Publications by authors named "Harshil Shah"

29 Publications

  • Page 1 of 1

Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population.

World J Gastrointest Pathophysiol 2021 Mar;12(2):14-24

Department of Gastroenterology, Henry Ford Hospital, Detroit, MI 48202, United States.

Background: Gallstones and cholecystectomy have been proposed as risk factors for non-alcoholic fatty liver disease (NAFLD). The reason for this may be that both gallstones, as well as NAFLD share several risk factors with regards to their development. Currently, there is a lack of sufficient evidence showing an association between these clinical conditions.

Aim: To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD.

Methods: We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases, 10 revision, Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease (GSD) (includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder) as well as NAFLD (includes simple fatty liver and non-alcoholic steatohepatitis). Odds ratios (ORs) measuring the association between GSD (includes gallstones and cholecystectomy) and NAFLD were calculated using logistic regression after adjusting for confounding variables.

Results: Out of 14294784 hospitalizations in 2016-2017, 159259 were found to have NAFLD. The prevalence of NAFLD was 3.3% in patients with GSD and 1% in those without. NAFLD was prevalent in 64.3% of women with GSD as compared to 35.7% of men with GSD. After controlling for various confounders associated with NAFLD and GSD, multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones [OR = 6.32; 95% confidence interval (CI): 6.15-6.48] as well as cholecystectomy (OR = 1.97; 95%CI: 1.93-2.01). The association between NAFLD and gallstones was stronger in men (OR = 6.67; 95%CI: 6.42-6.93) than women (OR = 6.05; 95%CI: 5.83-6.27). The association between NAFLD and cholecystectomy was stronger in women (OR = 2.01; 95%CI: 1.96-2.06) than men (OR = 1.85; 95%CI: 1.79-1.92). value was less than 0.001 for all comparisons.

Conclusion: NAFLD is more prevalent in women with GSD than men. The association between NAFLD and cholecystectomy/gallstones indicates that they may be risk factors for NAFLD.
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http://dx.doi.org/10.4291/wjgp.v12.i2.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008957PMC
March 2021

Primary Malignant Mesothelioma of the Liver: Case Report and Review of the Literature.

Eur J Case Rep Intern Med 2020 18;7(12):002128. Epub 2020 Dec 18.

Guthrie Robert Packer Hospital, Sayre, PA, USA.

Introduction: Primary malignant mesothelioma of the liver is an extremely rare cancer, with only 16 cases reported in the literature so far. Diagnosis is challenging due to morphological similarity with common liver cancers and the extreme rarity of the condition.

Case Description: We present the case of a 70-year-old man who was found to have an incidental liver mass which was diagnosed as primary malignant mesothelioma of the liver.

Conclusion: Our report describes the presentation of this rare liver malignancy and the challenges associated with diagnosis and treatment.

Learning Points: Primary malignant mesothelioma of the liver is an extremely rare condition.This diagnosis should be considered during the evaluation and treatment of a liver mass.
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http://dx.doi.org/10.12890/2020_002128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875602PMC
December 2020

Description of neurodevelopmental phenotypes associated with 10 genetic neurodevelopmental disorders: A scoping review.

Clin Genet 2021 Mar 18;99(3):335-346. Epub 2020 Nov 18.

Cumming School of Medicine, University of Calgary, Calgary, Canada.

Neurodevelopmental disorders (NDDs) are a heterogeneous group of conditions including intellectual disability, global developmental delay, autism spectrum disorder, and attention deficit hyperactivity disorder. Advances in genetic diagnostic technology have led to the identification of a number of NDD-associated genes, but reports of cognitive and developmental outcomes in affected individuals have been variable. The objective of this scoping review is to synthesize available information pertaining to the developmental outcomes of individuals with pathogenic variants in ten emerging recurrent NDD-associated genes identified from large scale sequencing studies; ADNP, ANKRD11, ARID1B, CHD2, CHD8, CTNNB1, DDX3X, DYRK1A, SCN2A, and SYNGAP1. After a comprehensive search, 260 articles were selected that reported on neurodevelopmental measures or diagnoses. We identify the spectrum of developmental outcomes for each genetic NDD, including prevalence of intellectual disability, frequency of co-morbid NDDs such as ADHD and autism, and commonly reported medical issues that can help inform diagnosis and treatment. There are significant gaps in our understanding of the natural history of these conditions. Future research focusing on barriers to assessment, the development of modified assessment tools appropriate for long-term outcomes in genetic NDD, and collection of longitudinal data will increase understanding of prognosis in these conditions and inform evaluations of treatment.
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http://dx.doi.org/10.1111/cge.13882DOI Listing
March 2021

Paralytic ileus in the United States: A cross-sectional study from the national inpatient sample.

