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Nso N, Mergen D, Ikram M, Macrinici V, Hussain K, Lee K, Ugwendum D, Trimingham M, Balasubramanian S, Sam R, Njei B. Cardiovascular morbidity and mortality in lean vs. non-lean MASLD: A comprehensive meta-analysis. Curr Probl Cardiol 2024; 49:102569. [PMID: 38599554 DOI: 10.1016/j.cpcardiol.2024.102569] [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: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Lean metabolic dysfunction-associated steatotic liver disease (MASLD), characterized by a BMI < 25 kg/m² (or < 23 kg/m² in Asians), presents a challenging prognosis compared to non-lean MASLD. This study examines cardiovascular outcomes in both lean and non-lean MASLD cohorts. METHODS In this meta-analysis, pooled odds ratios (ORs) within 95 % confidence intervals (CIs) were calculated for primary outcomes (cardiovascular mortality and major adverse cardiovascular events [MACE]) and secondary outcomes (cardiovascular disease [CVD], all-cause mortality, hypertension, and dyslipidemia). Studies comparing lean and non-lean MASLD within the same cohorts were analyzed, prioritizing those with larger sample sizes or recent publication dates. RESULTS Twenty-one studies were identified, encompassing lean MASLD patients (n = 7153; mean age 52.9 ± 7.4; 56 % male) and non-lean MASLD patients (n = 23,514; mean age 53.2 ± 6.8; 63 % male). Lean MASLD exhibited a 50 % increase in cardiovascular mortality odds compared to non-lean MASLD (OR: 1.5, 95 % CI 1.2-1.8; p < 0.0001). MACE odds were 10 % lower in lean MASLD (OR: 0.9, 95 % CI 0.7-1.2; p = 0.7), while CVD odds were 40 % lower (p = 0.01). All-cause mortality showed a 40 % higher odds in lean MASLD versus non-lean MASLD (p = 0.06). Lean MASLD had 30 % lower odds for both hypertension (p = 0.01) and dyslipidemia (p = 0.02) compared to non-lean MASLD. CONCLUSION Despite a favorable cardiometabolic profile and comparable MACE rates, lean individuals with MASLD face elevated cardiovascular mortality risk.
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Affiliation(s)
- Nso Nso
- Division of cardiovascular disease, University of Chicago (Endearvor Health), IL, USA
| | - Damla Mergen
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens, NY, USA
| | - Mashaal Ikram
- Division of cardiovascular disease, University of Chicago (Endearvor Health), IL, USA
| | - Victor Macrinici
- Division of cardiovascular disease, University of Chicago (Endearvor Health), IL, USA
| | - Kifah Hussain
- Division of cardiovascular disease, University of Chicago (Endearvor Health), IL, USA
| | - Kevin Lee
- Division of cardiovascular disease, University of Chicago (Endearvor Health), IL, USA
| | - Derek Ugwendum
- Department of Medicine, Loyola University School of Medicine, Illinois, USA
| | - Mia Trimingham
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | | | - Riya Sam
- Division of cardiovascular disease, University of Chicago (Endearvor Health), IL, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale School of Medicine, CT, USA.
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Dimala CA, Nso N, Wasserlauf J, Njei B. Electrocardiographic abnormalities in patients with metabolic dysfunction-associated steatotic liver disease: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102580. [PMID: 38653446 DOI: 10.1016/j.cpcardiol.2024.102580] [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: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION This study review aimed to consolidate current knowledge on the electrocardiographic abnormalities observed in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD). METHODS This was a systematic review of studies on the association between MASLD and electrocardiographic abnormalities, published between January 1, 1946, and October 31, 2023. Data from eligible studies were extracted, analyzed, synthesized, and summarized. RESULTS We evaluated a total of 27 studies with 8,607,500 participants overall and 1,005,101 participants with MASLD. There was a statistically significant association between MASLD and prevalent atrial fibrillation (pooled OR: 1.34 95 % CI: 1.20-1.49, p < 0.001, n = 12), shorter QRS duration (pooled SMD: -0.073, 95 % CI: -0.144 - -0.001, n = 2, p = 0.048, n = 2), QTc prolongation (p < 0.001, n = 2), LVH (pooled OR: 1.48, 95 % CI: 1.25-1.75, p < 0.001, n = 3), low voltage (p < 0.001, n = 1), ST changes (OR: 1.41, 95 % CI: 1.04-1.91, p = 0.027, n = 1), T wave inversion (p < 0.001, n = 1), axis deviation (OR: 3.21, 95 % CI: 1.99-5.17, p < 0.001, n = 1), conduction defect (OR: 2.79, 95 % CI: 1.83-4.26, p < 0.001, n = 1) and bundle branch block (OR: 2.90, 95 % CI: 1.82-4.61, p < 0.001, n = 1), any persistent heart block (p < 0.001, n = 1), fragmented QRS (p < 0.001, n = 1), and p wave dispersion (p < 0.001, n = 1) CONCLUSION: MASLD is associated with multiple ECG abnormalities which are potential markers of early cardiac involvement, highlighting the multisystemic nature of MASLD. These specific ECG abnormalities could be used in screening and management algorithms to improve cardiac risk stratification in MASLD patients. PROSPERO REGISTRATION CRD42023477501.
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Affiliation(s)
- Christian Akem Dimala
- Division of Cardiovascular Medicine, University of Texas Medical Branch, 301 University Blvd., 5.106 John Sealy Annex, Galveston, TX 77555-0553, United States.
| | - Nso Nso
- Division of Cardiology, University of Chicago (Northshore), Evanston, IL, United States
| | - Jeremiah Wasserlauf
- Cardiovascular Institute, North Shore University Health System, Evanston, IL, United States
| | - Basile Njei
- Yale University School of Medicine, New Haven, CT, United States
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Sink J, Peigh G, Speakman B, Banno J, Sanders D, Nso N, Waits G, Lohrmann G, Elsayed M, Carneiro H, Baman J, Pfenniger A, Patil KD, Arora R, Kim SS, Chicos AB, Lin AC, Passman RS, Knight BP, Dandamudi S, Kaplan RM, Huang H, Wasserlauf J, Verma N. Correlation between high- and low-voltage impedance measurements following subcutaneous implantable cardioverter-defibrillator implantation. Heart Rhythm 2024; 21:492-494. [PMID: 38159788 DOI: 10.1016/j.hrthm.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Joshua Sink
- Department of Internal Medicine, Northwestern University, Chicago, Illinois
| | - Graham Peigh
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Joseph Banno
- Division of Cardiology, Corewell Health, Grand Rapids, Michigan
| | - David Sanders
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nso Nso
- Division of Cardiology, Northshore University Health System, Evanston, Illinois
| | - George Waits
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Graham Lohrmann
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Mahmoud Elsayed
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Herman Carneiro
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jayson Baman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Anna Pfenniger
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Rishi Arora
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Susan S Kim
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Albert C Lin
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Rachel M Kaplan
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Henry Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology, Northshore University Health System, Evanston, Illinois
| | - Nishant Verma
- Division of Cardiology, Northwestern University, Chicago, Illinois.
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Faisaluddin M, Balasubramanian S, Ahmed A, Hussain K, Nso N, Gaznabi S, Erwin JP, Pursnani A, Ricciardi M. Temporal trends and procedural safety of transcatheter mitral valve repair with mitraclip in patients with hypertrophic cardiomyopathy: Insights from the national inpatient sample. Curr Probl Cardiol 2024; 49:102354. [PMID: 38135106 DOI: 10.1016/j.cpcardiol.2023.102354] [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: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
Data on utilization and safety of mitral Transcatheter Edge-to-Edge Repair (TEER) among hypertrophic cardiomyopathy (HCM) patients is limited. Our study aimed to assess the national utilization, safety, and clinical outcomes of TEER procedures among HCM patients using a nationwide real-world cohort. HCM patients undergoing TEER hospitalizations between 2015-2020 were identified using ICD-10 (International Classification of Diseases, (ICD-10-CM/PCS). HCM-TEER and HCM No-TEER formed the two comparison groups. Demographic characteristics, baseline comorbidities, procedural complications, inpatient mortality, length of stay (LOS), and cost of hospitalization were compared between the propensity-matched cohorts. Numeric values of 10 or less were not reported per NIS data use agreements. A total of 39,625 weighted cases of TEER were identified from 2015-2020. Of the included patients, 335 patients had the HCM diagnosis. The median age of the HCM-TEER group was 74 (70-79) vs. 79 (72-85) for the no-TEER cohort. The TEER procedure was more frequently performed among Caucasians (86.57%) and females (53.73%). The TEER procedure among HCM patients had similar in-hospital mortality (Adjusted odds ratio: aOR 1.50, 95% CI [0.68-3.29]; p = 0.30) and net adverse cardiac events (NACE) (aOR 1.16, 95% CI [0.73-1.85]; p = 0.51). TEER among HCM was associated with higher odds of gastrointestinal/hematological (aOR 2.33, 95% CI [1.29-4.19]; p = 0.003) complications. However, the odds of cardiac complications (aOR 0.57, 95% CI [0.33-0.96]; p = 0.03) were not higher. The median length of stay was similar in both the groups (median: 2 vs. 2, p = 0.74), although TEER among HCM was associated with higher costs of hospitalization ($44729.36 vs. $40513.82, p < 0.01). TEER is a minimally invasive procedure and could be a safe option for symptomatic HCM patients with significant MR who are poor surgical candidates. Mitral TEER among HCM has been increasingly utilized in recent years in the United States more commonly in obstructive HCM and is associated with no difference in mortality and net adverse cardiac events but higher odds for gastrointestinal/hematological complications than non-HCM patients.
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Affiliation(s)
| | - Senthil Balasubramanian
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA.
