Publications by authors named "Binav Shrestha"

22 Publications

  • Page 1 of 1

Impact of COVID19 on resident physicians of a community hospital in New York city.

J Community Hosp Intern Med Perspect 2021 Jan 26;11(1):4-8. Epub 2021 Jan 26.

Department of Pulmonary Medicine, Interfaith Medical Center, Brooklyn, NY, USA.

Novel Corona Virus Disease 19 has created unforeseen burden on health care. New York city is one of the epicenters of pandemic and here we explore physical, mental and social impact of COVID 19 on Resident Physicians (RP) working within the center of this epicenter. This is a single-center cross-sectional web-based survey involving RP of a community hospital in Brooklyn, New York. Questionnaire was formulated in online platform. We used a convenient sampling method. Univariate analysis was conducted and presented the distribution of qualitative responses as frequency and percentages. COVID19 related symptoms were reported by 39.8% RP. COVID19 IgG and IgM antibodies, both negative were reported by 34.9%, while only 6% RPs were IgG antibody positive. Symptomatic RP tested for COVID19-PCR was positive in 42.42%. Self-isolation from family during the pandemic was reported by only 14.5%. Financial constraints, lack of accommodation, and emotional reasons were main reasons of not being able to self isolate. Being bothered by 'Anxiety' and 'Nervousness' were reported by 8.5% on 'Almost every day' while 46.3% reported on 'several days in the two weeks duration'. 'Uncontrollable worrying', 'Feeling down', 'Depressed,' or 'Hopeless' was reported as 'Not at all' by 78.8% and 3.7% reported it to 'occur nearly every day for the last two weeks'. Aftermath of fight against pandemic has left RP with significant physical, mental, and social impact. Appropriate stress management and safety interventions are urgently needed. Further studies are needed to explore the detailed impact of COIV19 on RP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2020.1834670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850354PMC
January 2021

Incidence, Predictors, Causes, and Cost of 30-Day Hospital Readmission in Chronic Obstructive Pulmonary Disease Patients Undergoing Bronchoscopy.

Cureus 2020 Jun 13;12(6):e8607. Epub 2020 Jun 13.

Pulmonary Medicine, Interfaith Medical Center, Brooklyn, USA.

Introduction Chronic obstructive pulmonary disease (COPD) has a significant disease burden and is among the leading causes of hospital readmissions, adding a significant burden on healthcare resources. The association between 30-day readmission in a COPD patient undergoing bronchoscopy and a wide range of modifiable potential risk factors, after adjusting for sociodemographic and clinical factors, has been assessed, and comparison has been made with COPD patients not undergoing bronchoscopy. Methods We conducted a comprehensive analysis of the 2016 Nationwide Readmission Database (NRD) of 30-day all-cause readmission among COPD patients undergoing bronchoscopy. A Cox's proportional hazards model was used to obtain independent relative risks of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy. Our primary outcome was the 30-day all-cause readmission rate in both groups. Other secondary outcomes of interest were the 10 most common reasons for readmission, resource utilization, independent predictors of readmission, and relative proportion of comorbidities between the index admission (IA) and the readmission in both groups. Results The overall rate of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy was 17.32% and 15.87%, respectively. The final multivariate model in the bronchoscopy group showed that the variables found to be an independent predictor of readmission were: pulmonary hypertension (hazard ratio [HR] 2.35; 95% confidence interval [CI] 1.26-4.25; P < .01), adrenal insufficiency (HR 4.47; 95% CI 1.44-13.85; P = .01) and discharge to rehab status. Independent predictor variables of admission in Group B were gender (women < men; HR 0.91; 95% CI 0.88-0.93; P < .01), and type of insurance (Medicaid > Medicare > private insurance). For all patients undergoing bronchoscopy, the mean length of stay (LOS) for IA was 11.91 ± 20.21 days, and LOS for readmission was 5.87 ± 5.48 days. The mean total cost of IA for patients undergoing bronchoscopy was much higher than that of readmission ($26,916 vs. $12,374, respectively). The entire LOS for readmission was 1,265 days, with a total cost of $2.66 million. For patients not undergoing bronchoscopy during the IA, mean LOS for IA was 4.26 ± 4.27 days, and mean LOS for readmission was 5.39 ± 5.51 days, which was longer than the IA in Group B but still shorter than LOS for readmission in Group A (patients undergoing bronchoscopy). The mean total cost of readmission was higher than the IA ($8,137 for IA vs. $10,893 for readmission). The total LOS in this group of patients was 313,287 days, with the total cost of readmission at $628 million. Conclusions Patients undergoing bronchoscopy have a slightly higher rate of 30-day readmissions as compared to patients not undergoing bronchoscopy, and the LOS is also slightly higher in this group during subsequent readmissions as compared to readmission in patients not undergoing bronchoscopy in IA. The readmission rate in COPD patients is impacted by a variety of social, personal, and medical factors. Patients with multiple medical comorbidities have a higher risk of readmission. In our understanding, bronchoscopy in a patient with acute exacerbation of COPD should be reserved for selected patients, and the rationale should be clarified, as it affects the overall LOS and healthcare expenditure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.8607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294856PMC
June 2020

