilateral lower extremities. He was recently started on trimethoprim-sulfamethoxazole due to concern for cellulitis. Differential diagnosis for acute-onset rash with the patient’s history presented as a challenge to the internist, as the differential is broad. Our case goes through the differential diagnosis to contrast the different presentations of rash in a patient with vasculitis. Ultimately skin biopsy in conjunction with a past positive cryoglobulinemic level helped confirm the diagnosis of cutaneous vasculitis, following which he was started on appropriate treatment and recovered.
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Affiliation(s)
- Khalid Sawalha
- White River Health System, Batesville, AR, USA
- Khalid Sawalha, MD, White River Health System Inc, 1710 Harrison Street, Batesville, AR 72501, USA.
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Al-Akchar M, Sawalha K, Al-Khadra Y, Kittleson M, Missula V, Sundararajan T, Koester C, Salih M, Bhattarai M, Ibrahim A, Chami Y, DeMartini T, Hafiz AM. Outcomes of cardiogenic shock with autoimmune rheumatological disorders. Cardiovasc Revasc Med 2021; 38:70-74. [PMID: 34426085 DOI: 10.1016/j.carrev.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
AIMS Data on cardiogenic shock (CS) in autoimmune diseases (AID) is limited. Our study aims to evaluate in-hospital outcomes of CS in hospitalized patients with underlying AID compared with patients without AID. METHODS The National Inpatient Sample (NIS) database years 2011-17 was used to identify hospitalizations for CS. We retrospectively compared in-hospital outcomes of CS in patients with underlying AID versus non-AID. RESULTS Of 863,239 patients diagnosed with CS, 23,127 (2.7%) had underlying AID. The AID population was older with more women and African American patients (P < 0.001 for all). There was a significant increase in in-hospital mortality in patients with AID vs non-AID that persisted after adjustment for demographics, comorbidities, insurance, socioeconomic status and hospital characteristics (38.3% vs 36.3%, aOR 1.06; 95% CI: 1.02-1.09, P = 0.001). Patients with AID had a lower rate of respiratory complications (11.5% vs 13.1%), acute stroke (6.0% vs 6.8%), use of mechanical circulatory support (12.0% vs 14.5%) and discharge to an outside facility (29.1% vs 28.8%) (P ≤ 0.001 for all). Using multivariable logistic regression, we identified female gender, Native American ethnicity, heart failure, coagulopathy, pulmonary circulation disorders, metastatic cancer, and fluid and electrolytes disorders as independent predictors of mortality in patients with AID who were diagnosed with CS. CONCLUSION Patients with AID hospitalized with CS have increased mortality which may be related to their underlying disease process and lack of effective disease-directed therapy for CS related to AID.
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Affiliation(s)
- Mohammad Al-Akchar
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America.
| | - Yasser Al-Khadra
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States of America
| | - Venkata Missula
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Tharani Sundararajan
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Cameron Koester
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Mohsin Salih
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Mukul Bhattarai
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Abdisamad Ibrahim
- Division of Cardiology, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Youssef Chami
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Tony DeMartini
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Abdul Moiz Hafiz
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
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Battisha A, Madoukh B, Sawalha K, Patel B. Iatrogenic Right Atrial Thrombus Complicated by Pulmonary Embolism: Management and Outcomes. Curr Cardiol Rev 2021; 17:e230421188336. [PMID: 33238847 PMCID: PMC8762153 DOI: 10.2174/1573403x16999201124201632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
Right atrial thrombus can originate from distal venous sources or can be iatrogenic, secondary to the placement of central venous catheters, atrial devices, or surgeries. One of the most common complications of Central Venous Catheters (CVCs) is thromboembolism, which can be either fixed to the right atrium or can be free-floating. Device-related Right Atrial Thrombosis (RAT) can result in catheter occlusion, vascular occlusion, infection, and pulmonary embolism. The true incidence of these complications is unknown because the diagnosis may not be considered in asymptomatic patients, and it might be missed by Transthoracic Echocardiography (TTE). In this literature review, we discuss iatrogenic etiologies of RAT that is complicated by pulmonary embolism. We highlight the importance of maintaining a high index of suspicion of iatrogenic RAT, possible complications, and its management.