SAGE Open Med 2020 6;8:2050312120962636. Epub 2020 Oct 6.

Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA.

Introduction: Paralytic ileus is a common clinical condition leading to significant morbidity and mortality. Most studies to date have focused on postoperative ileus, a common but not exclusive cause of the condition. There are limited epidemiological data regarding the incidence and impact of paralytic ileus and its relationship to other clinical conditions. In this cross-sectional study, we analyzed national inpatient hospitalization trends, demographic variation, cost of care, length of stay, and mortality for paralytic ileus hospitalizations as a whole.

Methods: The National Inpatient Sample database was used to identify all hospitalizations with the diagnosis of paralytic ileus (International Classification of Diseases, 9th Revision code 560.1) as primary or secondary diagnosis during the period from 2001 to 2011. Statistical analysis was performed using Cochran-Armitage trend test, Wilcoxon rank sum test, and Poisson regression.

Results: In 2001, there were 362,561 hospitalizations with the diagnosis of paralytic ileus as compared to 470,110 in 2011 (p < 0.0001). The age group 65-79 years was most commonly affected by paralytic ileus throughout the study period. In-hospital all-cause mortality decreased from 6.03% in 2001 to 5.10% in 2011 (p < 0.0001). However, the average cost of care per hospitalization increased from US$19,739 in 2001 to US$26,198 in 2011 (adjusted for inflation, p < 0.0001).

Conclusion: There was a significant rise in the number of hospitalizations of paralytic ileus with increased cost of care and reduced all-cause mortality.
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http://dx.doi.org/10.1177/2050312120962636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545785PMC
October 2020

Dieulafoy's Lesion: Decade-Long Trends in Hospitalizations, Demographic Disparity, and Outcomes.

Cureus 2020 Jul 13;12(7):e9170. Epub 2020 Jul 13.

Internal Medicine, Westchester Medical Center, Valhalla, USA.

Background Dieulafoy's lesion is a relatively rare, but potentially life-threatening, condition where a tortuous arteriole, most commonly in the stomach, may bleed and lead to significant gastrointestinal hemorrhage. Limited epidemiological data exist on patient characteristics and the annual number of hospitalizations associated with such lesions. The aim of our study is to determine the inpatient burden of Dieulafoy's lesion. Methods We analyzed the National Inpatient Sample (NIS) database for all subjects with a discharge diagnosis of Dieulafoy's lesion of the stomach, duodenum, and colon using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 537.84 and 569.86 as the primary or secondary diagnosis during the period from 2002 to 2011. Statistical significance of variation in the number of hospital discharges and demographics during the study period was achieved using the Cochrane-Armitage trend test. Results In 2002, there were 1,071 admissions with a discharge diagnosis of Dieulafoy's lesion as compared to 7,414 in 2011 (p < 0.0001). Dieulafoy's lesion was found to be most common in the age group of 65-79 years (p < 0.0001). Overall, it was found to be more common in males as compared to females (p = 0.0261). The white race was most commonly affected amongst all the races. The average cost of care per hospitalization increased from $14,992 in 2002 to $25,594 in 2011 (p < 0.0001). Conclusion There has been a steady rise in the number of inpatient admissions with Dieulafoy's lesions. Advances in diagnostic techniques likely play a key role in the higher detection rates along with the possible involvement of other unknown factors. Men, in the age group of 65 to 79 years, and Whites were found to have significantly higher admission rates than all other groups, with a significant increase in the cost of care.
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http://dx.doi.org/10.7759/cureus.9170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424366PMC
July 2020

Clinical characteristics and in hospital outcomes of heart transplant recipients undergoing percutaneous coronary intervention: Insights from the National Inpatient Sample.

