Publications by authors named "Abbas Alshami"

28 Publications

  • Page 1 of 1

Improving Hospital Length of Stay: Results of a Retrospective Cohort Study.

Healthcare (Basel) 2021 Jun 19;9(6). Epub 2021 Jun 19.

Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA.

(1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June-August 2019 to June-August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings.
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http://dx.doi.org/10.3390/healthcare9060762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234441PMC
June 2021

COVID-19 Associated Spontaneous Pneumothorax and Pneumopericardium: A Case Report.

Cureus 2021 May 5;13(5):e14861. Epub 2021 May 5.

Critical Care, United General Hospital, Houston, USA.

Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemics of our time. There have been several complications of this disease that have also proven to be debilitating and deadly. While primarily affecting the respiratory system, some cases presented with uncommon complications such as pneumopericardium and spontaneous pneumothorax. We present a case of an elderly female diagnosed with COVID-19 found to have both spontaneous pneumothorax and pneumopericardium. She had a complicated hospital course and ultimately succumbed to her illness. While the pathogenesis of these conditions is not yet fully understood, further studies are needed to help clinicians develop treatment and prevention strategies to improve patient outcomes.
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http://dx.doi.org/10.7759/cureus.14861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178127PMC
May 2021

Outcomes of Renal Function in Cardiogenic Shock Patients With or Without Mechanical Circulatory Support.

J Clin Med Res 2021 May 25;13(5):283-292. Epub 2021 May 25.

Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA.

Background: The objective of the study was to compare the renal outcomes in patients presenting with all-cause cardiogenic shock who were supported by either Impella devices (Abiomed, Danvers, MA), intra-aortic balloon pump (IABP), or vasopressors alone. Outcomes of cardiogenic shock remain poor even with the advancement of early revascularization and circulatory supportive care. Percutaneous mechanical circulatory support (MCS) device has emerged as an effective strategy in protecting end organ function especially renal function during high risk percutaneous coronary intervention (PCI) and in patients with cardiogenic shock. Currently, comparative data amongst various MCS modalities and their association with improvement of renal function in cardiogenic shock patients have not been well characterized.

Methods: Data from New Jersey Cardiac Catheterization Data registry of cardiogenic shock patients from a single tertiary care institution that underwent cardiac catheterization and the modality used to treat were obtained, either with Impella devices, IABP, or treatment with vasopressors alone. Retrospective chart review was conducted to assess the incidence of acute kidney injury (AKI) on patients with cardiogenic shock prior to and after cardiac catheterization and renal function was evaluated over the course of 96 h after cardiac catheterization. Statistical analysis was performed to ascertain significant difference in creatinine and estimated glomerular filtration rate (eGFR) in patients who received Impella devices, IABP, or were treated with vasopressors alone.

Results: A total of 61 all-cause cardiogenic shock patients met the inclusion and exclusion criteria and were included in the study with 19 receiving IABPs, 15 receiving Impella devices, and 27 treated with vasopressors alone. Baseline characteristics among these three groups did not show any statistically significant difference. A total of 29 cardiogenic shock patients had experienced AKI prior to cardiac catheterization in which those receiving Impella devices showed statistically significant decrease in creatinine and increase in eGFR at 72 and 96 h (P < 0.05) compared to baseline. Within the same cohort, Impella group showed statistically significant lower creatinine at 96 h when compared to IABP. Patients that experienced AKI after cardiac catheterization did not show any statistically significant changes in renal function regardless of modality used.

Conclusion: The results of our study suggest that Impella devices improve renal function in all-cause cardiogenic shock patients who experience AKI prior to undergoing cardiac catheterization.
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http://dx.doi.org/10.14740/jocmr4449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166292PMC
May 2021

Endobronchial Hamartoma Presenting as Recurrent Pneumonia and Chronic Cough.

Cureus 2021 Mar 5;13(3):e13717. Epub 2021 Mar 5.

Pulmonary and Critical Care, Jersey Shore University Medical Center, Neptune, USA.