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Affiliation(s)
- Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA 01107, United States
| | - Bader Madoukh
- Overland Park Regional Medical Center-HCA Midwest Health, Overland Park, KS 66215, United States
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA 01107, United States
| | - Brijesh Patel
- Heart and Vascular Institute, West Virginian University, Medical Center, Morgantown, WV 26505, United States
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Battisha A, Altibi AM, Madoukh B, Sheikh O, Sawalha K, Shaikh S, Al-Sadawi M. Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review. Curr Cardiol Rev 2021; 17:204-208. [PMID: 32525780 PMCID: PMC8226206 DOI: 10.2174/1573403x16666200611132045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardiobiliary fistula. However, BPT in the absence of a detectable fistula is extremely rare. LEARNING OBJECTIVE A biliary pericardial tamponade is a rare form of tamponade warranting a prompt workup (e.g., MRCP or HIDA scan) for a potential fistula between the biliary system and the pericardial space. A pericardio-biliary fistula can be iatrogenic or traumatic. People with a history of chest wall trauma, abdominal surgery, or chest surgery are at increased risk. The use of HIDA scanning plays a salient role in effectively surveilling for the presence of a fistula - especially when MRCP is contraindicated. CASE PRESENTATION A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade is the subject of the study. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). The patient underwent extensive workup to identify a potential fistula between the hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified. LITERATURE REVIEW A total of six previously published BPT were identified: all were males, with a mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. - Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid - HIDA scan) for an iatrogenic vs. traumatic pericardio- biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula.
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Affiliation(s)
- Ayman Battisha
- University of Massachusetts Medical School, Baystate, Springfield, MA 01107, United States
| | - Ahmed M Altibi
- Henry Ford Allegiance Health Hospital, Jackson, MA 49201, United States
| | - Bader Madoukh
- Overland Park Regional Medical Center, Overland Park, KS 66215, United States
| | - Omar Sheikh
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Khalid Sawalha
- University of Massachusetts Medical School, Baystate, Springfield, MA 01107, United States
| | - Shakil Shaikh
- State University of New York: Downstate Medical Center, Brooklyn, NY 11202, United States
| | - Mohammed Al-Sadawi
- State University of New York: Downstate Medical Center, Brooklyn, NY 11202, United States
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Sawalha K, Khan S, Suarez E, Beresic N, Kamoga GR. Is the thrombolysis in myocardial infarction (TIMI) score a reliable source in a rural hospital for the management of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI)? J Community Hosp Intern Med Perspect 2021; 11:446-449. [PMID: 34211646 PMCID: PMC8221156 DOI: 10.1080/20009666.2021.1930506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. An estimated number 25,000 deaths than their urban counterparts, which coincide with a TIMI risk score of ≥3, potentially limit the utility of the TIMI risk score in risk stratification in rural catherization laboratories. The objective of this study was to assess the reliability of TIMI score as early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in rural hospital. Methods: A retrospective chart review study in a rural hospital was conducted for subjects that received left heart catheterizations, exercise stress tests, or chemical stress tests for a diagnosis of UA/NSTEMI. A total of 399 subjects who underwent left heart catheterization and/or stress testing were recruited for this study. A total of 153 subjects who were transferred out to a larger facility, transitioned to comfort care, refused intervention, or passed away were excluded from the study. The 246 remaining subjects were classified into two groups, those with TIMI 0–2 compared with those having TIMI ≥ 3. A null hypothesis was postulated that there was no significant difference between the two groups with regard to prevalence of either positive stress test or evidence of obstructive coronary disease following coronary angiography. T-test and Wilcoxon rank-sum analysis were performed through SPSS statistical analysis. Results: Formal statistical analysis using T-test as well as Wilcoxon rank-sum test comparing the two groups showed p = 0.34 for T-test and p = 0.60 for Wilcoxon rank-sum test. This is consistent with the postulated null hypothesis: that there is no significant difference between the two surgery groups with respect to the mean/median TIMI score. Conclusion: There was no statistical difference between high and low TIMI score in the intervention of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in a rural hospital.