Catheter Cardiovasc Interv 2020 11 13;96(6):E585-E592. Epub 2020 Aug 13.

Independent Researcher, Ahmedabad, Gujarat, India.

Objectives: Cardiac transplant patients are at increased risk of Coronary Allograft Vasculopathy which requires percutaneous coronary intervention (PCI).

Background: We aim to determine national epidemiology describing trends, mortality, and morbidity risks in patients with heart transplant undergoing PCI.

Methods: We used Nationwide Inpatient Sample (NIS) data from 2002 to 2014 to identify adult hospitalizations with PCI using ICD 9 codes. Acute myocardial infarction (AMI), cardiac transplant status and complications were identified using validated ICD-9-CM diagnosis codes. Endpoints were in-hospital mortality and peri-procedural complications. Propensity match analysis was performed to compare the end-points between DES and BMS.

Results: Total 8,613,900 patients underwent PCI, of which 1,531(0.002%) patients had prior heart transplant status. Among these 1,531 PCIs, 311(20%) were due to AMI including 125(8%) due to STEMI. 74% of PCIs were done in males and 78% of the PCIs were performed in the 60-79 age group. Out of 1,380 stents placed, 1,090 were DES (79%) and 290 (21%) were BMS. Mortality was higher in the BMS versus DES (8.34% vs. 3.45%, p = .012), CONCLUSION: We concluded that majority of the population who underwent PCI were older males. DES was used more than BMS. The use of BMS is associated with increased mortality, cardiac complications and Acute Kidney Injury requiring dialysis compared with DES which likely is representative of preferential use of DES in these patient population.
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http://dx.doi.org/10.1002/ccd.29184DOI Listing
November 2020

Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States.

Cureus 2020 Jun 30;12(6):e8922. Epub 2020 Jun 30.

Hospital-Based Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA.

Background The 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study. Objective The aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database. Methods We used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression. Results After excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; = 0.01). Conclusion The unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients.
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http://dx.doi.org/10.7759/cureus.8922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392362PMC
June 2020

Outcomes of percutaneous coronary interventions in patients with liver transplant.

Catheter Cardiovasc Interv 2020 11 29;96(6):E576-E584. Epub 2020 Jul 29.

Guthrie Healthcare System, Sayre, Pennsylvania.

Objective: Our aim is to describe characteristics of liver transplant patients undergoing percutaneous coronary interventions (PCI) as well as in-hospital outcomes including the mortality and peri-procedural complications from the largest publicly available inpatient database in the United States from 2002 to 2014.

Background: Outcomes of PCI are well studied in patients with end-stage liver disease but not well studied in patients who receive liver transplant (LT).

Methods: Data derived from Nationwide Inpatient Sample (NIS) were analyzed for years 2002-2014. Adult Hospitalizations with PCI were identified using ICD-9-CM procedure codes. LT status and various complications were identified by using previously validated ICD-9-CM diagnosis codes. Endpoints were in-hospital mortality and peri-procedural complications. Propensity match analysis was performed to compare the endpoints between two groups.

Results: During the study period, 8,595,836 patients underwent PCI; 4,080 (0.04%) patients had prior LT status. 93% of patients were above age 59 years, 79% were males and 69% were nonwhites. Out of the total patients with LT status, 73% had hypertension, 57% had diabetes mellitus, and 47% had renal failure. Post-PCI complications were studied further in both liver and non-LT patients after 1:1 propensity match which showed the incidence of acute kidney injury (AKI) was higher in LT group (12.3 vs 10.7%, p = .024) but dialysis requiring AKI was similar.

Conclusion: Among the LT recipients undergoing PCI, majority were nonwhite males. Almost more than half of the recipients had diabetes mellitus and renal failure. Incidence of AKI was higher in LT group, but other peri-procedural complications were comparable.
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http://dx.doi.org/10.1002/ccd.29168DOI Listing
November 2020

Chylous Ascites and Pleural Effusion Treated With Intravenous Octreotide.

Cureus 2020 Jun 17;12(6):e8669. Epub 2020 Jun 17.

Gastroenterology and Hepatology, Guthrie Clinic, Robert Packer Hospital, Sayre, USA.