Endobronchial valves for persistent air leak all-cause mortality and financial impact: US trend from 2012-2016.

J Community Hosp Intern Med Perspect 2019 1;9(5):397-402. Epub 2019 Nov 1.

Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA.

: Endobronchial valves (EBV) are considered an innovation in the management of the persistent air leak (PAL). They offer a minimally invasive alternative to the traditional approach of pleurodesis and surgical intervention. We examined trends in mortality, length of stay (LOS), and resources utilization in patients who underwent EBV placement for PAL in the US. : We utilized discharge data from the Nationwide Inpatient Sample (NIS) for five years (2012-2016). We included adults diagnosed with a pneumothorax who underwent EBV insertion at ≥ 3 days from the day of chest tube placement; or following invasive thoracic procedure. We analyzed all-cause mortality, LOS, and resources utilization in the study population. : A total of 1,885 cases met our inclusion criteria. Patients were mostly middle-aged, males, whites, and had significant comorbidities. The average LOS was 21.8 ± 20.5 days, the mean time for chest tube placement was 3.8 ± 5.9 days, and the mean time for EBV insertion was 10.5 ± 10.3 days. Pleurodesis was performed before and after EBV placement and in 9% and 6%, respectively. : Our study showed that the all-cause mortality rate fluctuated throughout the years at around 10%. Despite EBV being a minimally invasive alternative, its use has not trended up significantly during the study period. EBVs are also being used off-label in the US for spontaneous pneumothorax. This study shall provide more data to the scarce literature about EBV for PAL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2019.1675229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830260PMC
November 2019

Ecstasy induced acute systolic heart failure and Non-Ischemic Cardiomyopathy in a young female: a rare case report and literature review.

J Community Hosp Intern Med Perspect 2019 5;9(4):336-339. Epub 2019 Sep 5.

Department of Cardiology, Interfaith Medical Center, Brooklyn, NY, USA.

Ecstasy or 3,4-methylenedioxymethamphetamine (MDMA) is an illicit recreational drug. Effects include euphoria, increased sensory awareness, and central stimulation. Although various arrhythmias, as well as dilated cardiomyopathy, have been previously noted to occur with chronic use, cardiac toxicities are seldom reported in an acute setting. Herein, we present a 28-year-old female patient with no prior medical condition that presented to the Emergency Department with chest pain following intake of MDMA. Electrocardiographic findings, as well as laboratories, were suggestive of possible Acute Non-ST elevation myocardial infarction. Upon admission, cardiac catheterization revealed patent coronary arteries. Stark regional wall motion abnormalities were observed along with reduced ejection fraction. Acute systolic heart failure was treated with standard medical management. Subsequent reassessment of ventricular function with Echocardiography revealed marked improvement. This article describes a case of MDMA induced heart failure, including details of evaluation, management, and monitoring of patient progress. It brings further attention to potential acute harmful effects of MDMA on cardiac function and viability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2019.1650593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735291PMC
September 2019

Characteristics of 30-day readmission in spontaneous pneumothorax in the United States: a nationwide retrospective study.

J Community Hosp Intern Med Perspect 2019 19;9(3):215-220. Epub 2019 Jun 19.

Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA.