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Affiliation(s)
- Khalid Sawalha
- Internal Medicine Department, White River Health System, Batesville, AR, USA
| | - Shoaib Khan
- Internal Medicine Department, White River Health System, Batesville, AR, USA
| | - Edwin Suarez
- Internal Medicine Department, White River Health System, Batesville, AR, USA
| | - Nicholas Beresic
- Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Gilbert-Roy Kamoga
- Internal Medicine Department, White River Health System, Batesville, AR, USA
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Sawalha K, Sobash PT, Kamoga GR. A Rare Cause of Drug-Induced Pancytopenia: Trimethoprim-Sulfamethoxazole-Induced Pancytopenia. Clin Pract 2021; 11:358-362. [PMID: 34204861 PMCID: PMC8293064 DOI: 10.3390/clinpract11020050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/13/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Pancytopenia is a decrease across cellular hematological lines. Many different etiologies can cause this clinical picture including viral and bacterial infections, chemicals, malignancy, and medications. Particular attention should be paid to the onset, timing, and severity as they can indicate the underlying cause. In cases of iatrogenic-induced pancytopenia, the offending agent should be stopped immediately and the patient should be monitored for recovery of cell lines. While not well reported in the literature, trimethoprim-sulfamethoxazole (TMP-SMX) is a cause of pancytopenia. We present a case of drug-induced pancytopenia secondary to TMP-SMX that resolved quickly with cessation of use.
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Sawalha K, Habash FJ, Vallurupalli S, Paydak H. Theophylline in Treatment of COVID-19 Induced Sinus Bradycardia. Clin Pract 2021; 11:332-336. [PMID: 34205865 PMCID: PMC8293092 DOI: 10.3390/clinpract11020047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
This is a retrospective case series of two patients with laboratory-confirmed coronavirus 2 (SARS-CoV-2) infection, presented to the University of Arkansas for Medical Sciences in January 2021. Medical records of these patients were reviewed using the EPIC electronic health record system. Clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. Both of the patients presented with dizziness and presyncope related to sinus bradycardia in which they received treatment with 1 mg of IV atropine and theophylline 200 mg orally. We share these two cases of theophylline treatment in COVID-19 induced sinus bradycardia. The first patient was a 39-year-old female, with a past medical history of polycystic ovarian syndrome, who presented to the emergency department with lightheadedness and dizziness. Two weeks prior to her presentation, she was tested positive for COVID-19 infection that was treated with azithromycin, dexamethasone and aspirin. Upon presentation, her ECG showed sinus bradycardia at a rate of 48 bpm. The second patient, a 21-year-old female with no significant past medical history, presented with presyncope. Three weeks prior to her presentation, she tested positive for COVID-19 infection that was treated symptomatically at her home. Upon presentation, her ECG showed junctional rhythm at a heart rate of 51 bpm.
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Affiliation(s)
- Khalid Sawalha
- Internal Medicine Division, White River Health System, Batesville, AR 72501, USA
- Correspondence: ; Tel.: +1-984-3641-158
| | - Fuad J. Habash
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72501, USA; (F.J.H.); (S.V.)
| | - Srikanth Vallurupalli
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72501, USA; (F.J.H.); (S.V.)
| | - Hakan Paydak
- Electrophysiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72501, USA;
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Sawalha K, Nair D. Doubly Blinded: An Uncommon Cause of Acute Visual Loss Due to Orbital Compartment Syndrome. Clin Pract 2021; 11:327-331. [PMID: 34073719 PMCID: PMC8161439 DOI: 10.3390/clinpract11020046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
A 68-year-old female patient with a past medical history of atrial fibrillation on anticoagulation regimen with Apixaban and Clopidogrel presented for her scheduled Watchman device implantation. The device was indicated as patient was high risk for falling. Successful implantation of the left atrial appendage device was carried out, and the patient was sent to the floor. One hour after the procedure, the patient started having left-sided diplopia along with severe eye pain. An immediate CT scan of the head showed left superior orbital mass, concerning for hematoma. Urgent left canthotomy with cantholysis was conducted bedside. However, despite early interventions, the patient’s vision was lost.
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Affiliation(s)
- Khalid Sawalha
- Internal Medicine Division, White River Health System, Batesville, AR 72501, USA
- Correspondence: ; Tel.: +1-984-364-1158
| | - Devi Nair
- Electrophysiology Division, White River Health System, Batesville, AR 72501, USA;
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36
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Al-Akchar M, Missula V, Al-Khadra Y, Sawalha K, Sundararajan T, Koester C, Bhattarai M, Salih M, Chami Y, DeMartini T, Hafiz AM. OUTCOMES OF CARDIOGENIC SHOCK IN PATIENTS WITH AUTOIMMUNE DISEASES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02246-4] [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: 11/25/2022]
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Sawalha K, Kamoga G. Extremely high high-density lipoprotein cholesterol with coronary artery disease: Case report. Clin Case Rep 2021; 9:e04092. [PMID: 34026136 PMCID: PMC8122131 DOI: 10.1002/ccr3.4092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 12/03/2022] Open
Abstract
Whether this extremely high high-density lipoprotein (HDL) level due to chronic alcohol abuse or cholesteryl ester transfer protein or others, we report this interesting case of extremely high high-density lipoprotein to emphasize that serum HDL is not always protective from development of coronary heart disease.