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Kifah Hussain
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Nso Nso
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Safwan Gaznabi
- University Hospital for the Albert Einstein College of Medicine at Montefiore Medical Center, Bronx, NY, USA
| | - John P Erwin
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Amit Pursnani
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
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Hussain K, Nso N, Tsourdinis G, Haider S, Mian R, Sanagala T, Erwin JP, Pursnani A. A systematic review and meta-analysis of left atrial strain in hypertrophic cardiomyopathy and its prognostic utility. Curr Probl Cardiol 2024; 49:102146. [PMID: 37863460 DOI: 10.1016/j.cpcardiol.2023.102146] [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: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Despite advances in noninvasive imaging modalities to identify atrial fibrillation (AF) risk in Hypertrophic Cardiomyopathy (HCM), there is a paucity of evidence concerning the impact of low Left Atrial strain (LAS) on AF and major adverse cardiac events (MACE) incidence in these patients. This study investigated the diagnostic and prognostic significance of LAS in predicting AF and MACE in HCM. Findings revealed lower LA reservoir (MD: -11.79, 95% CI -14.83, -8.74; p<0.00001), booster (MD: -4.10, 95% CI -6.29, -1.91; p=0.0002), and conduit (MD: -7.52, 95% CI -9.39, -5.65; p<0.00001) strains in HCM patients versus healthy controls, and also indicated a significant association between low LA reservoir/conduit/booster strain and the development of new AF as well as MACE prevalence in HCM patients. The results from this study suggest the valuable role of LA strain in HCM and its utility in predicting the development of new AF and cardiac events in HCM patients.
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Affiliation(s)
- Kifah Hussain
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States.
| | - Nso Nso
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - George Tsourdinis
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Suha Haider
- University of Sussex, Brighton, United Kingdom
| | - Raza Mian
- Loyola University, Chicago, IL, United States
| | - Thriveni Sanagala
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - John P Erwin
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Amit Pursnani
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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Ngonge AL, Nso N, Mbome Y, Brgdar A, Tabot MT, Ahmad B, Taha M, Alebna P, Munawar M, Asangmbeng N, Effoe V, Mehrotra P, Fatima U. Comparison of Percutaneous Coronary Intervention-Related Adverse Cardiac Outcomes in Patients With in-stent vs de novo Chronic Total Occlusion: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101797. [PMID: 37178988 DOI: 10.1016/j.cpcardiol.2023.101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI. This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multicentered studies published between January 2005 and December 2021. We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89, P < 0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53, P < 0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10, P < 0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00, P = 0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables. The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.
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Affiliation(s)
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Queens New York, NY
| | - Yolanda Mbome
- Department of Medicine, Richmond University Medical Center, Staten Island, NY
| | - Ahmed Brgdar
- Department of Medicine, Howard University Hospital, Washington, DC
| | - Mpey Tabot Tabot
- Department of Medicine, Howard University Hospital, Washington, DC
| | - Basharat Ahmad
- Department of Medicine, Howard University Hospital, Washington, DC
| | - Mohamed Taha
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Prince Alebna
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Muhammad Munawar
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Nformbuh Asangmbeng
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA
| | - Valery Effoe
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA
| | - Prafulla Mehrotra
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Urooj Fatima
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
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Badejoko SO, Nso N, Buhari C, Amr O, Erwin JP. Point-of-Care Ultrasound Overview and Curriculum Implementation in Internal Medicine Residency Training Programs in the United States. Cureus 2023; 15:e42997. [PMID: 37671219 PMCID: PMC10476883 DOI: 10.7759/cureus.42997] [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: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) augments physical examination and expedites diagnostic care and clinical decision-making. The use of POCUS in internal medicine (IM) appears inconsistent despite its commendable benefits. It is not fully incorporated into the IM residency core competency skills or academic curriculum. This narrative literature review explores the benefits of POCUS and evaluates the need for an IM-focused POCUS curriculum. The obstacles and a proposed curriculum are also described.
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Affiliation(s)
- Solomon O Badejoko
- Internal Medicine, St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - Nso Nso
- Internal Medicine/Cardiology, NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Illinois, USA
| | - Cyrus Buhari
- Cardiology, St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - Omar Amr
- Emergency Medicine (Ultrasound), St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - John P Erwin
- Medicine/Cardiology, NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Illinois, USA
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Salam S, Nso N, Kondaveeti R, Ching THS, Nassar M, Sachmechi I. Efficacy of I-131 Treatment Dosage for Hyperthyroidism With Current Institution Formula. J Endocrinol Metab 2023; 13:49-56. [DOI: 10.14740/jem874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Buttar C, Lakhdar S, Nso N, Guzman-Perez L, Dao T, Mahmood K, Hendel R, Lavie CJ, Collura G, Trandafirescu T. Meta-Analysis Comparing Outcomes of Remote Hemodynamic Assessment Versus Standard Care in Patients With Heart Failure. Am J Cardiol 2023; 192:79-87. [PMID: 36758268 DOI: 10.1016/j.amjcard.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 02/09/2023]
Abstract
In patients with congestive heart failure (CHF), remote hemodynamic monitoring can reduce heart failure exacerbation and mortality. In this study, we compared the effectiveness of remote hemodynamic monitoring with that of standard care in the management of patients with CHF. The remote monitoring group included 7,733 patients, and the control group included 7,567 patients. Chi-square test and I-square statistics were used to assess heterogeneity. Risk ratios (RRs) were calculated using fixed-effects and random-effects methods to determine the risk of all-cause hospitalization and CHF-related hospitalization (primary outcomes) and all-cause mortality and device outcomes (secondary outcomes). Pooled findings indicated a 7% lower risk of all-cause hospitalization in the remote monitoring group than that in the control group (RR 0.93, 95% confidence interval [CI] 0.89 to 0.98, p = 0.004). The results also revealed a 32% lower risk of CHF-related hospitalization in the remote monitoring group than that in the control group (RR 0.68, 95% CI 0.65 to 0.71, p <0.001). No statistically significant differences were noted between the groups in terms of all-cause mortality (RR 0.97, 95% CI 0.87 to 1.07, p = 0.53) and device outcomes (RR 1.23 95% CI 0.92 to 1.65, p = 0.16). These results provided evidence regarding the comparable effectiveness of remote CHF monitoring and routine care. The current evidence is insufficient to introduce remote hemodynamic CHF monitoring; however, our results suggest that the integration of telemonitoring systems with routine medical management may improve heart failure care.
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Affiliation(s)
- Chandan Buttar
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Sofia Lakhdar
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
| | - Nso Nso
- Department of Cardiology, University of Chicago, Illinois
| | - Laura Guzman-Perez
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
| | - Tristan Dao
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Kiran Mahmood
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Hendel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Carl J Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Giovina Collura
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
| | - Theo Trandafirescu
- Division of Critical Care Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
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Ghallab M, Ahmed N, Nso N, Abdelmoteleb S, Munira MS. AN INTERESTING CASE OF CONGENITAL LONG QT SYNDROME WITH A COINCIDENTAL FINDING OF MYCOBACTERIUM AVIUM COMPLEX LUNG INFECTION COMPLICATED WITH CARDIAC ARREST. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04355-3] [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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Lakhdar S, Buttar C, Nso N, Mahmood K. META-ANALYSIS COMPARING OUTCOMES OF REMOTE HEMODYNAMIC ASSESSMENT VERSUS STANDARD CARE IN PATIENTS WITH CHRONIC HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00863-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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Nso N, Kolton L, Robin C, Robin JC. IS THE BIGLYCAN GENE PATHOGENIC IN SPONTANEOUS CORONARY ARTERY DISSECTION AND FIBROMUSCULAR DYSPLASIA? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03918-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Nso N, Nyabera A, Nassar M, Mbome Y, Emmanuel K, Alshamam M, Sumbly V, Guzman L, Shaukat T, Bhangal R, Ojong GA, Radparvar F, Rizzo V, Munira MS. Incidence and risk factors of cardiovascular mortality in patients with gastrointestinal adenocarcinoma. PLoS One 2023; 18:e0262013. [PMID: 36706093 PMCID: PMC9882755 DOI: 10.1371/journal.pone.0262013] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/15/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) cancers are common and fatal. Improved cancer-directed therapies, with thier substantial role in improving cancer-specific survival, may increase non-cancer mortality-including cardiovascular mortality-in these patients. AIM To identify the risk factors of cardiovascular mortality in GI adenocarcinoma patients. METHODS Data of GI adenocarcinoma patients were gathered from the Surveillance, Epidemiology, and End Results database. We used Pearson's chi-square test to assess the relationships between categorical variables. We used the Kaplan-Meyer test in the univariate analysis and Cox regression test for the multivariate analysis. RESULTS Among 556,350 included patients, 275,118 (49.6%) died due to adenocarcinoma, 64,079 (11.5%) died due to cardiovascular causes, and 83,161 (14.9%) died due to other causes. Higher rates of cardiovascular mortality were found in patients ≥ 50 years (HR, 8.476; 95% CI, 7.91-9.083), separated (HR, 1.27; 95% CI, 1.184-1.361) and widowed (HR, 1.867; 95% CI, 1.812-1.924), patients with gastric (HR, 1.18; 95% CI, 1.1-1.265) or colorectal AC (HR, 1.123; 95% CI, 1.053-1.198), and patients not undergone surgery (HR, 2.04; 95% CI, 1.958-2.126). Lower risk patients include females (HR, 0.729; 95% CI, 0.717-0.742), blacks (HR, 0.95; 95% CI, 0.924-0.978), married (HR, 0.77; 95% CI, 0.749-0.792), divorced (HR, 0.841; 95% CI, 0.807-0.877), patients with pancreatic AC (HR, 0.83; 95% CI, 0.757-0.91), and patients treated with chemotherapy (HR, 0.416; 95% CI, 0.406-0.427). CONCLUSIONS Risk factors for cardiovascular mortality in GI adenocarcinoma include advanced age, males, whites, separated and widowed, gastric or colorectal adenocarcinoma, advanced grade or advanced stage of the disease, no chemotherapy, and no surgery. Married and divorced, and patients with pancreatic adenocarcinoma have a lower risk.