: Our study aimed to determine the national estimates of the 30-day all-cause readmission rate among patients with spontaneous pneumothorax and to investigate the burden of these readmissions in terms of mortality, length of stay and hospitalization costs in the USA. : We utilized the Nationwide Readmission Database for 2013-2014 and identified adults with a primary diagnosis of spontaneous pneumothorax. We analyzed and reported patient- and hospital-level variables of the study cohort. Our primary outcome was 30-day readmission rate, including the reasons for readmission. Our secondary outcomes included all-cause mortality, resources utilization and predictors of readmissions. : We identified 47,108 index admissions with spontaneous pneumothorax. The 30-day readmission rate was 13.6%. The most common reason for admission was recurrent pneumothorax. In index admissions, the in-hospital mortality rate was 3.1%; whereas, in readmissions, the mortality was higher (4.6%, < 0.001). Both age group 45-64 (: 1.31, 95% : [1.15-1.49], < 0.001) and history of cancer (: 1.34, 95% : [1.17-1.53], < 0.001) were found to predict the risk of 30-day readmission. : The 30-day readmission rate in patients with spontaneous pneumothorax was 13.6%, and a recurrent event was the most likely cause. The 30-day readmissions were associated with higher mortality and hospitalization charges. Middle age and history of cancer increase likelihood of 30-day readmission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2019.1618135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586084PMC
June 2019

Twenty-Eight-Day-Long Delirium Tremens.

J Investig Med High Impact Case Rep 2019 Jan-Dec;7:2324709619847228

1 Interfaith Medical Center, Brooklyn, NY, USA.

Refractory alcohol withdrawal delirium is uncommon in day-to-day clinical practice. This case report presents a rare case of delirium tremens of unusually long duration that was complicated by the difficulty in tapering down benzodiazepines despite adding midazolam drip as well as phenobarbitone to the management regimen and excluding other possible diagnoses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2324709619847228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505229PMC
May 2020

Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review.

Case Rep Med 2019 31;2019:3435108. Epub 2019 Mar 31.

Department of Cardiology, Interfaith Medical Centre, Brooklyn, NY, USA.

Clozapine is an atypical antipsychotic agent indicated in the treatment of medication-resistant schizophrenia. It is often reserved as a last line of treatment owing to the potential for serious and potentially life-threatening side effects, the most serious being agranulocytosis requiring close hematological monitoring and possible discontinuation of the medication from further use in the patient even when the agranulocytosis resolves. Other complications of clozapine include sedation, weight gain, elevated triglyceride levels, postural hypotension, and tachycardia. However, the potentially serious complication of myocarditis, though rare (with an incidence of 3%), may lead to cardiomyopathy as described in our present case. We present a 21-year-old patient who was started on clozapine for management of schizophrenia. He developed fever and tachycardia and was admitted to the medical unit on intravenous antibiotics for management of sepsis as he met the criteria for systemic inflammatory response syndrome. His labs revealed an elevated troponin and trending eosinophilia, which, in the context of clozapine use, raises the suspicion of clozapine cardiotoxicity. Echocardiogram showed reduced systolic function (45%). Clozapine was immediately discontinued, and his repeat echocardiogram showed normalization of his systolic function. In view of the increased prevalence of psychiatric illnesses, internists should be aware of rare but potentially life-threatening side effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/3435108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462315PMC
March 2019

Polysomnographic variables in Alternate overlap syndrome: data from sleep heart health study.

J Community Hosp Intern Med Perspect 2019 Apr 12;9(2):108-112. Epub 2019 Apr 12.

Department of Pulmonary Medicine, Interfaith Medical Centre, Brooklyn, NY, USA.