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Affiliation(s)
- Khalid Sawalha
- Internal Medicine DivisionWhite River Health SystemBatesvilleARUSA
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38
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Medling T, Gobeil K, Sawalha K, Abozenah M, Tavares P, Friedman P, Naimi T, Pack Q. DO REPORTED HEALTH BENEFITS OF MODERATE ALCOHOL USE INFLUENCE DRINKING BEHAVIOR IN PATIENTS WITH HEART DISEASE? J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01352-8] [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: 11/24/2022]
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Sawalha K, Kunnumpurath A, Kamoga GR. The Efficacy of Intravenous Insulin Infusion in the Management of Hypertriglyceridemia-Induced Pancreatitis in a Rural Community Hospital. J Investig Med High Impact Case Rep 2021; 8:2324709620940492. [PMID: 32643965 PMCID: PMC7350394 DOI: 10.1177/2324709620940492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A 28-year-old female presented to the emergency room with epigastric pain, nausea, and vomiting; her lipase was elevated, and computed tomography of abdomen showed evidence of acute pancreatitis. Her past medical history was significant for poorly controlled insulin requiring type 2 diabetes mellitus and 2 previous admissions for hypertriglyceridemia-induced pancreatitis. Due to the severity of her pancreatitis presentation, she was admitted to the intensive care unit. She received aggressive intravenous fluid hydration and was started on an insulin drip. Apheresis was strongly considered given the degree of her hypertriglyceridemia (11 602 mg/dL), but there was no timely access to this treatment option. She, however, significantly improved with insulin therapy alone. Her triglyceride levels decreased rather quickly to 4783 mg/dL within 24 hours and by the fourth day of admission were comfortably <1000 mg/dL with insulin infusion along with clinical improvement. She was discharged on niacin and insulin therapy along with her home medications of statin and fenofibrate.
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40
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Bhardwaj PV, Rastegar V, Meka R, Sawalha K, Brennan M, Stefan MS. The Association Between Body Mass Index, Frailty and Long-Term Clinical Outcomes in Hospitalized Older Adults. Am J Med Sci 2021; 362:268-275. [PMID: 33894183 DOI: 10.1016/j.amjms.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While frailty is thought to be a wasting disorder, there is scarce data regarding the association between frailty and body mass index (BMI). The aim of this study was to determine the relationship between BMI, frailty, and mortality among hospitalized older adults. METHODS This is a secondary analysis of a prospective cohort study of patients aged ≥65 years admitted to a tertiary center between 2014 and 2016. Frailty was assessed by Reported Edmonton Frailty Scale (REFS) and categorized as: not frail, vulnerable/mild frail, and moderate/severe frail. BMI (kg/m2) was categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0- 29.9), or obese (≥ 30.0). Primary outcome was all-cause one-year mortality. RESULTS Among 769 patients included in the study, 55.4% were frail. There was no statistically significant association between frailty categories and levels of BMI. Frail patients had a higher risk of death than non-frail after adjusting for confounders [HR: 1.98, 95% CI (1.46, 2.70) for mild frail and HR 2.03, 95% CI (1.43, 2.87) for moderate/severe frail]. Compared with normal weight patients, those who were overweight had a survival advantage if they were non-frail [HR 0.55, 95% CI (0.31, 0.96)] or vulnerable/mild frail [HR 0.65, 95% CI (0.43, 0.97)] but not if they were moderate/severe frail. There were no other statistically significant differences in survival by BMI and frailty categories. CONCLUSIONS We did not find a relationship between BMI and frailty among hospitalized older adults. Overweight patients had a survival advantage if they were non-frail or vulnerable. There is need for further longitudinal studies assessing the interaction between frailty and BMI in older adults.