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Affiliation(s)
- Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
- * E-mail:
| | - Akwe Nyabera
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Yolanda Mbome
- Department of Medicine, Richmond University Medical center, Staten Island, NY, United States of America
| | - Kelechi Emmanuel
- Department of Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, United States of America
| | - Mohsen Alshamam
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Vickram Sumbly
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Laura Guzman
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Tanveer Shaukat
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Rubal Bhangal
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Gilbert Ako Ojong
- Department of Medicine, La Magna Health/United Regional Hospital, Wichita Falls, Texas, United States of America
| | - Farshid Radparvar
- Division of Cardiology, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
| | - Most Sirajum Munira
- Division of Cardiology, Icahn School of Medicine at Mount Sinai / NYC H&H Queens, New York, NY, United States of America
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Nassar M, Ghernautan V, Nso N, Nyabera A, Castillo FC, Tu W, Medina L, Ciobanu C, Alfishawy M, Rizzo V, Eskaros S, Mahdi M, Khalifa M, El-Kassas M. Gastrointestinal involvement in systemic sclerosis: An updated review. Medicine (Baltimore) 2022; 101:e31780. [PMID: 36397401 PMCID: PMC9666124 DOI: 10.1097/md.0000000000031780] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The gastrointestinal tract (GI) is the second most affected organ system in individuals suffering from systemic/localized scleroderma (SSc) or localized scleroderma. SSc can affect any part of the GI, between the oral cavity and anorectum. The annual incidence of SSc in the United States is estimated to be 19.3 cases per million adults, with the highest incidence reported in people aged 44 to 55. Females are 5 times more likely than males to suffer from SSc. Morbidity and mortality rates associated with SSc are predominantly elevated among patients with GI manifestations. Esophageal and intestinal manifestations impact 90% and 40% to 70% of patients with systemic scleroderma, respectively. SSc patients are known to suffer from small bowel hypomotility and small intestinal bacterial overgrowth, which cause malabsorption and malnutrition, ultimately contributing to the 50% mortality rate. Fecal incontinence is a common symptom of SSc that can lead to depression. SSc patients may suffer from gastrointestinal complications that can negatively impact their quality of life on a daily basis. Multidisciplinary approaches are necessary for systematically managing gastrointestinal complications associated with SSc. A prospective study should focus on developing targeted therapies to improve recovery patterns and prognosis in cases of SSc. This article summarizes the epidemiology, commonly reported clinical manifestations, complications, and available treatments for treating GI pathology in SSc patients.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Victoria Ghernautan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Akwe Nyabera
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Francisco Cuevas Castillo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Wan Tu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Luis Medina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | | | - Mostafa Alfishawy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Saphwat Eskaros
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Mamdouh Mahdi
- Internal Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohamed Khalifa
- Hospital Management Department, Helwan University, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- * Correspondence: Mohamed El-Kassas, Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan 11795 Cairo, Egypt (e-mail: )
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15
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Cancarevic I, Nassar M, Daoud A, Ali H, Nso N, Sanchez A, Parikh A, Ul Hosna A, Devanabanda B, Ahmed N, Soliman KM. Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis: A systematic review and meta-analysis. World J Virol 2022; 11:352-361. [PMID: 36188740 PMCID: PMC9523330 DOI: 10.5501/wjv.v11.i5.352] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/20/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been the most talked-about disease of the past few years. Patients with significant comorbidities have been at particular risk of adverse outcomes. This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease, a group of patients known to be particularly susceptible to infectious complications.
AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.
METHODS We searched PubMed/MEDLINE, EMBASE, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Web of Science databases for relevant terms and imported the results into the Covidence platform. From there, studies were assessed in two stages for relevance and quality, and data from studies that satisfied all the requirements were extracted into a spreadsheet. The data was then analyzed descriptively and statistically.
RESULTS Of the 920 studies identified through the initial database search, only 17 were included in the final analysis. The studies included in the analysis were mostly carried out during the first wave. We found that COVID-19 incidence among patients on hemodialysis was significant, over 10% in some studies. Those who developed COVID-19 infection were most likely going to be hospitalized, and over 1 in 5 died from the infection. Intensive care unit admission rate was lower than the infection lethality rate. Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.
CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections, and a significant proportion was infected during the first wave. Their prognosis is overall much worse than in the general population, and every effort needs to be made to decrease their exposure.
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Affiliation(s)
- Ivan Cancarevic
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
| | - Hatem Ali
- Department of Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Angelica Sanchez
- Department of Medicine, Universidad Autonoma de Santo Domnigo, Santo Domingo 10105, Dominican Republic
| | - Avish Parikh
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Asma Ul Hosna
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Bhavana Devanabanda
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Nazakat Ahmed
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
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16
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Nassar M, Nso N, Emmanuel K, Alshamam M, Munira MS, Misra A. Coronary Artery Calcium Score directed risk stratification of patients with Type-2 diabetes mellitus. Diabetes Metab Syndr 2022; 16:102503. [PMID: 35653928 DOI: 10.1016/j.dsx.2022.102503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS This study aimed to review the available data on the role of coronary artery calcium (CAC) scoring as the preferred adjunct modality to improve risk prediction and reduce the incidence of major adverse cardiac events and mortality in T2DM patients. METHODS We reviewed the findings of 21 studies. RESULTS This study revealed that the CAC scoring system could enhance cardiovascular disease (CVD) risk stratification and positively affect the medical management of patients with T2DM. CONCLUSION A CAC scoring approach is necessary to reduce the incidence and prevalence of preventable CVD events in patients with type 2 diabetes.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Kelechi Emmanuel
- Department of Medicine, University of Pittsburgh Medical Center Pinnacle, PA, USA.
| | - Mohsen Alshamam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Most Sirajum Munira
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), India.
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17
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Nso N, Nassar M, Trimingham M, Mbome Y, Lyonga Ngonge A, Badejoko SO, Akbar S, Azhar A, Lakhdar S, Ghallab M, Guzman Perez LM, Rizzo V, Munira MS. Invasive Management of Vertebrobasilar Artery Stenosis and Occlusion: A Meta-Analysis on Efficacy and Safety Endpoints. Cureus 2022; 14:e24751. [PMID: 35686282 PMCID: PMC9170364 DOI: 10.7759/cureus.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
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18
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Bhangal R, Sandhu JK, Umar Z, Shah D, Nso N. The Impact of COVID-19 Infection on a Neurologically Compromised Male With Fahr’s Disease Presenting With Acute Delirium and Aspiration Pneumonia: A Case Report. Cureus 2022; 14:e24233. [PMID: 35602824 PMCID: PMC9115732 DOI: 10.7759/cureus.24233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/24/2022] Open
Abstract
Fahr’s disease or idiopathic basal ganglia calcification is a rare, sporadic, genetically dominant, and inherited neurological condition that manifests with dysphagia and Parkinson’s disease. The computed tomography (CT) scan is the method of choice to diagnose basal ganglia calcifications seen in Fahr’s disease. This case report elaborates on the emergency management of a 58-year-old male patient with acute respiratory distress, acute delirium, schizophrenia, Fahr’s syndrome, and history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 or COVID-19) infection. The patient’s chest X-ray, laboratory workup, and vital signs were suggestive of aspiration pneumonia-induced sepsis and acute hypoxemic respiratory failure. Post-admission antibiotic management reduced sepsis complications without improving the altered mental status. A comprehensive clinical assessment suggested the attribution of Fahr’s disease to the patient’s aspiration pneumonia and other clinical complications. In addition, COVID-19 infection, sepsis-induced inflammatory processes, and pre-existing neurological compromise possibly deteriorated the patient’s neurological outcomes, overall prognosis, and recovery.
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19
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Vest M, Ciobanu C, Nyabera A, Williams J, Marck M, Landry I, Sumbly V, Iqbal S, Shah D, Nassar M, Nso N, Rizzo V. Biliary Anastomosis Using T-tube Versus No T-tube for Liver Transplantation in Adults: A Review of Literature. Cureus 2022; 14:e24253. [PMID: 35602800 PMCID: PMC9117859 DOI: 10.7759/cureus.24253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/06/2022] Open
Abstract
The T-tube-directed biliary anastomosis in orthotopic liver transplantation (OLT) aims to minimize preventable biliary complications, including bile leaks and strictures. Biliary complications in patients with OLT increase the risk of morbidity and mortality. This review paper evaluated the current evidence on the routine use of T-tube reconstruction in OLT cases. A review of prospective, retrospective, observational, cohort studies as well as systematic reviews, meta-analyses, review papers, and opinion papers has been conducted to evaluate the therapeutic potential of T tube-based biliary anastomosis in cases of OLT. Our finding showed a bile leak incidence of 16.6% and 6.6% in T-tube and non-T-tube groups, respectively. The results indicated a lower incidence of anastomotic fistulae in the non-T-tube group (0.6%) compared to the T-tube group (4%). The findings negated statistically significant differences in the three-year actuarial survival rates based on biliary anastomosis with and without T-tube intervention (62.5% vs. 69.8%). The studies revealed a 6-11% and 2-11% incidence of cholangitis in OLT patients with T-tube-based reconstruction and those without a T-tube, respectively, and 26% and 20% incidence of total biliary complications in OLT patients with and without T-tube, respectively. In addition, the findings ruled out the influence of a T-tube on the incidence of perioperative complications, endoscopies, and reoperations in OLT cases. The current evidence correlates the increased incidence of bile leaks, cholangitis, and overall biliary complications with the use of a T-tube during OLT. In addition, T-tube-guided reconstruction has no impact on perioperative complications, overall survival, endoscopies, and reoperations in OLT cases.