Pneumonia is an infection of the lungs that can result from various etiologies, including bronchial obstruction. It is estimated that 5.4% of community-acquired pneumonia occurs as a result of an endobronchial obstruction, classifying them as post-obstructive pneumonia. Pulmonary hamartomas are benign and exceedingly rare tumors. These hamartomas are usually asymptomatic and found incidentally on imaging, however, they can cause patients to develop post-obstructive pneumonia. We present a 40-year-old female with cough, fatigue, and recurrent right lower lobe pneumonia. Upon workup with bronchoscopy and biopsy, she was subsequently found to have an endobronchial hamartoma resulting in recurrent pneumonia in the same location. We are happy to report that the patient had a resection of the mass, as well as of the affected lung lobe, and has been pneumonia-free for five months. We hope to encourage a greater index of suspicion for endobronchial masses, including rare tumors, when a patient presents with recurrent pneumonia in the same location.
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http://dx.doi.org/10.7759/cureus.13717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019537PMC
March 2021

Anticoagulants Used in Cardiac Catheterization of Patients With Chronic Lymphocytic Leukemia: A Case Report and Overview.

Cureus 2021 Mar 1;13(3):e13633. Epub 2021 Mar 1.

Internal Medicine, Jersey Shore University Medical Center, Neptune, USA.

Percutaneous coronary intervention (PCI) is one of the most frequently performed invasive therapeutic procedures and plays a key role in the long-term survival of patients with ischemic heart disease. Over 965,000 angioplasties are performed annually in the United States alone. While the technique and equipment have undergone significant revisions and improvement, the medical community will still benefit from more data and guidance on the optimal selection of mandatory peri-operation anticoagulation in specific, high-risk populations. Many of these procedures are performed on high-risk individuals who have an inherently higher risk of hemorrhage or thrombosis. Unfractionated heparin is the most popular choice in the general population, however, its use carries certain limitations. Here we will describe the use of an uncommonly used anticoagulant in a patient being actively treated for leukemia. We will also discuss the unique properties and benefits of the four most frequently used anticoagulants during a cardiac angioplasty. Our team describes the successful use of bivalirudin during an urgent PCI in a 71-year-old female with eight previous stents that was followed by an uncomplicated recovery period. Our experience contributes to a small, but growing, body of evidence that bivalirudin may be a safe choice to use in lieu of unfractionated heparin in patients with underlying oncological disease. Our patient had several comorbidities that significantly increased their risk of bleeding. We will also review the clinical trials that compared the four most commonly used anticoagulants during cardiac catheterization.
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http://dx.doi.org/10.7759/cureus.13633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011627PMC
March 2021

Nonischemic Dilated Cardiomyopathy in Untreated Long-Term Psoriatic Arthritis: A Newly Recognized Association: A Case Report with Mini Review.

Am J Case Rep 2021 Apr 2;22:e930041. Epub 2021 Apr 2.

Department of Rheumatology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA.

BACKGROUND Psoriasis is a chronic inflammatory skin disease associated with multiple comorbidities including psoriatic arthritis (PsA), atherosclerotic disease, metabolic syndrome, diabetes, hypertension, obesity, and depression. Interestingly, nonischemic cardiomyopathy, especially dilated cardiomyopathy (DCM), has been associated with psoriasis and reported in only in a few cases in the literature. CASE REPORT We report the rare case of a 58-year-old man with a medical history of untreated severe psoriasis and PsA who presented with a sudden onset of shortness of breath. Laboratory and radiographic studies showed an elevated level of B-type natriuretic peptide and acute bilateral pulmonary edema. The patient had normal coronary arteries on cardiac catheterization and echocardiography showed newly diagnosed DCM with systolic and diastolic dysfunction. Cardiac magnetic resonance imaging was consistent with nonischemic DCM (NIDCM) with no evidence of hypertrophy, infiltrative process, or edema. The patient was diagnosed with acute congestive heart failure secondary to NIDCM in the setting of long-standing untreated psoriasis. He responded well to diuretics, was placed on guideline-directed medical therapy, and was discharged with a LifeVest personal cardiac defibrillator. As an outpatient, the patient was started on secukinumab, a monoclonal antibody against interleukin-17A. At his last follow-up appointment, the patient reported improvement in his cardiac symptoms and resolution of his psoriatic skin lesions; repeat echocardiography showed improvement in his ejection fraction. CONCLUSIONS Although studies have shown a higher prevalence of cardiovascular disease in patients with psoriasis, an association with NIDCM has not been studied sufficiently. We recommend further studies of the prevalence, pathogenesis, screening, and management of NIDCM in patients with psoriasis.
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http://dx.doi.org/10.12659/AJCR.930041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024668PMC
April 2021

Psoriasis as risk factor for non-ischemic dilated cardiomyopathy: a population-based cross-sectional study.