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Affiliation(s)
- Prarthna V Bhardwaj
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Vida Rastegar
- Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
| | - Rohini Meka
- Department of Hospital Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Maura Brennan
- Division of Geriatrics, University of Massachusetts Medical School - Baystate, Springfield MA, USA.
| | - Mihaela S Stefan
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA; Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
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41
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Sawalha K, Habash F, Vallurupalli S, Paydak H. Inappropriate Sinus Tachycardia Following Viral Illness. Clin Pract 2021; 11:219-222. [PMID: 33918562 PMCID: PMC8167556 DOI: 10.3390/clinpract11020032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycardia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion.
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Affiliation(s)
- Khalid Sawalha
- Internal Medicine Division, White River Health System, Batesville, AR 72501, USA
- Correspondence: ; Tel.: +1-984-364-1158
| | - Fuad Habash
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (F.H.); (S.V.)
| | - Srikanth Vallurupalli
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (F.H.); (S.V.)
| | - Hakan Paydak
- Electrophysiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
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42
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Sawalha K, Abd Elazim A, Hussein O. Ipsilateral Vocal Cord Paralysis After Acute Anterior Ischemic Stroke. Perm J 2021; 25:1. [DOI: 10.7812/tpp/20.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Ahmed Abd Elazim
- Department of Neurology, The New Mexico University Health Sciences Center, Albuquerque, NM
| | - Omar Hussein
- Department of Neurology, The New Mexico University Health Sciences Center, Albuquerque, NM
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Gupta K, Khan A, Kumar M, Sawalha K, Abozenah M, Singhania R. Readmissions Rates After Myocardial Infarction for Gastrointestinal Bleeding: A National Perspective. Dig Dis Sci 2021; 66:751-759. [PMID: 32436123 DOI: 10.1007/s10620-020-06315-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) bleeding is one most common complications of acute myocardial infarction (AMI). We aimed to determine the incidence, in-hospital outcomes, associated healthcare burden and predictors of GI bleeding within 30 days after AMI. METHODS Data were extracted from Nationwide Readmission Database 2010-2014. Patients were included if they had a primary diagnosis of ST or non-ST elevation myocardial infarction. Exclusion criteria were admissioned in December, aged less than 18 years and a diagnosis of type-2 MI. The primary outcome was 30-day readmission with upper or lower GI bleeding. Secondary outcomes were in-hospital mortality, etiology of bleeding, in-hospital complications, procedures, length of stay, and total hospitalization charges. Independent predictors of readmission were identified using multivariate logistic regression analysis. RESULTS Out of the 3,520,241 patients discharged with ACS, 10,018 (0.3%) were readmitted with GI bleeding within 30 days of discharge. 60% had lower GI bleeding. Most common sources suspected were GI cancers in 17% and hemorrhoidal bleeding in 10%. In hospital mortality rate for readmission was 3.6%. Independent predictors of readmission were age, Charlson comorbidity score, history of chronic kidney disease, GI tumor, inflammatory bowel disease and artificial heart valve. Type of treatment for AMI had no impact on readmission. Patients readmitted had higher rates of shock (adjusted odds ratio, 1.48, 95% CI 1.01-3.72). CONCLUSIONS In the first nationwide study, 30-day incidence of GI bleeding after AMI is 0.3%. GI bleeding complicating AMI carries a substantial in-hospital mortality and cost of care.
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Affiliation(s)
- Kamesh Gupta
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA.
| | - Ahmad Khan
- Department of Internal Medicine, West Virginia University- Charleston Division, Charleston, WV, USA
| | - Manish Kumar
- Department of Internal Medicine, Yale-Danbury Hospital, Danbury, CT, USA
| | - Khalid Sawalha
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA
| | - Mohammed Abozenah
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA
| | - Rohit Singhania
- Department of Gastroenterology, UMMS-Baystate Medical Center, Springfield, MA, USA
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Abstract
An 88-year-old male patient with a past medical history of hypertension and gastroesophageal disease presented with nausea, vomiting, and hypothermia. He was admitted for further testing, which revealed elevated creatine kinase and its MB isoenzyme (CK-MB) and troponin with no significant electrocardiogram changes. He denied cardiac symptoms or any previous cardiac history. The patient was treated with fluids and antibiotics in which improvement in his symptoms was noted. In this article, we share this rare case of hypothermia associated with elevation of CK-MB.