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20
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Alshamam MS, Nso N, Nassar M, Idrees Z, Ghernautan V, Khan S, Abdalazeem Y, Munira M. T-wave Inversions in Cerebellar and Occipital Lobe Infarcts in the Setting of Deep Vein Thrombosis and Pulmonary Embolism Suggestive of Paradoxical Emboli: A Case Report. Cureus 2022; 14:e24230. [PMID: 35602844 PMCID: PMC9115622 DOI: 10.7759/cureus.24230] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/14/2022] Open
Abstract
Cardiological causes account for the majority of acute electrocardiographic (ECG) changes. The reason for this fear is the irreversibility of myocardial necrosis. Generally, various changes can be observed in the ECG, including ST-T changes, QTc prolongation, arrhythmias, and T-wave inversions. Even though T-wave inversions can be seen in myocardial ischemia/infarction, they are rarely seen in acute cerebrovascular accidents (CVAs). We present the case of a 66-year-old woman who initially presented at our facility with dizziness in the context of orthostatic hypotension. An initial cardiac evaluation revealed no cardiac involvement. She was treated with intravenous fluids (IVF), which improved her symptoms. The patient's mental status was markedly altered approximately four days after admission. In this instance, she was found to have abnormal ECG findings (not previously observed on the ECG that was obtained on the day of admission), elevated troponin T levels, as well as elevated pro-B-type natriuretic peptide (pro-BNP). The patient was given aspirin and clopidogrel immediately and was placed on a heparin drip for a suspected non-ST elevation myocardial infarction (NSTEMI). A non-contrast computed tomography of the head revealed an acute cerebrovascular accident (CVA), following which the heparin drip was stopped. The patient was then transferred to another acute care facility capable of performing neurosurgical interventions. Additionally, a computed tomography angiography (CTA) of the chest and lower extremities venous duplex showed bilateral pulmonary emboli and deep venous thrombosis (DVT), respectively.
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21
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Nso N, Nassar M, Zirkiyeva M, Mbome Y, Lyonga Ngonge A, Badejoko SO, Akbar S, Azhar A, Lakhdar S, Guzman Perez LM, Abdalazeem Y, Rizzo V, Munira M. Factors Impacting Stent Thrombosis in Patients With Percutaneous Coronary Intervention and Coronary Stenting: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e23973. [PMID: 35547463 PMCID: PMC9089933 DOI: 10.7759/cureus.23973] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/17/2022] Open
Abstract
Stent thrombosis (ST) is a frequently reported complication in cardiac patients with percutaneous coronary intervention (PCI) that adversely impacts their prognostic outcomes. Medical literature reveals several baseline characteristics of PCI patients that may predict their predisposition to ST and its potential complications. Our systematic review and meta-analysis aimed to determine the diagnostic significance of these baseline parameters in terms of determining the risk of ST among adult patients with PCI. We statistically evaluated 18 baseline characteristics of more than 15,500 PCI patients to delineate their stent thrombosis attribution. We included a number of articles focusing on baseline parameters in-stent thrombosis-related PCI scenarios. We explored the articles of interest based on inclusion/exclusion parameters across PubMed, JSTOR, Cochrane library, Google Scholar, and Embase. Medical subject headings (MeSH) words included “stent thrombosis,” “percutaneous coronary intervention,” and “coronary stenting.” We extracted the research articles published between 2005 and 2021 on April 20, 2021. The included studies also focused on procedures and clinical factors concerning their association with PCI-related ST. Our findings ruled out the progression of abnormal left ventricular ejection fraction (LVEF)-related stent thrombosis in PCI patients (odds ratio {OR}: 9.68, 95% CI: 1.88-49.90, p=0.007). We found an insignificant clinical correlation between stent thrombosis and PCI in the setting of acute coronary syndrome (ACS). Our study outcomes further revealed the absence of stent thrombosis in PCI patients with antiplatelet prescription (OR: 32.42, 95% CI: 21.28-49.39). The findings affirmed the absence of ST in PCI patients receiving aspirin therapy (OR: 32.77, 95% CI: 18.73-57.34; OR: 4.59, 95% CI: 1.97-10.73). The majority of the included studies negated the clinical correlation of stent thrombosis with diabetes mellitus in the setting of PCI (OR: 0.49, 95% CI: 0.06-3.78). Our study did not reveal statistically significant results based on stent thrombosis in PCI patients with drug-eluting stents (OR: 2.91, 95% CI: 0.35-24.49). The findings also did not reveal the impact of cardiac biomarker elevation on stent thrombosis in PCI patients (OR: 8.42, 95% CI: 2.54-27.98, p=0.0005). Eight studies revealed a statistically insignificant correlation between myocardial infarction and stent thrombosis in PCI scenarios (OR: 2.69, 95% CI: 0.89-8.11, p=0.08). The clinical correlation between PCI and stent thrombosis/major bleeding in the setting of hypertension also proved statistically insignificant at 0.67 (OR: 1.31, 95% CI: 0.38-4.51, p=0.97). The study findings did not correlate mean body mass index and multivessel coronary artery disease with ST in PCI scenarios (OR: 1.98, 95% CI: 0.02-239.58, p=0.78; OR: 1.09, 95% CI: 0.58-2.04, p=0.80). Only two studies revealed statistically significant results confirming stent thrombosis in PCI patients with a prior history of PCI (OR: 0.49, 95% CI: 0.23-1.06; OR: 0.33, 95% CI: 0.02-5.59; p=0.03). Our findings question the clinical significance of baseline characteristics in terms of predicting stent thrombosis in PCI patients. The results support the requirement of future studies to investigate complex interactions between procedural, medicinal, genetic, and patient-related factors contributing to the development of stent thrombosis in PCI patients.
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22
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Shah D, Umar Z, Ilyas U, Nso N, Zirkiyeva M, Rizzo V. New-Onset Atrial Fibrillation in COVID-19 Infection: A Case Report and Review of Literature. Cureus 2022; 14:e23912. [PMID: 35530910 PMCID: PMC9076057 DOI: 10.7759/cureus.23912] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/03/2022] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many cases of arrhythmias have been reported in patients with COVID-19 infection. We present the case of a 66-year-old female with no known cardiovascular history who presented with worsening shortness of breath and productive cough and tested positive for COVID-19 infection in the ED. The patient had a recent hospitalization for COVID-19 infection during which she was treated with dexamethasone and remdesivir therapy and her course remained uncomplicated at that time. Following this, she developed worsening shortness of breath at home for which she presented to the ED. During this hospitalization, she was treated with dexamethasone, remdesivir, and supplemental oxygen. On day six of hospitalization, the patient became tachycardic and had palpitations. Cardiac monitor and EKG showed evidence of new-onset atrial fibrillation (NOAF). Initially patient received metoprolol and diltiazem, both of which failed to achieve adequate rate control. Following this, the patient was started on carvedilol 30 mg every six hours, which attained good rate control. Her CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, and sex category) score was 4 for which she was started on apixaban 5mg twice daily. The patient was discharged on the same medications. Despite increasing reported incidences of NOAF in COVID-19 infection, only little is known about the optimal management strategies and possible etiopathology. The aim of our review is to highlight the possible mechanisms triggering atrial fibrillation in COVID-19 infection and go over the management strategies while reviewing the available literature.
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Umar Z, Ilyas U, Shah D, Nso N, Foster A, Zirkiyeva M. Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease. Cureus 2022; 14:e23774. [PMID: 35509729 PMCID: PMC9062685 DOI: 10.7759/cureus.23774] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 12/04/2022] Open
Abstract
Ischemic colitis is one of the most common ischemic pathologies of the gastrointestinal system and can be divided into non-gangrenous and gangrenous forms. The pathophysiology involves restricted blood supply to the colonic mucosa. Several risk factors have been implicated in the development of ischemic colitis. Lactulose, one of the mainstay therapies for the treatment of hepatic encephalopathy in patients with cirrhosis, has been rarely reported as a cause of ischemic colitis. To the best of our knowledge, there has been only one case report associating lactulose use with the development of ischemic colitis. The exact pathophysiology is unknown but might be associated with the fermentation of lactulose by intestinal bacteria, causing gaseous distention and increasing the intraluminal pressure. We present the case of a 77-year-old African American male, a known case of non-alcoholic liver cirrhosis with portal hypertension and esophageal varices, brought in by his family to the emergency department for altered mental status, non-bilious vomiting, abdominal distension, and pain for one day. On physical examination, the patient had upper extremity asterixis and was alert but disoriented to place and person. Diagnostic paracentesis was performed, which revealed leukocytosis, predominantly neutrophils. The patient was admitted for spontaneous bacterial peritonitis and hepatic encephalopathy with decompensated liver cirrhosis. The patient was started lactulose with a goal of three to four bowel movements per day. Despite adequate treatment, the patient continued to develop worsening mental function and abdominal distension. This was later followed by a bloody bowel movement. Laboratory assessment showed an elevated white blood cell count, worsening kidney function, and high anion gap metabolic acidosis. CT scan revealed dilated loops of bowel with air and fluid along with submucosal wall edema, findings suggestive of ischemic colitis. Given the poor prognosis and the patient's condition, colonoscopy was deferred. Lactulose was discontinued, as it was thought to be a contributing cause of the patient's ischemic colitis. His condition continued to deteriorate, and he passed away on Day 18 of admission.
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Umar Z, Ilyas U, Nso N. Sickle Cell Disease and COVID-19 Infection: Importance of COVID-19 Testing and Approach to Management. Cureus 2022; 14:e23604. [PMID: 35494937 PMCID: PMC9051589 DOI: 10.7759/cureus.23604] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/05/2022] Open
Abstract
Sickle cell disease is an autosomal recessive disorder resulting in the substitution of CTG by CAG in the sixth codon of the beta-globin gene. As a result of this, the hydrophilic glutamic acid residue is replaced by hydrophobic valine residue, leading to the formation of hemoglobin tetramer HBS. This alteration in the beta-globin chain makes the red blood cells prone to sickling, especially in the presence of risk factors such as stress, hypoxia, and infection. These sickled red blood cells have the tendency to adhere to the endothelium and lead to vessel occlusion and distal tissue ischemia. The recent coronavirus disease 2019 (COVID-19) outbreak has impacted millions across the globe, putting individuals with co-morbidities at particularly high risk, and patients with sickle cell disease are no exception. We present the case of a 47-year-old African American male presenting to the emergency department with subjective fevers and a two-day history of pain in the arms, legs, and chest. A diagnosed case of sickle cell disease, the patient was on hydromorphone for pain management but ran out of his medications a few weeks before presentation. On examination, the patient was saturating well with mild tenderness upon palpation of the arms, legs, and chest. On complete blood count, the patient had a hemoglobin of 11.3 g/dL and a white cell count of 13.1 x10(3)/mcL. The patient had a normal mean corpuscular volume with reticulocytosis, hypochromia, ovalocytosis, poikilocytosis, polychromasia, and target cells. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) was positive. The chest X-ray did not reveal any significant findings. He was admitted to the medicine floor for the management of sickle cell crisis and was placed under airborne and droplet precautions. The patient was started on hydromorphone for pain management and intravenous fluid hydration. On the second day of admission, the patient reported increasing shortness of breath. He was saturating 90% on room air and 94% on 2 liters of supplemental oxygen. The white blood cell count increased to 18.42 x10(3)/mcL and the chest X-ray revealed reticular densities with patchy alveolar opacities in the left lung. Given the decline in respiratory status, the patient was started on remdesivir. Over the course of his hospital stay, the patient's pain and respiratory status improved, with the patient saturating 97% on room air. He was discharged home with instructions to follow isolation precautions for at least two weeks, folic acid, and adequate pain management. An appointment was also scheduled for the patient to follow with a sickle cell nurse practitioner upon discharge.