BMC Cardiovasc Disord 2021 Mar 31;21(1):161. Epub 2021 Mar 31.

Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA.

Background: Psoriasis is a chronic inflammatory skin condition commonly associated with psoriatic arthritis, malignancy, diabetes, inflammatory bowel disease, and cardiovascular disease. Several reports and studies have reported an association between psoriasis and non-ischemic dilated cardiomyopathy (NIDCM). We aim to study the relationship between psoriasis and non-ischemic dilated cardiomyopathy in a large population-based study.

Methods: We utilized the Healthcare Cost and Utilization Project National Inpatient Sample 2017 database, which represents a 20% sample of all payer hospitalizations in the United States. We investigated hospitalizations for patients aged 18 years old or older with diagnoses of any type of psoriasis and non-ischemic dilated cardiomyopathy. Psoriasis, cardiomyopathy, and other comorbidities were identified through their international classification of diseases, 10th revision codes recorded in the discharge record for each hospitalization.

Results: Of a total of 6,084,184 all-cause admissions, 0.5% were admissions for patients with psoriasis (n = 32,807). Of the patients with and without psoriasis who had non-ischemic dilated cardiomyopathy, after adjusting for age, sex, race, diabetes mellitus, hypertension, alcohol abuse, cocaine abuse, arrhythmias, and obesity in a multivariate analysis, the presence of psoriasis was not significantly associated with non-ischemic dilated cardiomyopathy.

Conclusion: Psoriasis is a chronic autoimmune disorder which carries a higher cardiovascular events and more prevalent traditional atherosclerotic risk factors in comparison to the general population. However, association with non-ischemic cardiomyopathy or NIDCM in particular has not been studied sufficiently. Our study, being one of the first larger studies to assess this correlation, indicated no relationship between psoriasis and non-ischemic dilated cardiomyopathy.
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http://dx.doi.org/10.1186/s12872-021-01972-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015089PMC
March 2021

Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study.

BMC Neurol 2021 Mar 9;21(1):107. Epub 2021 Mar 9.

Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA.

Background: Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus.

Methods: We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition.

Results: A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality.

Conclusion: PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.
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http://dx.doi.org/10.1186/s12883-021-02143-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941613PMC
March 2021

Naloxone-Induced Acute Pulmonary Edema is Dose-Dependent: A Case Series.

Am J Case Rep 2021 Mar 17;22:e929412. Epub 2021 Mar 17.

Pulmonary and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA.

BACKGROUND Naloxone remains the mainstay for the treatment of opioids overdose both in the clinical and public settings. Naloxone has been showing relative safety, leading to trivial adverdse effects which are mostly due to acute withdrawal effects, but when used in patients with known long-term addiction, it usually requires additional dosing or rapid infusion to achieve detoxification effects in a timely manner or to sustain the effects after they fade away. In some patients this has resulted in fatal adverse effects, including non-cardiogenic pulmonary edema (NCPE), which may require intensive care for those patients. Whether the higher dose is the cause has been debatable and not enough studies have looked into this subject. CASE REPORT Here, we report a series of 2 cases where 2 young patients were given naloxone following opioid overdose. Both our patients required frequent dosing due to insufficient response or owing to the washout of the naloxone effect shortly after, given its short half-life. Although the administered doses were different, both patients developed the adverse effect of NCPE and required ventilator support. CONCLUSIONS Evidence suggests that such a catastrophic adverse effect following the administration of such a critical medication, which is known to be relatively safe and is being publicized for saving lives, might limit its use and would require more attention and further studies to standardize a safe dose, limiting these life-threatening events and decreasing the need for unnecessary invasive respiratory support as well as admissions to intensive care units, which might create an additional burden on the health care system.
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http://dx.doi.org/10.12659/AJCR.929412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983320PMC
March 2021

Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study.

J Clin Med 2021 Feb 25;10(5). Epub 2021 Feb 25.

Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.