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Affiliation(s)
| | | | - Eddie Liu
- White River Health System, Batesville, AR, USA
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Sawalha K, Abozenah M, Kadado AJ, Battisha A, Al-Akchar M, Salerno C, Hernandez-Montfort J, Islam AM. Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome. Cardiovasc Revasc Med 2021; 23:107-113. [PMID: 32847728 PMCID: PMC7434380 DOI: 10.1016/j.carrev.2020.08.028] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis has been reported to be associated with COVID-19 infection. However, guidelines for the diagnosis of COVID-19 myocarditis have not been established. METHODS Using a combination of search terms in the PubMed/Medline, Ovid Medline and the Cochrane Library databases and manual searches on Google Scholar and the bibliographies of articles identified, we reviewed all cases reported in the English language citing myocarditis associated with COVID-19 infection. RESULTS Fourteen records comprising a total of fourteen cases that report myocarditis/myopericarditis secondary to COVID-19 infection were identified. There was a male predominance (58%), with the median age of the cases described being 50.4 years. The majority of patients did not have a previously identified comorbid condition (50%), but of those with a past medical history, hypertension was most prevalent (33%). Electrocardiogram findings were variable, and troponin was elevated in 91% of cases. Echocardiography was performed in 83% of cases reduced function was identified in 60%. Endotracheal intubation was performed in the majority of cases. Glucocorticoids were most commonly used in treatment of myocarditis (58%). Majority of patients survived to discharge (81%) and 85% of those that received steroids survived to discharge. CONCLUSION Guidelines for diagnosis and management of COVID-19 myocarditis have not been established and our knowledge on management is rapidly changing. The use of glucocorticoids and other agents including IL-6 inhibitors, IVIG and colchicine in COVID-19 myocarditis is debatable. In our review, there appears to be favorable outcomes related to myocarditis treated with steroid therapy. However, until larger scale studies are conducted, treatment approaches have to be made on an individualized case-by-case basis.
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Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America,Corresponding author at: University of Massachusetts Medical School-Baystate Medical Center, 759 chestnut, street, Springfield, MA 01199, United States of America
| | - Mohammed Abozenah
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Anis John Kadado
- Department of Cardiology, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Mohammad Al-Akchar
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Colby Salerno
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Jaime Hernandez-Montfort
- Heart and Vascular Institute, Cleveland Clinic Florida, Weston, FL 33331, United States of America
| | - Ashequl M. Islam
- Department of Cardiology, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
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Ambesh P, Sawalha K, Groudan K, Lotfi A, Giugliano G. Coronary subclavian steal syndrome causing myocardial Infarction. Ann Card Anaesth 2021; 24:256-259. [PMID: 33884990 PMCID: PMC8253040 DOI: 10.4103/aca.aca_83_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Coronary subclavian steal syndrome (CSSS) is a rare complication of the internal mammary artery (IMA) grafting in coronary artery bypass surgery. The technical definition is myocardial ischemia due to the reduced flow of blood, or flow reversal in the IMA graft. This in most cases results from hemodynamically significant proximal subclavian artery stenosis. The clinical presentation is variable and ranges from unstable angina to myocardial infarction, and in some cases, sudden cardiac arrest. CSSS is an entity that is hard to diagnose if one is not actively looking for it. The clinical diagnosis is often complicated, and the prevalence of the disorder is frequently underestimated. In this case presentation, we report a case of myocardial infarction that resulted from significant proximal subclavian artery stenosis.
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Affiliation(s)
- Paurush Ambesh
- Department of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Kevin Groudan
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Gregory Giugliano
- Department of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
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Sawalha K, Kunnumpurath A, McCann R. An Unusual Cause of an Intraperitoneal Bleed: Bleeding Hepatic Artery Pseudoaneurysm Due to an Eroding Cholecystitis. J Investig Med High Impact Case Rep 2020; 8:2324709620982431. [PMID: 33349046 PMCID: PMC7758654 DOI: 10.1177/2324709620982431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An 80-year-old male patient presented with sepsis secondary to infected central line which was placed for native aortic valve endocarditis. He also had melena and abdominal pain prior to his presentation. Abdominal computed tomography (CT) was done, which showed cholelithiasis. Esophagogastroduodenoscopy was also done with no source of bleeding identified. Later, he developed hemodynamic instability requiring aggressive fluid resuscitation and multiple packed blood cell transfusions. In view of his hemodynamic instability, a repeat abdominal CT scan showed air droplets within the gallbladder pneumobilia, ascites, diverticulosis, and a bleeding infrahepatic hematoma measuring 6 × 10 cm, which was not on his prior scan 2 days prior. A mesenteric arteriogram was performed that identified an aneurysm of the right hepatic artery with no active bleeding; therefore, it was coiled. Due to his continued clinical decompensation, he underwent an urgent open cholecystectomy, in which serosanguineous fluid, cholecystocolic fistula, and old clot related to his previous bleed were encountered. However, control of bleeding was difficult, and the patient expired. We report this case of right hepatic artery aneurysm that we believe its etiology was related to eroding cholecystitis.