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Nso N, Nassar M, Mbome Y, Emmanuel KE, Lyonga Ngonge A, Badejoko S, Akbar S, Landry I, Alfishawy M, Munira M, Rizzo V. Comparative Assessment of the Long-Term Efficacy of Home-Based Versus Center-Based Cardiac Rehabilitation. Cureus 2022; 14:e23485. [PMID: 35475109 PMCID: PMC9035293 DOI: 10.7759/cureus.23485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
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Abstract
Severe acute respiratory syndrome coronavirus 2, or COVID-19, has triggered an unprecedented pandemic situation across the globe. Patients with COVID-19 frequently experience a range of clinical complications driven by their health status, comorbidities, and disease responsiveness. Patients with COVID-19 also encounter cardiovascular conditions that potentially increase their risk for mortality. Few clinical studies reveal the development of ST segment elevation myocardial infarction (STEMI) in patients with COVID-19.
New York City, USA, continues to witness and report a high incidence and prevalence of COVID-19 infections. New York City’s healthcare centres and hospitals have treated more than 6,000 cases of COVID-19 pneumonia in their inpatient and intensive care units.
The authors conducted a retrospective study of patients admitted to NYC Health + Hospitals, Queens, New York City, USA, with confirmed COVID-19 reverse transcriptase-PCR test findings between 29th March 2020 and 1st May 2020. The authors used a retrospective case series design to evaluate the association between laboratory-confirmed COVID-19 infection and hospitalisation for acute myocardial infarction. They utilised a series of ECGs to record and analyse STEMI patterns across patients with COVID-19. This study aimed to determine the risk/incidence of STEMI in patients with COVID-19, and its impact on their clinical presentation, angiographic findings, and clinical outcomes. The authors hypothesised STEMI as a significant COVID-19 complication, with the potential to impact the long-term prognostic outcomes of patients with COVID-19.
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Affiliation(s)
- Sofia Lakhdar
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Chandan Buttar
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Laura Guzman Perez
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Nso Nso
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Mahmoud Nassar
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Giovina Collura
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
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Nassar M, Nso N, Lakhdar S, Kondaveeti R, Buttar C, Bhangoo H, Awad M, Sheikh NS, Soliman KM, Munira MS, Radparvar F, Rizzo V, Daoud A. New onset hypertension after transplantation. World J Transplant 2022; 12:42-54. [PMID: 35433331 PMCID: PMC8968475 DOI: 10.5500/wjt.v12.i3.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/14/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
It has been reported that up to 90% of organ transplant recipients have suboptimal blood pressure control. Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality. In addition, rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival. Nevertheless, hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients. Hence, specific management awareness of those factors is mandated. An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, prevention, and management of hypertension after organ transplantation.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Chandan Buttar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Mahmoud Awad
- Department of Medicine, The Memorial Souad Kafafi University Hospital, 6th of October - Giza 0000, Egypt
| | - Naveen Siddique Sheikh
- Department of Physiology, CMH Lahore Medical College and Institute of Dentistry, Lahore - Punjab 0000, Pakistan
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Most Sirajum Munira
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Farshid Radparvar
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11211, Egypt
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Vest M, Grewal H, Shaukat T, Landry I, Nso N, O'Connor J, Rizzo V. Acute Pancreatitis and Prognosticating Its Severity in Young Adults: A Case Report. Cureus 2022; 14:e22749. [PMID: 35371853 PMCID: PMC8971073 DOI: 10.7759/cureus.22749] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis develops into mild acute, moderately severe, and severe forms in multiple clinical scenarios. The severity assessment of pancreatitis relies on various scoring systems, including CT Severity Index (CTSI), Multiple Organ Dysfunction Syndrome (MODS), Acute Physiology and Chronic Health Evaluation II (APACHE-II), Bedside Index for Severity in Acute Pancreatitis (BISAP), Systemic Inflammatory Response Syndrome (SIRS), Multiple Organ System Score (MOSS), Glasgow score, and Ranson's Criteria (RC). This case report corresponds to a 20-year-old male with acute pancreatitis of unknown etiology. The RC scoring method produced two points, which could not prognosticate the possible severity of acute pancreatitis in the young patient. The hospital course included intubation with mechanical ventilation and ICU management.
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Nso N, Emmanuel K, Nassar M, Bhangal R, Enoru S, Iluyomade A, Marmur JD, Ilonze OJ, Thambidorai S, Ayinde H. Impact of new-onset versus pre-existing atrial fibrillation on outcomes after transcatheter aortic valve replacement/implantation. IJC Heart & Vasculature 2022; 38:100910. [PMID: 35146118 PMCID: PMC8802123 DOI: 10.1016/j.ijcha.2021.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation increases the risk of all primary and secondary outcomes after TAVR/TAVI. NOAF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI. Pre-AF is associated with a higher risk of AKI and early bleeding episodes after TAVR/TAVI.
Patients with aortic stenosis who undergo transcatheter aortic valve replacement/transcatheter aortic valve implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation (pre-AF) and new-onset atrial fibrillation (NOAF) post-operatively. This systematic review and meta-analysis aimed to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury (AKI), length of stay (LOS), and early/late bleeding in patients with NOAF or pre-AF who undergo TAVR/TAVI. PubMed, Google Scholar, JSTOR, Cochrane Library, and Web of Science were searched for studies published between January 2012 and December 2020 reporting the association between NOAF/pre-AF and clinical complications after TAVR/TAVI. A total of 15 studies including 158,220 adult patients with TAVI/TAVR and NOAF or pre-AF were identified. Compared to patients in sinus rhythm, patients who developed NOAF had a higher risk of 30-day mortality, AKI, early bleeding events, extended LOS, and stroke after TAVR/TAVI (odds ratio [OR]: 3.18 [95% confidence interval [CI] 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients in sinus rhythm, patients with pre-AF had a higher risk of AKI and early bleeding episodes after TAVR/TAVI (OR: 2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively). Atrial fibrillation is associated with a higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI.
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Nassar M, Baraka B, Osman A, Nso N, Mohamed M. The safety aspects of accepting living kidney donors with pelvi-ureteric junction dysfunction. Int Urol Nephrol 2022; 54:461-461. [DOI: https:/doi.org/10.1007/s11255-021-02893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/16/2021] [Indexed: 10/20/2023]
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Lyonga Ngonge A, Ganta N, Jalal Eldin A, Effoe V, Nso N, Williams D. The Dilemma in the Management of Thromboembolic Disease in the Setting of Concomitant Aortic Pseudoaneurysm. Cureus 2021; 13:e20668. [PMID: 35106211 PMCID: PMC8786573 DOI: 10.7759/cureus.20668] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Ascending aortic pseudoaneurysm (AAP) is a rare and serious complication of cardiothoracic surgeries or blunt chest trauma. We present a patient with paroxysmal atrial fibrillation, acute right pontine stroke, and acute pulmonary embolism (PE) with an incidental AAP that precluded the use of anticoagulation and surgery. The case findings substantiate the need for a CT-based assessment of aortic pathology after coronary artery bypass grafting (CABG) in the asymptomatic patient to determine the most appropriate treatment modalities. However, the high cost of CT imaging and the potential radiation exposure challenge its routine use in high-risk patients.
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Nso N, Nyabera A, Nassar M, Alshamam MS, Sumbly V, Vest M, Patel N, Ojong G, Rizzo V. Cannabis and Its Potential Protective Role Against Inflammatory Bowel Disease: A Scoping Review. Cureus 2021; 13:e18841. [PMID: 34804696 PMCID: PMC8597664 DOI: 10.7759/cureus.18841] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
Globally, around 15%-40% of patients suffering from inflammatory bowel disease (IBD) use Cannabis for pain reduction, increased appetite, and reduced need for other medications. Although many patients report having benefited by using Cannabis in IBD, there is still a lack of consensus regarding the use of Cannabis in IBD. The aim is to identify, explore and map literature on the potential protective role of Cannabis against IBD through this scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during the search to answer the focal question: (1) Does Cannabis play a protective role against IBD as assessed by clinical remission; (2) If yes, what is the mechanism of action for this protective role. There were only three randomized controlled trials (RCTs) and three observational studies that satisfied the selection criteria of this scoping review. Although promising results including the improvement in general well-being/ Harvey-Bradshaw Index, health perception enhancement [4.1±1.43 to 7±1.42 (p = 0.0002)], weight gain, Crohn's Disease Activity Index (CDAI) score<150, Mayo scores (4-10), and reduction in clinical complications have been found in some studies, its medical use in IBD is still questionable due to the lack of high-quality evidence. Future RCTs studies should determine the cannabis treatment parameters and validate its safety and effectiveness in the IBD setting. The highlights include: the current literature provides inconclusive evidence concerning the protective role of cannabis for IBD patients; limited research evidence regarding the therapeutic use of cannabinoids for IBD warrants future investigation via RCTs; cannabis provides some benefits to IBD patients by improving their general well-being perceptions, Harvey-Bradshaw Index, Mayo scores, and minimizing their clinical complications.