Background: Diabetic ketoacidosis (DKA) is a well-known complication of diabetes mellitus with a significantly high mortality if not immediately and properly treated. Therefore, strategies for prevention of DKA are ever so important when managing diabetes mellitus, especially in the non-compliant patient population. Previously studies have suggested insulin pump use to carry an increased risk of DKA compared to insulin injections, while European studies suggest the opposite. We aimed to perform a retrospective cohort study to determine the risk of DKA in insulin pump versus injection in the United States.

Methods: We utilized the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2017 database, which represents a 20% sample of all payer hospitalizations in the United States. These hospitalizations were systematically selected by the Agency for Healthcare Resources and Quality (AHRQ) and we included all type 1 diabetes mellitus patients over the age of 18 who were on insulin, either pump or injections, in our study.

Results: We found a total of 58,260 admissions for patients with type 1 DM. Of these, 7850 had insulin pump, 30,672 used insulin injection, and 19,738 had no prior insulin use. We found that insulin pump use, compared to injections, failed to predict a lower incidence of DKA in hospitalized patients.

Conclusion: Although several studies from European countries have found a reduction of DKA risk with insulin pump use, in this study we found no clear significant difference in a United States-based study. While this may be possible due to different legislating and regulation organizations, further studies are warranted to further evaluate the benefit of either insulin dispensing modality.
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http://dx.doi.org/10.3390/jcm10050898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956187PMC
February 2021

Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions.

Healthcare (Basel) 2021 Jan 21;9(2). Epub 2021 Jan 21.

Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA.

Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1-2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords "discharge against medical advice," "DAMA," "leave against medical advice," and "AMA." We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.
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http://dx.doi.org/10.3390/healthcare9020111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909809PMC
January 2021

Predictability of Inpatient Mortality of Different Comorbidities in Both Types of Acute Decompensated Heart Failure: Analysis of National Inpatient Sample.

Cardiol Res 2021 Feb 11;12(1):29-36. Epub 2020 Dec 11.

Department of Acute and Continuing Care, The University of Texas Health Science Center at Houston, Houston, TX, USA.

Background: Several prediction models have been proposed to assess the short outcomes and in-hospital mortality among patients with heart failure (HF). Several variables were used in common among those models. We sought to focus on other, yet important risk factors that can predict outcomes. We also sought to stratify patients based on ejection fraction, matching both groups with different risk factors.

Methods: We conducted a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016 database.

Results: There were totally 116,189 admissions for acute decompensated heart failure (ADHF). Of these, 50.9% were for heart failure with reduced ejection fraction (HFrEF) group (n = 59,195), and 49.1% were for heart failure with preserved ejection faction (HFpEF) group (n = 56,994). Overall, in-hospital mortality was 2.5% of admissions for ADHF (n = 2,869). When stratified by HF types, admissions for HFrEF had higher mortality rate (2.7%, n = 1,594) in comparison to admissions for HFpEF (2.2%, n = 1,275) (P < 0.001). Significantly associated variables in univariate analyses were age, race, hypertension, diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation/flutter, obesity, and chronic ischemic heart disease (IHD), while gender and chronic obstructive pulmonary disease (COPD) did not achieve statistical significance (P > 0.1).

Conclusions: To our knowledge, this is the first study to stratify HF patients based on ejection fraction and utilizing different predictors and in-hospital mortality. These and other data support the need for future research to utilize these predictors to create more accurate models in the future.
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http://dx.doi.org/10.14740/cr1186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781262PMC
February 2021

Unusual Longevity of Edwards Syndrome: A Case Report.

Genes (Basel) 2020 12 7;11(12). Epub 2020 Dec 7.

Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.

Background: Trisomy 18, also known as Edwards syndrome, was first described in the 1960s and is now defined as the second most common trisomy. While this genetic disease has been attributed to nondisjunction during meiosis, the exact mechanism remains unknown. Trisomy 18 is associated with a significantly increased mortality rate of about 5-10% of patients surviving until 1 year of age. We present a case of a 26-year-old female diagnosed with trisomy 18, well outliving her life expectancy, maintaining a stable state of health.