: To evaluate influence of asthma on polysomnographic variables of patients with obstructive sleep apnea (OSA).: A longitudinal retrospective study using data collected from the Sleep Heart Health Study (SHHS).: All 2822 patients included had OSA, 2599 were non-asthmatic whereas 223 were asthmatics. Average BMI for non-asthmatics was 28.8 kg/m whereas asthmatics had 29.5 kg/m. Median pack-years of smoking was 1.42 vs. 1.98 in non-asthmatic and asthmatic groups, respectively. Sex distribution, age (in years), BMI, FEV, FVC, AHI ≥ 4% (all apneas, hypopneas with ≥4% oxygen desaturation or arousal per hour of sleep), RDI ≥ 3% (overall respiratory distribution index at ≥3% oxygen desaturation or arousal), sleep latency, percentage of sleep time in apnea/hypopnea and Epworth sleep scale score were all statistically significant. Non-asthmatics had greater AHI (12.63/hr) compared to asthmatics (11.34/hour), = 0.0015. RDI in non-asthmatics and asthmatics was (23.07 vs 20.53; = 0.009). Sleep latency was found to be longer in asthmatics 19.8 minutes vs. 16 minutes ( = 0.008). Epworth sleepiness scale score was high in asthmatics (9 vs. 8, = 0.002).: OSA was found more severe in non-asthmatic subgroup, but asthmatics had statistically significant higher Epworth sleepiness scale score and sleep latency. Clinicians should be vigilant and keep low threshold to rule out OSA particularly on patients with difficult to control asthma, smoker, GERD, obese and nasal disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2019.1595951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484460PMC
April 2019

Rectourethral Fistula Secondary to Transurethral Resection of the Prostate.

Cureus 2018 Oct 22;10(10):e3476. Epub 2018 Oct 22.

Internal Medicine, Interfaith Medical Center, Brooklyn, USA.

An 82-year-old male with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) presented to the hospital with suprapubic pain, abdominal distension, and diarrhea. The physical examination was remarkable for an indwelling Foley's catheter. Diagnostic imaging confirmed the diagnosis of a rectourethral fistula (RUF). The most common presenting symptoms of RUF are pneumaturia, fecaluria, and urine leakage from the rectum, which may present similarly to diarrhea. He lacked the common features of RUF such as pneumaturia and fecaluria, which may be explained by a blockage of the catheter with fecal material. This case represents a rare outcome following a TURP, and it is significant due to the high morbidity associated with RUF. As such, clinicians must suspect a RUF in a post-TURP patient with diarrhea and no other obvious etiology due to the morbidity associated with RUF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.3476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318087PMC
October 2018

Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case report and literature review.

J Community Hosp Intern Med Perspect 2018 15;8(5):311-314. Epub 2018 Oct 15.

Department of Medicine, Wayne State University/Detroit Medical center, Detroit, MI, USA.

Valproic acid (VPA) is a commonly used agent in the management of seizures and psychiatric disorders. Hyperammonemia is a common complication of VPA with 27.8% of patients having elevated levels - that is unrelated to hepatotoxicity and normal transaminases. Common side effects include obesity, insulin resistance, metabolic disorder and severe forms of hepatotoxicity. Other rare and idiosyncratic reactions have been reported, one of which is presented in our case. A 27-year old patient presented with hyperammonemia and encephalopathy as a consequence of idiosyncratic VPA reaction causing drug-induced liver injury (DILI) with severely elevated transaminases. DILI is commonly overlooked when investigating encephalopathy in the setting of VPA. Physicians should consider DILI in the context of hyperammonemia and transaminitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2018.1514933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197012PMC
October 2018

A Rare Case of Systemic Lupus Erythematosus with Gastric Ulcer and Acute Pancreatitis: A Case Report and Literature Review.

Gastroenterology Res 2018 Aug 8;11(4):321-325. Epub 2018 Feb 8.

Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease which can manifest in many different organ systems. Gastrointestinal (GI) involvement is common in SLE, but the symptoms are usually mild. More severe GI complications including acute pancreatitis and peptic ulcer bleeding are rare but represent a significant risk of morbidity and mortality. We present a case of a 25-year-old Hispanic female with a severe SLE flare. The initial presentation included symptoms of hematemesis and epigastric abdominal pain secondary to both gastric ulceration and acute pancreatitis, an atypical presentation of an SLE flare. The non-specific symptom of abdominal pain makes both acute pancreatitis and gastric ulcer disease a clinical challenge; however, clinicians need to have a high suspicion for these conditions co-existing at the same time due to higher mortality rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14740/gr1048wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089583PMC
August 2018

Metachronous Granular Cell Tumor of the Descending Colon.

Gastroenterology Res 2018 Aug 8;11(4):317-320. Epub 2018 Feb 8.

Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA.