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Affiliation(s)
- Nso Nso
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Akwe Nyabera
- Internal Medicine, New York City Health and Hospitals/Queens, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, New York, USA
| | - Mohsen S Alshamam
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, New York, USA
| | - Vikram Sumbly
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, New York, USA
| | - Mallorie Vest
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Nehal Patel
- Internal Medicine, Chicago Medical School, Chicago, USA
| | - Gilbert Ojong
- Internal Medicine, La Magna Health/United Regional Hospital, Atlanta, USA
| | - Vincent Rizzo
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Nso N, Nassar M, Lakhdar S, Enoru S, Guzman L, Rizzo V, Munira MS, Radparvar F, Thambidorai S. Comparative Assessment of Transvenous versus Subcutaneous Implantable Cardioverter-defibrillator Therapy Outcomes: An Updated Systematic Review and Meta-analysis. Int J Cardiol 2021; 349:62-78. [PMID: 34801615 DOI: 10.1016/j.ijcard.2021.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a high risk of ventricular arrhythmias. This study aimed to evaluate the safe replacement of TV-ICD with S-ICD based on updated recent evidence. METHODS We systematically searched EMBASE, JSTOR, PubMed/MEDLINE, and Cochrane Library on 30 July 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS We identified 26 studies that examined 7542 (58.27%) patients with S-ICD and 5400 (41.72%) with TV-ICD. The findings indicated that, compared to patients with TV-ICD, patients with S-ICD had a lower incidence of defibrillation lead failure (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.98; p = 0.05), lead displacement or fracture (OR, 0.25; 95% CI, 0.12-0.86; p = 0.0003), pneumothorax and/or hemothorax (OR: 0.22, 95% CI 0.05, 0.97, p = 0.05), device failure (OR: 0.70, 95% CI 0.51, 0.95, p = 0.02), all-cause mortality (OR: 0.44 [95% CI 0.32, 0.60], p < 0.001), and lead erosion (OR: 0.01, 95% CI 0.00, 0.05, p < 0.001). Patients with TV-ICD had a higher incidence of pocket complications than patients with S-ICD (OR, 2.13; 95% CI, 1.23-3.69; p = 0.007) and a higher but insignificant incidence of inappropriate sensing (OR, 3.53; 95% CI, 0.97-12.86; p = 0.06). CONCLUSIONS The S-ICD algorithm was safer and more effective than the TV-ICD system as it minimized the incidence of pocket complications, lead displacement or fracture, inappropriate sensing, defibrillation lead failure, pneumothorax/hemothorax, device failure, lead erosion, and all-cause mortality. Future studies should explore the scope of integrating novel algorithms with the current S-ICD systems to improve cardiovascular outcomes.
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Affiliation(s)
- Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA.
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Sofia Lakhdar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Sostanie Enoru
- Division of Cardiovascular Disease, SUNY Downstate Medical Center, NY, USA
| | - Laura Guzman
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Most S Munira
- Division of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Farshid Radparvar
- Division of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Senthil Thambidorai
- Cardiovascular Medicine Division, HCA Medical City of Fort Worth, TX/Medicine -TCU and UNTHSc School of Medicine, Fort Worth, TX, USA
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Nassar M, Daoud A, Nso N, Medina L, Ghernautan V, Bhangoo H, Nyein A, Mohamed M, Alqassieh A, Soliman K, Alfishawy M, Sachmechi I, Misra A. Diabetes Mellitus and COVID-19: Review Article. Diabetes Metab Syndr 2021; 15:102268. [PMID: 34562865 PMCID: PMC8416292 DOI: 10.1016/j.dsx.2021.102268] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS We aim to cover most of the current evidence on the mutual effect of diabetes & COVID-19 infection on each other and the management of the COVID-19 patients with diabetes. METHODS We utilized databases to review the current evidence related to diabetes mellitus and COVID-19. RESULTS We discussed the most recent evidence of diabetes milieus and COVID-19 regarding risk factors, management, complications, and telemedicine. CONCLUSION Diabetes mellitus is associated with a significant risk of complications, extended hospital stays, and mortality in COVID-19 infected patients.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Ahmed Daoud
- Internal Medicine Department, Faculty of Medicine Cairo University, Cairo, Egypt.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Luis Medina
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Victoria Ghernautan
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Harangad Bhangoo
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Andrew Nyein
- New York Institute of Technology College of Osteopathic Medicine, NYC, USA.
| | - Mahmoud Mohamed
- Medicine department, North Mississippi Medical Center, Tupelo, MS, USA.
| | - Ahmed Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Karim Soliman
- Division of Nephrology, Department of Medicine and Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Egypt.
| | - Issac Sachmechi
- Chair of Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens USA.
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, Chairman, National Diabetes, Obesity, And Cholesterol Foundation (N-DOC), President, Diabetes Foundation (India) (DFI), USA.
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Nso N, Nassar M, Baraka B, Mbome Y, Alfishawy M. Adrenal Insufficiency in patients with cardiogenic shock: A meta-analysis. Diabetes Metab Syndr 2021; 15:102274. [PMID: 34628137 DOI: 10.1016/j.dsx.2021.102274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adrenal Insufficiency (AI) is rarely observed in patients with cardiogenic shock (CS). We aimed to identify the prevalence of AI in patients with CS and its effect on their clinical outcomes. AIMS Our study aimed to determine the prevalence of AI in CS patients who underwent treatments for CS. METHODS The articles concerning AI in CS were extracted for review from PubMed/Medline, Science Direct, World Wide Science.org, and Pro-Quest. The research articles included patients with CS, post-cardiac-arrest shock, out-of-hospital cardiac arrest, and CS after acute myocardial infarction. RStudio (version 1.0.136) was used for analyzing AI in CS patients. RESULTS The search revealed 1463 unique publications, including 256 studies identified after screening the titles and the abstracts. Five observational cohort studies met the eligibility criteria for meta-analysis after the preliminary screening. The included studies reported a corticotropin stimulation test for AI diagnosis. The studies reportedly exhibited a low-to-fair quality. The random-effects pooled estimates indicated a 32% AI prevalence in the setting of CS [95% CI; 21%-45%; I2 = 81%]. The outcomes from the included studies were statistically significant for high heterogeneity (P = 0.001). The pooled results confirmed an 11%-51% AI prevalence in CS patients. CONCLUSIONS This meta-analysis revealed a moderate level prevalence of AI in CS patients.
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Affiliation(s)
- Nso Nso
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health+Hospitals / Queens, New York, NY, USA.
| | - Mahmoud Nassar
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health+Hospitals / Queens, New York, NY, USA.
| | - Bahaaeldin Baraka
- Clinical Oncology Department, Nottingham University Hospital, Nottingham, UK.
| | - Yolanda Mbome
- Internal Medicine Department, Richmond University Medical Center, New York, USA.
| | - Mostafa Alfishawy
- Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Egypt.
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Nso N, Nassar M, Guzman Perez LM, Shaukat T, Trandafirescu T. Localized Pulmonary Nocardia farcinica Infection As the Presenting Symptom of Acquired Immunodeficiency Syndrome. Cureus 2021; 13:e17611. [PMID: 34646662 PMCID: PMC8483601 DOI: 10.7759/cureus.17611] [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] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Nocardiosis is an opportunistic infection that most commonly affects immunocompromised patients, with clinical presentations ranging from localized to disseminated disease. In the United States, the reported incidence is approximately 500 to 1,000 cases per year, with an observed male-to-female predominance of 3:1. We present the case of a 37-year-old male with a past medical history of malaria who presented with watery, non-bloody diarrhea for four days associated with a fever for two weeks. The human immunodeficiency virus (HIV) was positive in the emergency room before admission. Computerized tomography (CT) of the chest with contrast revealed an irregular pleural base mass in the right lower lobe with several small air foci. CT of the abdomen and pelvis revealed the right pleural base lung mass to be adherent to the diaphragm, as well as mild splenomegaly. The cluster of differentiation 4 (CD4) count was 9 cells/mm3. An acid-fast bacilli (AFB) sputum culture was positive for Nocardia farcinica. Trimethoprim-sulfamethoxazole was started for a Nocardia farcinica pulmonary infection, in addition to antiretroviral therapy. The patient was strongly encouraged to follow-up at the outpatient department.