Case Presentation: A 26-year-old female with non-mosaic Edwards syndrome presented to the clinic for follow up after recent hospitalization for aspiration pneumonia. The definitive diagnosis of trisomy 18 was made prenatally utilizing chromosomal analysis and G-banding and fluorescence in situ hybridization (FISH) on cells obtained via amniocentesis. Her past medical history is characterized by severe growth and intellectual limitations; recurrent history of infections, especially respiratory system infections; and a ventricular septal defect (VSD) that was never surgically repaired. She remains in good, stable health and is under close follow-up and monitoring.

Conclusions: Despite the fact that Edwards syndrome carries a significantly high mortality rate due to several comorbidities, recent literature including this case report has identified patients surviving into adulthood. Advancements in early detection and parent education have likely allowed for these findings. We aim to present a case of an adult with trisomy 18, living in stable condition, with an importance on medical follow-up.
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http://dx.doi.org/10.3390/genes11121466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762407PMC
December 2020

Breaking Bad News, a Pertinent Yet Still an Overlooked Skill: An International Survey Study.

Healthcare (Basel) 2020 Nov 20;8(4). Epub 2020 Nov 20.

Department of Pulmonary and Critical Care, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.

Delivering bad news to patients is a challenging yet impactful everyday task in clinical practice. Ideally, healthcare practitioners should receive formal training in implementing these protocols, practice in simulation environments, and real-time supervision with feedback. We aimed to investigate whether healthcare providers involved in delivering bad news have indeed received formal training to do so. We conducted a cross-sectional survey study that targeted all healthcare providers in the intensive care units of 174 institutions in 40 different countries. Participants included physicians, nurses, medical students, nursing students, pharmacists, respiratory technicians, and others. The survey tool was created, validated, and translated to the primary languages of these countries to overcome language barriers. A total of 10,106 surveys were collected. Only one third of participants indicated that they had received a formal training. Providers who had received formal training were more likely to deliver bad news than those who had not. Younger and less experienced providers tend to deliver bad news more than older, more experienced providers. The percentage of medical students who claimed they deliver bad news was comparable to that of physicians. Medical schools and post-graduate training programs are strongly encouraged to tackle this gap in medical education.
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http://dx.doi.org/10.3390/healthcare8040501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711660PMC
November 2020

Administration of inhaled noble and other gases after cardiopulmonary resuscitation: A systematic review.

Am J Emerg Med 2020 10 2;38(10):2179-2184. Epub 2020 Jul 2.

The University of Texas Health Science Center at Houston, USA; University of Texas Medical Branch at Galveston, USA; United Memorial Medical Center/United General Hospital, Houston, TX, USA. Electronic address:

Objective: Inhalation of noble and other gases after cardiac arrest (CA) might improve neurological and cardiac outcomes. This article discusses up-to-date information on this novel therapeutic intervention.

Data Sources: CENTRAL, MEDLINE, online published abstracts from conference proceedings, clinical trial registry clinicaltrials.gov, and reference lists of relevant papers were systematically searched from January 1960 till March 2019.

Study Selection: Preclinical and clinical studies, irrespective of their types or described outcomes, were included.

Data Extraction: Abstract screening, study selection, and data extraction were performed by two independent authors. Due to the paucity of human trials, risk of bias assessment was not performed DATA SYNTHESIS: After screening 281 interventional studies, we included an overall of 27. Only, xenon, helium, hydrogen, and nitric oxide have been or are being studied on humans. Xenon, nitric oxide, and hydrogen show both neuroprotective and cardiotonic features, while argon and hydrogen sulfide seem neuroprotective, but not cardiotonic. Most gases have elicited neurohistological protection in preclinical studies; however, only hydrogen and hydrogen sulfide appeared to preserve CA1 sector of hippocampus, the most vulnerable area in the brain for hypoxia.

Conclusion: Inhalation of certain gases after CPR appears promising in mitigating neurological and cardiac damage and may become the next successful neuroprotective and cardiotonic interventions.
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http://dx.doi.org/10.1016/j.ajem.2020.06.066DOI Listing
October 2020

Spontaneous Subcutaneous Emphysema and Pneumomediastinum in COVID-19 Patients: An Indicator of Poor Prognosis?

Am J Case Rep 2020 Jul 24;21:e925557. Epub 2020 Jul 24.

Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA.

BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe acute respiratory distress syndrome and, more uncommonly, subcutaneous emphysema and pneumomediastinum. We present a case series of 3 patients with COVID-19 infection managed in the Intensive Care Unit and found to have subcutaneous emphysema and pneumomediastinum on chest imaging. CASE REPORT We present a case series of 3 men, ages 36, 47, and 78 years, diagnosed with COVID-19 via RT-PCR, found to have severe acute respiratory distress syndrome, and managed in the Intensive Care Unit. Two patients described in this case series were mechanically ventilated on low positive end-expiratory pressures and developed subcutaneous emphysema and pneumomediastinum on chest imaging, and 1 patient developed subcutaneous emphysema prior to intubation. Each of these patients had a more eventful hospital course and worse outcomes than most COVID-19 infected patients. CONCLUSIONS Subcutaneous emphysema and pneumomediastinum in COVID-19 patients have been rarely reported and is poorly understood. In our institution, we have found the diagnosis of subcutaneous emphysema and pneumomediastinum in COVID-19 patients is associated with unfavorable outcomes and worse prognosis.
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http://dx.doi.org/10.12659/AJCR.925557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405921PMC
July 2020

Bilateral facial cutaneous angiomyolipomas: First case in the literature and a possible correlation with human immunodeficiency virus.

IDCases 2020 8;21:e00909. Epub 2020 Jul 8.

Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA.

Angiomyolipomas (AMLs) are benign tumors consisting of smooth muscle-like cells, adipocyte-like cells, and epithelioid cells. They are usually renal in origin, and extrarenal AMLs are rare. Cutaneous AMLs are even more rare. We present a case of 65 year old female, with no underlying genetic condition, who developed bilateral facial cutaneous AMLs. To the best of our knowledge, this is the first case in the literature. In addition, we investigate and suggest a correlation between human immunodeficiency virus and AMLs.
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http://dx.doi.org/10.1016/j.idcr.2020.e00909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355718PMC
July 2020

Prosthetic mitral valve endocarditis.

IDCases 2020 26;21:e00891. Epub 2020 Jun 26.

Department of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

endocarditis is a fatal source of valvular infection with a near 100 % mortality rate if pharmacotherapy and valve-replacement surgery are not initiated swiftly after diagnosis. Complicating its diagnosis is the low yield for growth on standard blood culture and time requirements for molecular diagnostic tools to return a result. endocarditis of the mitral valve presents as valvular vegetations that reduce the caliber of the mitral valve and can cause syncope as in the case of mitral stenosis with subsequent valve failure, left atrial enlargement, and prospective cardiovascular failure. Reports of the management of endocarditis after serial mitral valve replacement are not prominent in the literature. We report the case of a 41-year-old female with previous mitral valve prosthesis who received a second prosthetic mitral valve after a syncopal episode. Vegetations resembling thrombi were noted on transesophageal echocardiogram, diagnosed as endocarditis, and successfully treated with antifungal therapy in conjunction with removal of her dysfunctional prosthesis.
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http://dx.doi.org/10.1016/j.idcr.2020.e00891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332524PMC
June 2020

Metastatic Osteoarticular Infective Endocarditis by Methicillin-sensitive Staphylococcus Aureus.

Cureus 2020 May 14;12(5):e8124. Epub 2020 May 14.

Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA.

Infective endocarditis (IE) is a well-known complication of bacteremia with high-risk microorganisms such as  and . Skin and soft tissue infections with Staphylococcus remain a significant cause of bacteremia and IE, even with proper prompt management of the source of infection and the absence of risk factors. Although methicillin-resistant is a well-known etiology for osteoarticular septic emboli in IE, healthcare providers should be aware of the hidden virulence of methicillin-sensitive  for metastatic osteoarticular infection. We report a case of IE with septic vertebral embolic lesion complicating a properly managed acute paronychia.
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http://dx.doi.org/10.7759/cureus.8124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292723PMC
May 2020

Postcolonoscopy Appendicitis: A Delayed Complication.

Cureus 2020 Apr 17;12(4):e7716. Epub 2020 Apr 17.

Emergency Medicine, Jersey Shore University Medical Center, Neptune, USA.