Granular cell tumors (GCTs) are uncommon tumors. They are believed to be neuronal in origin and are usually found in the head and/or neck area of the body. They have also been reported in various locations of the gastrointestinal (GI) system, usually discovered during routine screening colonoscopy. We report a case of GCT in a 58-year-old asymptomatic African American female as a metachronous tumor of a well-differentiated adenocarcinoma of the sigmoid colon, which was an incidental finding in screening colonoscopy. To our knowledge, this is the first case with GCT identified as a metachronous tumor following an adenocarcinoma of the colon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14740/gr1045wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089591PMC
August 2018

Sofosbuvir based regimens in the treatment of chronic hepatitis C genotype 1 infection in African-American patients: a community-based retrospective cohort study.

Eur J Gastroenterol Hepatol 2018 10;30(10):1200-1207

Department of Medicine and Division of Gastroenterology and Hepatology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York.

Background: Direct-acting antiviral (DAA) drugs have been highly effective in the treatment of chronic hepatitis C (HCV) infection. Limited data exist comparing the safety, tolerability, and efficacy of DAAs in African-American (AA) patients with chronic hepatitis C genotype 1 (HCV GT-1) in the community practice setting. We aim to evaluate treatment response of DAAs in these patients.

Patients And Methods: All the HCV GT-1 patients treated with DAAs between January 2014 and January 2018 in a community clinic setting were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy with a sustained virologic response at 12 weeks post-treatment (SVR12), and adverse reactions were assessed.

Results: Two-hundred seventy-eight patients of AA descent were included in the study. One-hundred sixty-two patients were treated with ledipasvir/sofosbuvir (SOF)±ribavirin, 38 were treated with simeprevir/SOF±ribavirin, and 38 patients were treated with SOF/velpatasvir. Overall, SVR at 12 weeks was achieved in 94.6% in patients who received one of the three DAA regimens (93.8% in ledipasvir/SOF group, 92.1% in simeprevir/SOF group, and 97.4% in SOF/velpatasvir group). Previous treatment experience, HCV RNA levels and HIV status had no statistical significance on overall SVR achievement (P=0.905, 0.680, and 0.425, respectively). Compensated cirrhosis in each of the treatment groups did not influence overall SVR of 12. The most common adverse effect was fatigue (27%). None of the patients discontinued the treatment because of adverse events.

Conclusion: In the real-world setting, DAAs are safe, effective, and well tolerated in African-American patients with chronic HCV GT-1 infection with a high overall SVR rate of 94.6%. Treatment rates did not differ on the basis of previous treatment and compensated cirrhosis status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MEG.0000000000001233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133221PMC
October 2018

Intramuscular Epinephrine-Induced Transient ST-Elevation Myocardial Infarction.

J Investig Med High Impact Case Rep 2018 Jan-Dec;6:2324709618785651. Epub 2018 Jul 6.

Interfaith Medical Center, Brooklyn, NY, USA.

Myocardial infarction in the setting of anaphylaxis may result from the anaphylaxis itself or from the epinephrine used to treat the anaphylaxis. While cases of myocardial infarction due to large doses of intravenous epinephrine have previously been reported, myocardial infarction after therapeutic doses of intramuscular epinephrine is rarely reported. A 23-year-old male presented with sudden onset of difficulty in swallowing and speech after eating takeout food. He was treated with intramuscular epinephrine for presumed angioedema following which he immediately developed chest tightness associated with ST elevation on electrocardiogram and elevated serum troponin. His symptoms and electrocardiogram findings were transient and resolved within the next 10 minutes. . Epinephrine is lifesaving during anaphylaxis and should be promptly used. Health care providers, however, need to be aware and vigilant of this rare complication of epinephrine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2324709618785651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069038PMC
July 2018

Rhabdomyolysis: An Unusual Presentation of Infection in an Adult-A Case Report and Literature Review.

Case Rep Med 2018 21;2018:6897975. Epub 2018 Jun 21.

Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA.

is a common cause of community-acquired pneumonia, and many extrapulmonary manifestations have been described, but rhabdomyolysis is infrequently reported in adults. Of the few cases that have been reported in adults, it was almost exclusively seen when pneumonia was present. We report a case of a 30-year-old male who came in with complaints of fever and myalgia for three days. Immunoglobulin M antibodies for were positive and trending up, despite having no radiographic evidence of pneumonia on chest X-ray or CT scan. He was treated successfully with levofloxacin and intravenous hydration. Later, his condition was clinically and biochemically improved, and he was discharged. Our patient did not present with typical respiratory tract symptoms of a mycoplasma infection. In addition, there was an absence of pneumonia on imaging, suggesting that rhabdomyolysis secondary to mycoplasma might be underdiagnosed and go untreated in the setting of low clinical suspicion. Upon review of the literature, there is only one other case of mycoplasma infection where rhabdomyolysis occurred in the absence of pneumonia. However, the degree of rhabdomyolysis in our case was much more severe. Although rare, when faced with rhabdomyolysis, should be kept as a differential diagnosis even in the absence of pneumonia on radiological imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2018/6897975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033244PMC
June 2018

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study.

J Community Hosp Intern Med Perspect 2018 12;8(3):95-100. Epub 2018 Jun 12.

Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA.

: The aim of our study is to determine the clinical, biochemical, and imaging factors that affect the duration of hospital stay in patients admitted with normotensive acute pulmonary embolism. : This was a single-center retrospective study conducted in a community hospital in New York metropolitan area for patients admitted from October 2015 to October 2017. : A total of 79 patients were included, the mean age was 55.76 ( = 17.33), 29 cases were males (37%) and 50 cases were females (63%). Among all patients, 17 cases had short length of stay (LOS) (≤2 days) and 62 cases had long LOS (>2 days). There were statistically significant differences in age ( = .041), presence of lung disease ( = .036), number of comorbidities ( = .043), and pulmonary embolism severity index (PESI) scores (original and simplified;  = .002 and .001, respectively). Logistic regression analysis showed that PESI score significantly predicted long LOS ( 1.067, 95% [1.001, 1.137],  = .048). Similarly, sPESI significantly predicted long LOS ( 0.223, 95% [0.050, 0.999],  = .050). Both regression models were adjusted for age, lung disease, and number of comorbidities. : Both original and simplified PESI scores were statistically significant predictors of duration of hospital stay. Patients with multiple comorbidities or with chronic lung disease were also likely to have prolonged hospital stay. None of the cardiac biomarkers affected the duration of hospital stay, neither did the presence of right ventricular dysfunction nor treatment modality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20009666.2018.1466602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998290PMC
June 2018

Scleredema Diabeticorum with Superimposed Cellulitis and Abscess Formation.

Case Rep Endocrinol 2018 16;2018:9513768. Epub 2018 Apr 16.

Interfaith Medical Center, Brooklyn, NY, USA.

Scleredema diabeticorum is a rare cutaneous manifestation of diabetes mellitus. We present a case of an obese male with poorly controlled diabetes who came to the hospital with upper back pain and subsequently developed sepsis due to a small deep-seated abscess in his back that was drained and treated with antibiotics. He was also found to have extensive induration of the skin over his back and neck. Skin biopsy confirmed the diagnosis of scleredema diabeticorum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2018/9513768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926487PMC
April 2018

Acquired Amegakaryocytic Thrombocytopenia and Pure Red Cell Aplasia in Thymoma.

Case Rep Hematol 2018 11;2018:5034741. Epub 2018 Mar 11.

Interfaith Medical Center, Brooklyn, NY, USA.

Association of thymoma with myasthenia gravis, pure red cell aplasia, and aplastic anemia is well documented. However, thymoma complicated by acquired amegakaryocytic thrombocytopenia (AAMT) is rarely reported. Here, we present a case of a 60-year-old male with past medical history of recurrent invasive thymoma who presented with cough and blood in sputum. He was found to have severe normocytic normochromic anemia and thrombocytopenia that did not improve with intravenous steroids or multiple transfusions of red cells and platelets. Subsequent bone marrow biopsy showed severely depleted megakaryocytes and erythroid precursor cells with relative myeloid hyperplasia suggestive of amegakaryocytic thrombocytopenia and red cell aplasia. He was started on oral cyclosporine but subsequently developed leukopenia and refused any further treatment or diagnostic procedures and left the hospital against medical advice. AAMT, thus, may be a very early presentation of impending aplastic anemia, and treating physicians need to be aware of this entity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2018/5034741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866878PMC
March 2018

Direct-Acting Antivirals in Chronic Hepatitis C Genotype 4 Infection in Community Care Setting.