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Affiliation(s)
- Nso Nso
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Laura M Guzman Perez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York , USA
| | - Tanveer Shaukat
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Theo Trandafirescu
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Nassar M, Nso N, Medina L, Ghernautan V, Novikov A, El-Ijla A, Soliman KM, Kim Y, Alfishawy M, Rizzo V, Daoud A. Liver kidney crosstalk: Hepatorenal syndrome. World J Hepatol 2021; 13:1058-1068. [PMID: 34630874 PMCID: PMC8473490 DOI: 10.4254/wjh.v13.i9.1058] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/12/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
The dying liver causes the suffocation of the kidneys, which is a simplified way of describing the pathophysiology of hepatorenal syndrome (HRS). HRS is characterized by reversible functional renal impairment due to reduced blood supply and glomerular filtration rate, secondary to increased vasodilators. Over the years, HRS has gained much attention and focus among hepatologists and nephrologists. HRS is a diagnosis of exclusion, and in some cases, it carries a poor prognosis. Different classifications have emerged to better understand, diagnose, and promptly treat this condition. This targeted review aims to provide substantial insight into the epidemiology, pathophysiology, diagnosis, and management of HRS, shed light on the various milestones of this condition, and add to our current understanding.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Luis Medina
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Victoria Ghernautan
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Anastasia Novikov
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Alli El-Ijla
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Yungmin Kim
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Mostafa Alfishawy
- Department of Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo 11562, Egypt
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11211, Egypt
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Nassar M, Nso N, Ariyaratnam J, Sandhu J, Mohamed M, Baraka B, Ibrahim A, Alfishawy M, Zheng D, Bhangoo H, Soliman KM, Li M, Rizzo V, Daoud A. Coronavirus disease 2019 and renal transplantation. World J Clin Cases 2021; 9:7986-7997. [PMID: 34621855 PMCID: PMC8462194 DOI: 10.12998/wjcc.v9.i27.7986] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019 (COVID-19) struck the world, global health strategies have changed significantly. According to the Centers for Disease Control and Prevention, kidney transplant recipients are stratified as being high risk of developing fatal illness from COVID-19 infection. Kidney transplant is the gold-standard treatment for end-stage kidney disease subjects. During the pandemic, significant concerns have emerged regarding continuation of kidney transplant surgeries and management of kidney transplant recipients post-transplant. The added risk of immunosuppression in this cohort was and remains a theoretical concern, posing a potential risk of transplantation rather than benefit. This comprehensive review aims to cover most of the faced challenges in kidney transplantation in different stages of the pandemic. In addition, it will elucidate the epidemiology, nature, course of the disease, surgical consideration in donors and recipients as well as role of immunosuppression and management of COVID-19 infected kidney transplant recipients during these extraordinary circumstances.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Jonathan Ariyaratnam
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Jasmine Sandhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Mahmoud Mohamed
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Bahaaeldin Baraka
- Department of Oncology, Southend University Hospital, NHS Foundation Trust, Essex SS0 0RY, United Kingdom
| | - Atif Ibrahim
- Renal Division, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Mostafa Alfishawy
- Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo 0000, Egypt
| | - David Zheng
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Harangad Bhangoo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Matthew Li
- Department of Clinical Pharmacy, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 10029, United States
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
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Nso N, Toz B, Ching TH, Kondaveeti R, Abrudescu A. Tattoo-Associated Sarcoidosis With Severe Uveitis Successfully Treated With Mycophenolate Mofetil: A Report of Two Cases. Cureus 2021; 13:e17197. [PMID: 34540425 PMCID: PMC8439406 DOI: 10.7759/cureus.17197] [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] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Tattooing is an increasing trend among Western countries, with about 18% of the population undergoing the procedure once in their lifetime. The process looks simple; introduce exogenous pigment into the dermis layer of the skin, altering the skin color permanently. However, this simple procedure leads to several health issues and medical complications, both acute and chronic, and some are difficult to cure. Sarcoidosis is high on the list of severity involving almost all body organs. Multiple organ involvement makes this condition more difficult to treat. Lungs and lymphatics are the leading sites of involvement, followed by an inflammatory disease of the eye called uveitis. An additional problem is the limited confirmatory diagnostic tests and treatment options for sarcoidosis. Each patient must be considered unique based on their age, clinical presentation, and severity of involvement. Proper treatment must be tailored for better outcomes with minimum side effects and rapid cure. Here we describe two case reports of tattoo-associated sarcoidosis with severe uveitis successfully treated with mycophenolate mofetil.
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Affiliation(s)
- Nso Nso
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Bahtiyar Toz
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Tsung Han Ching
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Ravali Kondaveeti
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Adriana Abrudescu
- Rheumatology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Mohamed M, Sweeney T, Alkhader D, Nassar M, Alqassieh A, Lakhdar S, Nso N, Fülöp T, Daoud A, Soliman KM. ABO incompatibility in renal transplantation. World J Transplant 2021; 11:388-399. [PMID: 34631470 PMCID: PMC8465511 DOI: 10.5500/wjt.v11.i9.388] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/19/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
ABO blood group incompatibility (ABO-I) was historically considered an absolute contraindication to kidney transplantation due to the significant risk of acute antibody-mediated rejection and early graft loss. Nevertheless, the urge to minimize the gap between the candidates’ number on the waitlist for kidney transplants and the available kidney donors encourage investigation into finding ways to use organs from ABO-I kidney donors, especially in the era of using more potent immunosuppression therapies. This review aims to discuss a general overview of ABO-I kidney transplantation and the different protocols adopted by some transplant centers to meaningfully overcome this barrier.
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Affiliation(s)
- Mahmoud Mohamed
- Department of Medicine, North Mississippi Medical Center, Tupelo, MS 38804, United States
| | - Tara Sweeney
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Duaa Alkhader
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, New York, NY 11432, United States
| | - Ahmed Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Sofia Lakhdar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, New York, NY 11432, United States
| | - Tibor Fülöp
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
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Nassar M, Elshafey M, Gonzalez C, Nso N, Mahdi M, Elsayed I. Induction Therapy, HLA Mismatching, and Standard-Risk Kidney Transplantation. Am J Nephrol 2021; 52:691. [PMID: 34515034 DOI: 10.1159/000517908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mahmoud Nassar
- Medicine Department, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, New York, New York, USA
| | - Mohammed Elshafey
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Carlos Gonzalez
- Medicine Department, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, New York, New York, USA
| | - Nso Nso
- Medicine Department, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, New York, New York, USA
| | - Mamdouh Mahdi
- Professor of Nephrology, Dean of Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ingi Elsayed
- Renal Department, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
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Nassar M, Nso N, Gonzalez C, Lakhdar S, Alshamam M, Elshafey M, Abdalazeem Y, Nyein A, Punzalan B, Durrance RJ, Alfishawy M, Bakshi S, Rizzo V. Corrigendum to "COVID-19 vaccine-induced myocarditis case report with literature review" [Diabetes & Metabolic Syndrome: Clinical Research & Reviews Volume 15, Issue 5, September-October 2021, 102205]. Diabetes Metab Syndr 2021; 15:102277. [PMID: 34534777 PMCID: PMC8438226 DOI: 10.1016/j.dsx.2021.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mahmoud Nassar
- Medicine Department, Icahn School of Medicine at Mount Sinai, New York, USA; NYC Health + Hospitals Queens, New York, USA.
| | - Nso Nso
- Medicine Department, Icahn School of Medicine at Mount Sinai, New York, USA; NYC Health + Hospitals Queens, New York, USA
| | - Carlos Gonzalez
- Medicine Department, Icahn School of Medicine at Mount Sinai, New York, USA; NYC Health + Hospitals Queens, New York, USA
| | - Sofia Lakhdar
- Medicine Department, Icahn School of Medicine at Mount Sinai, New York, USA; NYC Health + Hospitals Queens, New York, USA
| | - Mohsen Alshamam
- NYC Health + Hospitals Queens, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mohammed Elshafey
- Obstetrics and Gynecology Department, University of Tennessee Health Science Center (UTHSC), Tennessee, USA
| | | | - Andrew Nyein
- New York Institute of Technology College of Osteopathic Medicine, NYC, USA
| | | | - Richard Jesse Durrance
- Division of Pulmonary and Critical Care Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, New York, USA
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Egypt
| | - Sanjiv Bakshi
- Cardiology Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Vincent Rizzo
- NYC Health + Hospitals Queens, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Nassar M, Nso N, Gonzalez C, Lakhdar S, Alshamam M, Elshafey M, Abdalazeem Y, Nyein A, Punzalan B, Durrance RJ, Alfishawy M, Bakshi S, Rizzo V. COVID-19 vaccine-induced myocarditis: Case report with literature review. Diabetes Metab Syndr 2021; 15:102205. [PMID: 34293552 PMCID: PMC8270733 DOI: 10.1016/j.dsx.2021.102205] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Mahmoud Nassar
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Nso Nso
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Carlos Gonzalez
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Sofia Lakhdar
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Mohsen Alshamam
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Mohammed Elshafey
- Obstetrics and Gynecology Department, University of Tennessee Health Science Center (UTHSC), Tennessee, USA.
| | | | - Andrew Nyein
- New York Institute of Technology College of Osteopathic Medicine, NYC, USA.
| | | | - Richard Jesse Durrance
- Division of Pulmonary and Critical Care Icahn School of Medicine at Mount Sinai / Elmhurst Hospital, New York, USA.
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Egypt.
| | - Sanjiv Bakshi
- Cardiology Division, Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
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Alshamam MS, Nso N, Idrees Z, Iqbal S, Ghernautan V, Sumbly V, Agladze M, Khan S, Sachmechi I. New-Onset Diabetes in the Setting of Beta-Cell Dysfunction in a Young Patient With COVID-19 Infection. Cureus 2021; 13:e16497. [PMID: 34430112 PMCID: PMC8373597 DOI: 10.7759/cureus.16497] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 01/21/2023] Open
Abstract
Reciprocal relationships between viral illness and chronic diseases have been established. Such relationships augment one another and increase the potential harm. The coronavirus 2019 pandemic proved that the most vulnerable populations are the ones with underlying chronic diseases, especially diabetes mellitus. As new data are evolving, viral illnesses, like COVID-19, have been speculated to potentially induce diabetes mellitus. Here we report a 20-year-old male with no past medical history who presented with polyuria, polydipsia, and dry mouth. He was found to have significant hyperglycemia. He had COVID-19-like symptoms a few weeks prior to admission and was tested positive for COVID-19, but the symptoms had resolved prior to his presentation. He was managed with intravenous fluids (IVFs), electrolytes replacement, and insulin. He was diagnosed with new-onset diabetes mellitus likely secondary to a recent COVID-19 infection and was discharged home on insulin, oral antidiabetic medications, and outpatient follow-up with primary care clinic and endocrinology clinic.