Colonoscopy is a procedure that enables a physician (usually a gastroenterologist) to directly image and examine the entire colon. It has both diagnostic and therapeutic benefits with a relatively low morbidity rate. Complications have been well described in the literature. Nevertheless, it is necessary for operators to be aware of the rare complications of colonoscopy. Acute appendicitis is an unusually rare occurrence following a colonoscopy, and it can be easily confused with other complications of the procedure. Prompt recognition of this complication can lead to early, effective treatment, and delayed diagnosis can lead to serious results. We present a case of a 33-year-old man who underwent a routine colonoscopy with no intraoperative complication who presented with appendicitis two weeks later as a rare delayed side effect; such a delayed presentation has not been described in the literature previously. This case highlights that appendicitis should be considered in the differential diagnosis of right-sided lower abdominal pain following a colonoscopy.
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http://dx.doi.org/10.7759/cureus.7716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234083PMC
April 2020

Extracorporeal Membrane Oxygenation as Treatment of Severe COVID-19 Infection: A Case Report.

Cureus 2020 Apr 17;12(4):e7714. Epub 2020 Apr 17.

Pulmonology and Critical Care, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, USA.

Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome (ARDS) accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation (VV-ECMO) may be used.  We present a case of a 41-year-old female, with no significant medical history and no recent history of exposure to sick contacts, presented to the emergency department (ED) with fever, severe shortness of breath, and flu-like symptoms with a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.
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http://dx.doi.org/10.7759/cureus.7714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233513PMC
April 2020

Influenza: National Trends Using the National Inpatient Sample Database from 1993 to 2015.

Cureus 2020 Apr 16;12(4):e7684. Epub 2020 Apr 16.

Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA.

Background There is a significant impact of influenza on individuals, families, and societies both economically and clinically. This significant impact is a result of hospital admissions, medication expenses, side effects, secondary bacterial infections, and more days off from work or other forms of reduced productivity for the patients or their caretakers. Our objective is to present the trends in the rate of hospital discharges per 100,000 population from the years 1993 through 2015, the mean age, and the inpatient mortality rate. Methods This is a retrospective study utilizing the National Inpatient Sample (NIS) from 1993 through 2015. Discharges due to influenza from 1993 to 2015 were identified, and the rate of discharges per 100,000 population, inpatient mortality, and mean age of discharged patients were trended. Linear regression was used to assess if the deviation from horizontal was statistically significant for the trends of the rate of discharges per 100,000 population, mean age, and percentage of the inpatient mortality. Result The mean age and inpatient mortality vary from year to year. The linear regression analysis for the trends was not statistically significant, and for the percentage of the inpatient mortality, the deviation from horizontal was not significant, P-value 0.75 and F-value: 0.09. Similarly, for the mean age, the deviation from horizontal was not significant with a P-value of 0.97 and an F-value of 0.001. However, the linear regression analysis for the rate of discharges per 100,000 population was remarkable for a statistically significant deviation from the horizontal with a P-value of 0.0002 and an F value of 19.5. Conclusion Recent advancements in influenza detection have made the detection feasible, quick, and cost-effective. However, the role of these advanced modalities on the outcome is still controversial. Our analysis revealed a significant increase in the rate of discharges due to influenza, but there was no significant change in the parentage of the inpatient mortality over the years between 1993 - 2015. Advanced influenza virus detection tests are now recommended in both outpatient (including emergency department) and inpatient admissions. The recent increase in inpatient admissions could be due to better detection modalities. However, no change in the percentage of inpatient mortality makes the impact of these detection tests on the outcome questionable. A further prospective study is warranted to assess the impact of these tests on the outcome.
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http://dx.doi.org/10.7759/cureus.7684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233507PMC
April 2020

Peripheral Embolization of Left Ventricular Thrombus Leading to Acute Bilateral Critical Limb Ischemia: A Rare Phenomenon.

Cardiol Res 2020 Apr 10;11(2):134-137. Epub 2020 Mar 10.

Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.