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Abstract
A 44-year-old male patient with no past medical history presented 2 weeks after
seropositive coronavirus disease 2019 (COVID-19) infection with vision problems suggestive
of optic neuritis. Radiological testing showed findings suspicious for acute bilateral
optic neuritis. The patient had also anti-MOG antibodies. Whether this was an optic
neuritis due to COVID-19, MOG antibody disease, or an activation of MOG antibody disease
by COVID-19 is discussed in this case.
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Hussein O, Sawalha K, Elazim AA, Greene-Chandos D, Torbey MT. Hyperbaric oxygen therapy after acute ischemic stroke with large penumbra: a case report. Egypt J Neurol Psychiatry Neurosurg 2020. [DOI: 10.1186/s41983-020-00225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hyperbaric oxygen therapy (HBOT) for the treatment of acute stroke has been under the radar for a long time. Previous studies have not been able to prove efficacy. Several factors might have contributed to such inconsistent results. The timing of delivering the hyperbaric oxygen in relation to the stage of stroke evolution may be an important factor. This was not taken into account in the previous studies as there was no feasible and standardized method to assess the penumbra in the acute phase. Now with the perfusion scan appearing as a key player in the acute stroke management, precise stroke patient selection for hyperbaric oxygen therapy deserves a second chance similar to mechanical thrombectomy.
Case presentation
A 62-year-old female patient who presented with acute large vessel stroke was not eligible for chemical or mechanical thrombectomy. There was a large penumbra on imaging. She got treated with several sessions of hyperbaric oxygen over a 2-week period immediately after stroke. The patient showed significant improvement on the follow-up perfusion imaging as well as some clinical improvement. The more impressive radiological improvement was probably due to the presence of relatively large core infarction at baseline affecting functional brain areas. The patient continued to improve clinically on her 6-month follow up visit.
Conclusion
Our case demonstrates immediate stroke-related penumbra improvement associated with HBOT. Based on that, we anticipate a potential role for HBOT in acute stroke management considering precise patient selection. Future randomized controlled trials are needed and should take that in consideration.
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Abozenah M, Kadado AJ, Aljamal A, Sawalha K, Salerno C, Battisha A, Hernandez-Montfort J, Lotfi A. Concurring hypertrophic cardiomyopathy and takotsubo cardiomyopathy: Assessment and management. Heart Lung 2020; 50:546-557. [PMID: 33143911 DOI: 10.1016/j.hrtlng.2020.10.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/12/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022]
Abstract
The prevalence of takotsubo cardiomyopathy (TCM) has been on the rise, but co-occurrence with hypertrophic cardiomyopathy (HOCM) remains rare. Although presenting patient demographics were similar to those in TCM, the potential for hemodynamic compromise was significantly compounded by the presence of underlying HOCM. Management was similar to standalone TCM, although use of inotropic agents and mechanical support appears to be more prevalent. Despite the increased potential for complications and the paucity of data regarding management, outcomes appear to be mostly favorable in both the hospitalization period and at follow-up. Interestingly, despite a new diagnosis of HOCM in about half the cases described, which signifies no significant left ventricular outflow tract (LVOT) gradient prior to TCM, half of those patients had a persistently elevated LVOT gradient after resolution of TCM. This poses a question of whether or not TCM can predispose to LVOT obstruction in HOCM patients even after its resolution.
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Affiliation(s)
- Mohammed Abozenah
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA.
| | - Anis John Kadado
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA
| | - Ahmad Aljamal
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Khalid Sawalha
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA
| | - Colby Salerno
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA
| | - Ayman Battisha
- Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA
| | | | - Amir Lotfi
- Department of Cardiology, UMMS-Baystate Medical Center, Springfield, MA, USA
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