Gastroenterology Res 2018 Apr 7;11(2):130-137. Epub 2018 Apr 7.

Department of Medicine and Division of Gastroenterology and Hepatology, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th St., Brooklyn, NY 11215, USA.

Background: Limited data exists comparing the safety, tolerability, and efficacy of direct-acting antivirals (DAAs) in patients with chronic hepatitis C genotype 4 (HCV GT-4) in the community practice setting. We aim to evaluate the treatment response of DAAs in these patients.

Methods: All the HCV GT-4 patients treated with DAAs between January 2014 and October 2017 in a community clinic setting were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy with sustained virologic response (SVR) at 12 weeks post treatment (SVR12), and adverse reactions were assessed.

Results: Fifty-two patients of Middle Eastern (primarily Egyptian) descent were included in the study. Thirty-two patients were treated with ledipasvir/sofosbuvir (Harvoni) ± ribavirin, 12 patients were treated with ombitasvir/paritaprevir/ritonavir/dasabuvir (ViekiraPak) ± ribavirin, and eight patients were treated with sofosbuvir/Velpatasvir (Epclusa). Ten patients (19.2%) had compensated cirrhosis. Overall, SVR at 12 weeks was achieved in 94% in patients who received one of the three DAA regimens (93.8% in Harvoni group, 91.7 % in ViekiraPak group and 100% in Epclusa group). Prior treatment status and type of regimen used in the presence of compensated cirrhosis had no statistical significance on overall SVR achievement (P value = 0.442 and P value = 0.091, respectively). The most common adverse effect was fatigue (27%).

Conclusions: In the real-world setting, DAAs are effective and well tolerated in patients with chronic HCV GT-4 infection with a high overall SVR rate of 94%. Large-scale studies are needed to further assess this SVR in these groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14740/gr999wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916637PMC
April 2018

Drug-Induced Liver Injury: An Institutional Case Series and Review of Literature.

J Investig Med High Impact Case Rep 2018 Jan-Dec;6:2324709618761754. Epub 2018 Mar 14.

Interfaith Medical Center, Brooklyn, NY, USA.

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the USA. DILI can be broadly classified as Intrinsic and Idiosyncratic. Identifying predictors and at-risk patients are challenging but can have a substantial clinical implication. This case report series demonstrates the importance of valproic acid, fluconazole, and amiodarone as potential hepatoxic agents of drug-induced liver injury leading to acute hepatic failure. The causality in all cases was established by Roussel Uclaf Causality Assessment Method/Council for International Organizations of Medical Sciences score and Naranjo Algorithm. Obesity, hypo-perfusion state, and concurrent hepatotoxic agent might identify at-risk patients. Further studies are required to understand the risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2324709618761754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858623PMC
March 2018

Risk factors predicting mortality in patients with lung abscess in a public tertiary care center in Karachi, Pakistan.

JNMA J Nepal Med Assoc 2013 Oct-Dec;52(192):571-5

Department of Chest Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan.

Introduction: Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan.

Methods: A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality.

Results: Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients<20 years of age (3/4, 75%). Patients with blood sugar levels of >200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL.

Conclusions: The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2015

Spinal cord injury rehabilitation in Nepal.

JNMA J Nepal Med Assoc 2013 Apr-Jun;52(190):427-31

Bracknell, Berkshire, UK.

Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the establishment of the various hospitals with rehabilitation units, rehabilitation centres and physical therapy units in different institutions. However, the spinal cord injury rehabilitation setting and scenario is different in Nepal from those in the developed countries since spinal cord injury rehabilitation care has not been adequately incorporated into the health care delivery system nor its importance has been realized within the medical community of Nepal. To name few, lack of human resource for the rehabilitation care, awareness among the medical personnel and general population, adequate scientific research evidence regarding situation of spinal injury and exorbitant health care policy are the important hurdles that has led to the current situation. Hence, it is our responsibility to address these apparent barriers to successful implementation and functioning of rehabilitation so that those with spinal injury would benefit from enhanced quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2014