Left ventricular thrombus (LVT) is a well-known complication of myocardial infarction (MI) leading to significant morbidity and mortality. LVT can also lead to systemic thromboembolic events causing threatening limb ischemia. We report a rare case of critical bilateral limb ischemia that resulted from peripheral embolization of LVT post MI, which was managed successfully by emergent surgical intervention and anticoagulation. A 74-year-old male with a medical history of hypertension, diabetes, hyperlipidemia and coronary artery disease status post stenting of the left anterior descending and left circumflex arteries presented to the emergency department with typical chest pain and progressive shortness of breath. Cardiac troponin levels on admission were 35 ng/mL of blood. The patient subsequently underwent emergent cardiac catheterization which revealed significant triple vessel disease, and was referred for coronary artery bypass grafting (CABG) surgery. Transthoracic and transesophageal echocardiograms revealed the presence of an apical aneurysm with chronic organized mobile thrombus at the apex. Post CABG, the patient complained of excruciating right leg pain. Computed tomography (CT) angiogram of the abdominal aorta and lower extremities revealed a large embolus at the aortic bifurcation occluding the right and nearly occluding the left common iliac arteries and thrombus in the right popliteal artery. He underwent emergent vascular surgery with resolution of his symptoms and remained without further complications. The incidence of LVT remains high in post-MI patients, and complications of LVT are known to include thromboembolic events. Peripheral embolization of acute or chronic LVT leading to bilateral distal embolization and critical limb ischemia remains a rare occurrence. This case report aims to aid clinicians to recognize and promptly manage LVT and related arterial thromboembolic events with anticoagulation and emergent surgical intervention if limb ischemia develops.
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http://dx.doi.org/10.14740/cr1030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092770PMC
April 2020

Cardiopulmonary resuscitation in television medical dramas: Results of the TVMD2 study.

Am J Emerg Med 2021 05 9;43:238-242. Epub 2020 Mar 9.

United General Hospital, Department of Acute and Continuing Care, The University of Texas Health Science Center at Houston, USA. Electronic address:

Introduction: Television medical dramas (TVMDs) use cardiopulmonary resuscitation (CPR) as a mean of achieving higher viewing rates. TVMDs portrayal of CPR can be used to teach laypersons attempting to perform CPR and to form a shared professional and layperson mental model for CPR decisions. We studied the portrayal of CPR across a wide range of TVMDs to see whether newer series fulfill this promise.

Materials And Methods: Advanced cardiac life support (ACLS) certified healthcare providers underwent training in the use of a unique instrument based on the AHA (American Heart Association) guidelines to assess TVMD CPR scenarios. Components of the assessment included the adequacy of CPR techniques, gender distribution in CPR scenes, performance quality by different healthcare providers, and CPR outcomes. Thirty-one TVMDs created between 2010 and 2018 underwent review.

Results: Among 836 TVMD episodes reviewed, we identified 216 CPR attempts. CPR techniques were mostly portrayed inaccurately. The recommended compressions depth was shown in only 32.0% of the attempts (n = 62). The recommended rate was shown in only 44.3% of the attempts (n = 86). Survival to hospital discharge was portrayed as twice higher in male patients (67.6%, n = 71) than in female patients (32.4%, n = 29) (p < 0.05). Paramedics were portrayed as having better performance than physicians or nurses; compression rates were shown to be within the recommendations in only 42% (n = 73) of the CPR attempts performed by physicians, 44% (n = 8) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Complete chest recoil after compression was shown in only 34% (n = 58) of the CPR attempts performed by physicians, 38% (n = 7) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Outcomes were better on the screen than in real life; among the episodes showing outcome (n = 202), the overall rate of survival from CPR was 61.9% (n = 125).

Conclusion: Portrayal of CPR in TVMDs remains a missed opportunity for improving performance and communication on CPR.
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http://dx.doi.org/10.1016/j.ajem.2020.03.018DOI Listing
May 2021

Management of hypertensive crises in the elderly.

J Geriatr Cardiol 2018 Jul;15(7):504-512

The University of Texas Health Science Center at Houston, USA.

Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.
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http://dx.doi.org/10.11909/j.issn.1671-5411.2018.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198269PMC
July 2018

How long should we wait for patients to wake up when they undergo targeted temperature management?

Resuscitation 2018 05 21;126:A1-A2. Epub 2018 Feb 21.

United Memorial Medical Centre, Houston, TX, USA; The University of Texas Health Science, Center at Houston, Houston, TX, USA; The University of Texas Medical Branch at Galveston, Houston, TX, USA. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2018.02.015DOI Listing
May 2018
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