Chylous ascites (CA) is uncommon in cirrhosis. It often presents as diuretic-resistant ascites and is associated with increased mortality. Diagnosis is done by the detection of triglyceride-rich ascitic fluid. There are no published guidelines on the management of CA. We describe the case of a middle-aged female who presented with CA secondary to cirrhosis, and the challenges associated with her treatment and her management with the use of intravenous octreotide.
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http://dx.doi.org/10.7759/cureus.8669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370588PMC
June 2020

Trends and outcomes of peptic ulcer disease in patients with cirrhosis.

Postgrad Med 2020 Nov 1;132(8):773-780. Epub 2020 Aug 1.

New York Medical College, Cardiology Division, New York Medical College Macy Pavilion , Valhalla, New York, United States.

Background: Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis.

Methods: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002-2014. Adult hospitalizations due to PUD were identified by previously validated ICD-9-CM codes as the primary diagnosis. Cirrhosis was also identified with presence of ICD-9-CM codes in secondary diagnosis fields. We analyzed trends and predictors of PUD in cirrhotic patients and utilized multivariate regression models to estimate the impact of cirrhosis on PUD outcomes.

Results: Between the years 2002-2014, there were 1,433,270 adult hospitalizations with a primary diagnosis of PUD, out of which 70,007 (4.88%) had cirrhosis as a concurrent diagnosis. There was a significant increase in the proportion of hospitalizations with a concurrent diagnosis of cirrhosis, from 3.9% in 2002 to 6.6% in 2014 (p < 0.001). In an adjusted multivariable analysis, in-hospital mortality was significantly higher in hospitalizations of PUD with cirrhosis (odd ratio [OR] 1.78; 95% confidence interval [CI] 1.63-1.97; P < 0.001), however, there was no difference in the discharge to facility (OR 1.00; 95%CI 0.94 - 1.07; P = 0.81). Moreover, length of stay (LOS) was also higher (6 days vs. 4 days, P < 0.001) among PUD with cirrhosis. Increasing age and comorbidities were associated with higher odds of in-hospital mortality among PUD patients with cirrhosis.

Conclusion: Our study shows that there is an increased hospital burden as well as poor outcomes in terms of higher in-hospital mortality among hospitalized PUD patients with cirrhosis. Further studies are warranted for better risk stratification and improvement of outcomes.
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http://dx.doi.org/10.1080/00325481.2020.1795485DOI Listing
November 2020

Role of Steroids in Post-streptococcal Glomerulonephritis Without Crescents on Renal Biopsy.

Cureus 2018 Aug 15;10(8):e3150. Epub 2018 Aug 15.

Nephrology, Guthrie Clinic/Robert Packer Hospital, Sayre, USA.

Steroid is usually indicated in patients with post-streptococcal glomerulonephritis (PSGN) with more than 30% crescents on renal biopsy. The role of steroids in patients without crescentic glomerulonephritis is not clear. We present a 19-year-old male patient who was diagnosed with PSGN three weeks after a sore throat infection. He developed acute renal and respiratory failure requiring hemodialysis and mechanical ventilation. The renal biopsy confirmed PSGN, but did not show severe histological features such as crescents formation. Due to lack of clinical improvement, trials of pulse dose methylprednisolone were initiated with prompt improvement in renal and respiratory function. Our case suggested the potential role of high dose steroids in select patients of PSGN with progressive renal failure, development of multi-organ system deterioration, and failed conservative management irrespective of histological findings.
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http://dx.doi.org/10.7759/cureus.3150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191008PMC
August 2018

Short-term outcomes of pulmonary embolism: A National Perspective.

Clin Cardiol 2018 Sep 24;41(9):1214-1224. Epub 2018 Sep 24.

Department of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida.

Background: Pulmonary embolism (PE) is associated with significant morbidity and mortality in hospitalized patients. Real time data on 90-day mortality, bleeding, and readmission is sparse.

Methods: The study cohort was derived from the National Readmission Data (NRD) 2013 to 2014. PE was identified using International Classification of Diseases, ninth Revision (ICD-9-CM) code 415.11/3/9 in the primary diagnosis field. Any admission within 90 days of primary admission was considered a 90-day readmission. Readmission etiologies were identified by ICD-9 code in the primary diagnosis field. Co-primary outcomes were 90-day readmission and 90-day mortality.