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Affiliation(s)
- Mohsen S Alshamam
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
| | - Nso Nso
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
| | - Zarwa Idrees
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals Queens, Jamaica, USA
| | - Saba Iqbal
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
| | - Victoria Ghernautan
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
| | - Vikram Sumbly
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
| | - Mariam Agladze
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
| | - Saifullah Khan
- General Medicine, Saint James School of Medicine, St. Vincent, VCT
| | - Issac Sachmechi
- Internal Medicine, Ichan School of Medicine at Mount Sinai, New York City (NYC) Health + Hospitals, Jamaica, USA
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Nassar M, Ghernautan V, Nso N, Nyabera A, Medina L, Tu W, Ciobanu C, Castillo F, Rizzo V, Eskaros S. Gastrointestinal Involvement in Systemic Sclerosis.. [DOI: 10.20944/preprints202108.0332.v1] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Introduction: The gastrointestinal tract (GI) is the second most affected organ system in systemic sclerosis or systemic/localized scleroderma (SSc) and is an important topic for research. Approximately 90% of patients with scleroderma exhibit pathology of the GI tract. The systemic scleroderma has the potential to impact any part of the gastrointestinal tract, between the oral cavity and anorectum. The pathological complications of scleroderma adversely impact the health-related quality of life of the affected patients and increase the treatment burden of patients and medical professionals. Study Aim: We summarized the epidemiology, commonly reported clinical manifestations, complications, and available therapies for treating the GI pathology in systemic scleroderma patients. Methodology: We performed a literature review using the keywords "systemic sclerosis," "scleroderma," "GI manifestations in scleroderma," and "GI complications of scleroderma" across databases, including Google Scholar, Medline, Embase, and PubMed. We also analyzed a range of case reports concerning scleroderma manifestations and treatment modalities. Results: Our research revealed the annual incidence of SSc attributing to19.3 cases per million adults in the United States. We found the highest incidence of systemic scleroderma in patients within the age range of 44-55 years. Our results affirmed 5:1 incidence of systemic scleroderma that confirmed the higher impact of this disease condition in females than male populations. We found that the gastrointestinal manifestations of systemic scleroderma predominantly elevate the morbidity and mortality incidence among the affected patients. Esophageal and intestinal manifestations impact 90% and 40-70% of patients with systemic scleroderma. The small bowel hypomotility and small intestinal bacterial overgrowth (SIBO) in systemic scleroderma cases trigger the episodes of malabsorption and malnutrition that eventually add to 50% of the mortality rate. Systemic sclerosis is associated with the high incidence of fecal incontinence that triggers depression and its deleterious mental health manifestations in many clinical scenarios. Conclusion: The gastrointestinal complications in systemic sclerosis potentially deteriorate the daily living activities of the affected patients. The systematic management of the gastrointestinal complications of systemic scleroderma warrants multidisciplinary approaches. Prospective studies should focus on developing targeted therapies for improving the recovery patterns and prognostic outcomes in systemic scleroderma cases.
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Alfishawy M, Nso N, Nassar M, Ariyaratnam J, Bhuiyan S, Siddiqui RS, Li M, Chung H, Al Balakosy A, Alqassieh A, Fülöp T, Rizzo V, Daoud A, Soliman KM. Liver transplantation during global COVID-19 pandemic. World J Clin Cases 2021; 9:6608-6623. [PMID: 34447809 PMCID: PMC8362541 DOI: 10.12998/wjcc.v9.i23.6608] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/02/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally. Liver transplantation (LT) has faced an unequivocal challenge during this unprecedented time. This targeted review aims to cover most of the clinical issues, challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.
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Affiliation(s)
- Mostafa Alfishawy
- Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo 0000, Egypt
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Jonathan Ariyaratnam
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Sakil Bhuiyan
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Raheel S Siddiqui
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Matthew Li
- Clinical pharmacy department, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Howard Chung
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Amira Al Balakosy
- Tropical Medicine Department, Ain Shams University, Cairo 11517, Egypt
| | - Ahmed Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Tibor Fülöp
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
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Emmanuel KE, Nassar M, Nso N. Prognostic Value of Cardiovascular Testing in Asymptomatic Patients With a History of Cardiovascular Disease: A Review of Contemporary Medical Literature. Cureus 2021; 13:e16892. [PMID: 34367842 PMCID: PMC8338770 DOI: 10.7759/cureus.16892] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/07/2023] Open
Abstract
The cardiac stress testing, carotid duplex, coronary artery calcium (CAC) scoring, myocardial perfusion imaging, coronary angiography, C-reactive protein (CRP), glycated hemoglobin (HbA1C), total serum cholesterol, duplex ultrasonography, digital subtraction angiography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography, and ankle-brachial index (ABI) independently predict the risks and prognostic outcomes in asymptomatic cardiovascular disease (CVD) patients. The peripheral artery disease (PAD) screening guides the diagnosis, management, and prognosis of hemodynamically significant arterial stenosis, calcification, and malignant hypertension in patients with CVD without symptoms. The 79% sensitivity and 96% specificity of ABI screening, 90% sensitivity and 97% specificity of MRA, and 95% sensitivity and 50% specificity of CTA for tracking arterial occlusion indicate the high prognostic value of these tests in the setting of CVD. The 85% specificity and 60-70% sensitivity of cardiac stress testing substantiate its suitability to determine asymptomatic CVD prognosis related to myocardial ischemia, heart failure, multivessel disease, and unstable angina. The carotid duplex ultrasound potentially identifies long-term mortality, stroke, atherosclerosis, plaque instability, and angiographic stenosis among asymptomatic CVD patients with 94% specificity and 90% sensitivity. The CAC scoring has a positive predictive value (PPV) of 45.7% for identifying aortic valve calcium and PPV of 79.3% for tracking thoracic artery calcium. The medical literature provides substantial evidence concerning the validity, reliability, and prognostic value of cardiovascular testing for asymptomatic patients. Future studies are needed to undertake detailed assessments of benefits versus adverse outcomes associated with the prospective scaling (of cardiovascular testing) across asymptomatic CVD patients.
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Affiliation(s)
- Kelechi E Emmanuel
- Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals Queens, New York, USA
| | - Nso Nso
- Internal Medicine, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals, New York, USA
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Nassar M, Nso N, Alfishawy M, Novikov A, Yaghi S, Medina L, Toz B, Lakhdar S, Idrees Z, Kim Y, Gurung DO, Siddiqui RS, Zheng D, Agladze M, Sumbly V, Sandhu J, Castillo FC, Chowdhury N, Kondaveeti R, Bhuiyan S, Perez LG, Ranat R, Gonzalez C, Bhangoo H, Williams J, Osman AE, Kong J, Ariyaratnam J, Mohamed M, Omran I, Lopez M, Nyabera A, Landry I, Iqbal S, Gondal AZ, Hassan S, Daoud A, Baraka B, Trandafirescu T, Rizzo V. Current systematic reviews and meta-analyses of COVID-19. World J Virol 2021; 10:182-208. [PMID: 34367933 PMCID: PMC8316876 DOI: 10.5501/wjv.v10.i4.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.
AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed.
METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain.
RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health, smoking, cancer, and transplant.
CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.
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Affiliation(s)
- Mahmoud Nassar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mostafa Alfishawy
- Department of Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo 11221, Outside of the US, Egypt
| | - Anastasia Novikov
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Salim Yaghi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Luis Medina
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Bahtiyar Toz
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Zarwa Idrees
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Yungmin Kim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Dawa Ongyal Gurung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Raheel S Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - David Zheng
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariam Agladze
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vikram Sumbly
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jasmine Sandhu
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Francisco Cuevas Castillo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nadya Chowdhury
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sakil Bhuiyan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Laura Guzman Perez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Riki Ranat
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Carlos Gonzalez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - John Williams
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Alaa Eldin Osman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Joyce Kong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jonathan Ariyaratnam
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Knoxville City, TN 38103, United States
| | - Ismail Omran
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariely Lopez
- Department of Medical, St. George's University, West Indies 38901, Grenada
| | - Akwe Nyabera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ian Landry
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Saba Iqbal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Anoosh Zafar Gondal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sameen Hassan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11221, Egypt
| | - Bahaaeldin Baraka
- Department of Oncology, Broomfiled Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, Chelmsford 12422, United Kingdom
| | - Theo Trandafirescu
- Department of Critical Care Unit, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
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Alshamam MS, Nso N, Idrees Z, Nassar M, Munira MS. Coronavirus Disease 2019 (COVID-19)-Induced Takotsubo Cardiomyopathy Prognosis in Geriatric Setting. Cureus 2021; 13:e16211. [PMID: 34367812 PMCID: PMC8341288 DOI: 10.7759/cureus.16211] [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] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
An 86-year-old female with a past medical history of hypertension, vertebral fractures with chronic lumbar pain, hip fracture, osteoporosis, deafness, and microcytic anemia underwent hospital admission for emergency medical management of her respiratory distress. The (overall) diagnostic workup confirmed COVID-19, the patient presented with 50% SPO2 (oxygen saturation), sinus tachycardia, diffuse bilateral pulmonary crackles, mild jugular venous distention (JVD), minimal bilateral pitting edema, elevated cardiac enzymes, bilateral pulmonary opacities, and ST-segment elevation. The cardiovascular assessment indicated stress-induced cardiomyopathy/Takotsubo cardiomyopathy (TCM) determined by 35%-40% LVEF (left ventricular ejection fraction), mid to apical left ventricular (LV) akinesia with preserved function in the proximal segment, aortic valve sclerosis, reduced excursion of Trileaflet valve (without stenosis), and mild-to-moderate tricuspid regurgitation with moderate pulmonary artery systolic pressure (PASP). The treatment protocol relied on 81 mg aspirin, 75 mg plavix, 20 mg lipitor, remdesivir, dexamethasone, ceftriaxone, azithromycin, red blood cells transfusion (pRBCs), endotracheal intubation for respiratory support, and systemic hemodynamic support. The patient’s condition did not improve despite all treatment, and she passed away after seven days following her hospital admission.
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Affiliation(s)
- Mohsen S Alshamam
- Internal Medicine, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals Queens, Jamaica, USA
| | - Nso Nso
- Internal Medicine, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals Queens, Jamaica, USA
| | - Zarwa Idrees
- Internal Medicine, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals Queens, Jamaica, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals Queens, Jamaica, USA
| | - Most Sirajum Munira
- Cardiology, Icahn School of Medicine at Mount Sinai/New York City (NYC) Health+Hospitals Queens, Jamaica, USA
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50
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Nassar M, Chung H, Dhayaparan Y, Nyein A, Acevedo BJ, Chicos C, Zheng D, Barras M, Mohamed M, Alfishawy M, Nso N, Rizzo V, Kimball E. COVID-19 vaccine induced rhabdomyolysis: Case report with literature review. Diabetes Metab Syndr 2021; 15:102170. [PMID: 34186348 PMCID: PMC8205294 DOI: 10.1016/j.dsx.2021.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Mahmoud Nassar
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Howard Chung
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Yarl Dhayaparan
- New York Institute of Technology College of Osteopathic Medicine, NYC, USA.
| | - Andrew Nyein
- New York Institute of Technology College of Osteopathic Medicine, NYC, USA.
| | | | - Celestin Chicos
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - David Zheng
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Mathieu Barras
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center USA.
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo, Egypt.
| | - Nso Nso
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Vincent Rizzo
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
| | - Eben Kimball
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA.
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