Results: We identified 260 614 patients with primary admission PE, 55 659 (21.36%) patients were readmitted within 90 days. Most of them were of old age (age ≥ 65 years: 49.04%) and females (52.78%). Among the etiologies of readmission pulmonary disorders (22.94%) (Including recurrent PE 7.33%), malignancies (8.31%), and bleeding disorders (6.75%) were the most important causes of 90-day readmissions. On multivariate analysis, higher readmission rates and 90 days mortality were seen in patients with heart failure, chronic pulmonary disease, Anemia, malignancy, and with higher Charlson score. Patients with longer length of stay during primary admission and who discharged to short/long-term facility were more likely get readmitted and die in 90 days. Paradoxically, obese patients showed an inverse relationship with co-primary outcomes.

Conclusions: Older female patients were more likely to have a pulmonary embolism. High-risk groups such as heart failure, chronic pulmonary disease, anemia, and malignancy need to be given extra attention to prevent worse outcomes.
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http://dx.doi.org/10.1002/clc.23048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490021PMC
September 2018

National Trends and Outcomes in Dialysis-Requiring Acute Kidney Injury in Heart Failure: 2002-2013.

J Card Fail 2018 Jul 3;24(7):442-450. Epub 2018 May 3.

Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.

Methods: We used the Nationwide Inpatient Sample (2002-2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).

Results: We identified 11,205,743 HF hospitalizations. Across 2002-2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36-2.63; P < .01) and adverse discharge (aOR 2.04, 95% CI 1.95-2.13; P < .01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002-2013. LoS and cost also decreased across this period.

Conclusions: The incidence of D-AKI in HF hospitalizations doubled across 2002-2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes.
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http://dx.doi.org/10.1016/j.cardfail.2018.05.001DOI Listing
July 2018

Recent updates for designing CCR5 antagonists as anti-retroviral agents.

Eur J Med Chem 2018 Mar 31;147:115-129. Epub 2018 Jan 31.

Department of Pharmaceutical Chemistry, Institute of Pharmacy, Nirma University, S.G. Highway, Ahmedabad 382481, India. Electronic address:

The healthcare system faces various challenges in human immunodeficiency virus (HIV) therapy due to resistance to Anti-Retroviral Therapy (ART) as a consequence of the evolutionary process. Despite the success of antiretroviral drugs like Zidovudine, Zalcitabine, Raltegravir WHO ranks HIV as one of the deadliest diseases with a mortality of one million lives in 2016. Thus, there emerges an urgency of developing a novel anti-retroviral agent that combat resistant HIV strains. The clinical development of ART from a single drug regimen to current triple drug combination is very slow. The progression in the structural biology of the viral envelope prompted the discovery of novel targets, which can be demonstrated a proficient approach for drug design of anti-retroviral agents. The current review enlightens the recent updates in the structural biology of the viral envelope and focuses on CCR5 as a validated target as well as ways to overcome CCR5 resistance. The article also throws light on the SAR studies and most prevalent mutations in the receptor for designing CCR5 antagonists that can combat HIV-1 infection. To conclude, the paper lists diversified scaffolds that are in pipeline by various pharmaceutical companies that could provide an aid for developing novel CCR5 antagonists.
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http://dx.doi.org/10.1016/j.ejmech.2018.01.085DOI Listing
March 2018

Atrial fibrillation: Utility of CHADS and CHADS-VASc scores as predictors of readmission, mortality and resource utilization.

Int J Cardiol 2017 Oct;245:162-167

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.

Background: CHADS and CHADS-VASc scores are widely used for thromboembolic risk assessment in Atrial Fibrillation(AF) cohort, however further utilization to predict outcomes is understudied.

Method: HCUP's National Readmission Data(NRD) 2013 was queried for AF admissions using ICD-9-CM code 427.31 in principal diagnosis field. Patients with mitral valve disease or repair/or replacement were excluded to estimate population with non-valvular AF only. CHADS and CHADS-VASc were calculated for each patient. Hierarchical two-level logistic and linear models were used to evaluate study outcomes in terms of mortality, 30 or 90-day readmissions, length of stay(LOS) and cost.

Result: Of 116,450 principal non-valvular AF admissions(50.2% female and 43.1% age≥75years) 29,179 patients were readmitted, with total 40,959 readmissions. Higher CHADS and CHADS-VASc score were associated with increased mortality from 0.4% for CHADS of 0 to 3.2% for score of 6 and from 0.2% for CHADS-VASc of 0 to 3.2% for score≥8. LOS increased from 2.20days for CHADS of 0 to 5.08days for score of 6, while cost increased from $7888 to $11,151. 30-day readmission rate increased from 8.9% for CHADS of 0 to 26.0% for score of 6, and 90-day readmission rate increased from 15.2% to 39%. CHADS-VASc scoring similarly demonstrated a trend towards increasing readmission rate, LOS and cost for higher scores. Also, similar results were seen in hierarchical modeling with increment of CHADS and CHADS-VASc scores.

Conclusion: CHADS and CHADS-VASc scores can be used as quick surrogate markers for predicting outcomes beyond thromboembolic risk. Physician familiarity with these systems makes them easy to use bedside clinical tools to improve outcomes and resource allocation.
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http://dx.doi.org/10.1016/j.ijcard.2017.06.090DOI Listing
October 2017

Short-term outcomes of atrial flutter ablation.

J Cardiovasc Electrophysiol 2017 Nov;28(11):1275-1284

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Understanding the factors associated with early readmissions following atrial flutter (AFL) ablation is critical to reduce the cost and improving the quality of life in AFL patients.

Method: The study cohort was derived from the national readmission database 2013-2014. International Classification of Diseases, 9th Revision (ICD-9-CM) diagnosis code 427.32 and procedure code 37.34 were used to identify AFL and catheter ablation, respectively. The primary and secondary outcomes were 90-day readmission and complications including in-hospital mortality. Cox proportional regression and hierarchical logistic regression were used to generate the predictors of primary and secondary outcomes respectively. Readmission causes were identified by ICD-9-CM code in primary diagnosis field of readmissions.

Result: Readmission rate of 18.19% (n = 1,010 with 1,396 readmissions) was noted among AFL patients (n = 5552). Common etiologies for readmission were heart failure (12.23%), atrial fibrillation (11.13%), atrial flutter (8.93%), respiratory complications (9.42%), infections (7.4%), bleeding (7.39%, including GI bleed-4.09% and intracranial bleed-0.79%) and stroke/TIA (1.89%). Multivariate predictors of 90-day readmission (hazard ratio, 95% confidence interval, P value) were preexisting heart failure (1.30, 1.13-1.49, P < 0.001), chronic pulmonary disease (1.37, 1.18-1.58, P < 0.001), anemia (1.23, 1.02-1.49, P = 0.035), malignancy (1.87, 1.40-2.49, P < 0.001), weekend admission compared to weekday admission (1.23, 1.02-1.47, P = 0.029), and length of stay (LOS) ≥5 days (1.39, 1.16-1.65, P < 0.001). Note that 50% of readmissions happened within 30 days of discharge.

Conclusion: Cardiac etiologies remain the most common reason for the readmission after AFL ablation. Identifying high risk patients, careful discharge planning, and close follow-up postdischarge can potentially reduce readmission rates in AFL ablation patients.
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http://dx.doi.org/10.1111/jce.13311DOI Listing
November 2017

Etiologies, Trends, and Predictors of 30-Day Readmissions in Patients With Diastolic Heart Failure.

Am J Cardiol 2017 Aug 1;120(4):616-624. Epub 2017 Jun 1.

Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.

An estimated half of all heart failure (HF) populations has been categorized to have diastolic HF (DHF), but sparse data are available describing etiologies and predictors of 30-day readmission in DHF population. The study cohort was derived from the National Readmission Database 2013 to 2014, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. DHF was identified using International Classification of Diseases, 9th Revision code 428.3x in primary diagnosis field. Readmission etiologies were identified by International Classification of Diseases, 9th Revision code in primary diagnosis field. The primary outcome was 30-day readmission. Hierarchical multivariable logistic regression was used to adjust for confounders. In total, 192,394 patients with DHF were included, of which 40,927 (21.27%) patients were readmitted with total readmissions of 47,056 within 30 days. Predictors of increased readmissions were age (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.001 to 1.0003, p <0.001), diabetes (OR 1.08, 95% CI 1.05 to 1.11, p <0.001), chronic pulmonary disease (OR 1.18, 95% CI 1.15 to 1.21, p <0.001), renal failure (OR 1.21, 95% CI 1.17 to 1.25, p <0.001), peripheral vascular disease (OR 1.05, 95% CI 1.02 to 1.09, p = 0.002), anemia (OR 1.12, 95% CI 1.10 to 1.15, p <0.001), transfusion during index admission (OR 1.18, 95% CI 1.13 to 1.23, p <0.001), discharge to the facility (OR 1.13, 95% CI 1.10 to 1.16, p <0.001), length of stay >2 days, and Charlson comorbidity index ≥3, whereas obesity (OR 0.82, 95% CI 0.80 to 0.85, p <0.001), elective admissions (OR 0.88, 95% CI 0.83 to 0.94, p <0.001), and non-Medicare/Medicaid primary payer were predictors of lower readmission rate. Most common etiologies of readmission were acute HF (28.01%), infections (9.54%), acute kidney injury (5.35%), acute respiratory failure (4.86%), and pneumonia (3.92%). In conclusion, DHF population with higher comorbidity burden, longer length of stay, and discharge to facility were prone to increased readmissions, with most common etiologies of readmission being HF, infections, and acute kidney injury.
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http://dx.doi.org/10.1016/j.amjcard.2017.05.028DOI Listing
August 2017

Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure.

Am J Cardiol 2017 03 14;119(5):760-769. Epub 2016 Dec 14.

Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.

Heart failure (HF) is the most common discharge diagnosis across the United States, and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the problem. The study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data 2013, sponsored by the Agency for Healthcare Research and Quality. HF was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Readmission was defined as a subsequent hospital admission within 30 days after discharge day of index admission. Readmission causes were identified using International Classification of Diseases, Ninth Revision, codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. From a total 301,892 principal admissions (73.4% age ≥65 years and 50.6% men), 55,857 (18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by coronary artery disease and arrhythmias), whereas pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (odds ratio, 95% confidence interval, p value: 1.06, 1.03 to 1.08, p <0.001), chronic lung disease (1.13, 1.11 to 1.16, p <0.001), renal failure/electrolyte imbalance (1.12, 1.10 to 1.15, p <0.001), discharge to facilities (1.07, 1.04 to 1.09, p <0.001), lengthier hospital stay, and transfusion during index admission. In conclusion, readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome.
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http://dx.doi.org/10.1016/j.amjcard.2016.11.022DOI Listing
March 2017

Geographical Variation in Peritoneal Dialysis Catheter Insertion and Initiation within the United States.

Perit Dial Int 2016 11-12;36(6):691-693

Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Peritoneal dialysis (PD) is an effective but underutilized renal replacement therapy modality. There are limited data regarding geographical variation in PD catheter insertion and utilization of PD as a first renal replacement therapy in the United States. We explored the variation in catheter insertion and initiation of PD utilizing 2 large, nationally representative databases. The incidence of catheter insertion differed significantly by geographical region, being highest in the South (7.30/100 end-stage renal disease [ESRD] patients; 95% confidence [CI] interval 6.78 - 7.81) and lowest in the West (5.91/100 ESRD patients; 95% CI 5.43 - 6.38). Peritoneal dialysis initiation also differed by region, being highest in the West (7.10/100 ESRD patients; 95% CI 6.83 - 7.30) and lowest in the Northeast (5.12/100 ESRD patients; 95% CI 4.87 - 5.30). Interestingly, the Northeast region, with the lowest rate of PD utilization, had the highest number of nephrologists per population (3.95/100,000 persons), and the West, with the highest PD utilization, had the lowest number of nephrologists (2.54/100,000 persons). Reasons for this variation should be explored further and efforts should be made to standardize PD implementation throughout the United States.
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http://dx.doi.org/10.3747/pdi.2016.00006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174880PMC
December 2017

Etiologies and Predictors of 30-Day Readmission and In-Hospital Mortality During Primary and Readmission After Transcatheter Aortic Valve Implantation.

Am J Cardiol 2016 Dec 30;118(11):1705-1711. Epub 2016 Aug 30.

Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address:

There are sparse data on the etiologies and predictors of readmission after transcatheter aortic valve implantation (TAVI). The study cohort was derived from the National Readmission Data 2013, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. TAVI was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. The coprimary outcomes were 30-day readmissions and in-hospital mortality during primary admission and readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. Our analysis included 5,702 (weighted n = 12,703) TAVI procedures. About 1,215 patients were readmitted (weighted n = 2,757) within 30 days during the study year. Significant predictors of readmission included transapical access (OR, 95% CI, p value) (1.23, 1.10 to 1.38, <0.01), diabetes (1.18, 1.06 to 1.32, p 0.004), chronic lung disease (1.32, 1.18 to 1.47, <0.01), renal failure (1.43, 1.24 to 1.65, <0.01), patients discharged to facilities (1.28, 1.14 to 1.43, <0.01), and those who had lengthier hospital stays during primary admission (length of stay >10 days: 3.06, 2.22 to 4.22, <0.01). Female gender (1.39, 1.16 to 1.68, <0.01), blood transfusion (1.88, 1.55 to 2.29, <0.01), use of vasopressors (3.63, 2.50 to 5.28, <0.01), hemodynamic support (6.39, 5.20 to 7.85, <0.01) and percutaneous coronary intervention (1.89, 1.30 to 2.74, 0.01) during primary admission were significant predictors of in-hospital mortality. Age and transapical access were significant predictors of in-hospital mortality during readmission. In conclusion, heart failure, pneumonia, and bleeding complications are among important etiologies of readmission in patients after TAVI. Patients who underwent transapical TAVI and those with slower in-hospital recovery and co-morbidities such as chronic lung disease and renal failure are more likely to be readmitted to the hospital.
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http://dx.doi.org/10.1016/j.amjcard.2016.08.052DOI Listing
December 2016

Endoscopic excision of intraventricular neurocysticercosis blocking foramen of Monro bilaterally.

Asian J Neurosurg 2016 Apr-Jun;11(2):176-7

Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.

Neurocysticercosis (NCC) is a parasitic infestation of the central nervous system. NCC parasitic infestation can be misdiagnosed as hydatid cyst or intraventricular epidermoid cyst that can cause a diagnostic dilemma. A 23-year-old male patient presented with headache and vomiting for 3-4 days and giddiness for 4-5 days. Magnetic resonance imaging with contrast was suggestive of a rim-enhancing lesion at the level of the foramen of Monro. Endoscopic excision of the lesion was done, and the patient had relief of a headache and vomiting immediately after the procedure. He is being followed up regularly. Intraventricular NCC occluding both foramen of Monro is a rare entity. Complete endoscopic surgical excision followed by appropriate drug therapy should be given to achieve a cure.
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http://dx.doi.org/10.4103/1793-5482.175622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802951PMC
April 2016

Demographic and histopathologic profile of pediatric brain tumors: A hospital-based study.

South Asian J Cancer 2015 Jul-Sep;4(3):146-8

Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.

Background: Very few hospital-based or population-based studies are published in the context to the epidemiologic profile of pediatric brain tumors (PBTs) in India and Indian subcontinent.

Aim: To study the demographic and histopathologic profile of PBTs according to World Health Organization 2007 classification in a single tertiary health care center in India.

Materials And Methods: Data regarding age, gender, topography, and histopathology of 76 pediatric patients (0-19 years) with brain tumors operated over a period of 24 months (January-2012 to December-2013) was collected retrospectively and analyzed using EpiInfo 7. Chi-square test and test of proportions (Z-test) were used wherever necessary.

Results: PBTs were more common in males (55.3%) as compared to females (44.7%) with male to female ratio of 1.23:1. Mean age was 10.69 years. Frequency of tumors was higher in childhood age group (65.8%) when compared to adolescent age group (34.2%). The most common anatomical site was cerebellum (39.5%), followed by hemispheres (22.4%). Supratentorial tumors (52.6%) were predominant than infratentorial tumors (47.4%). Astrocytomas (40.8%) and embryonal tumors (29.0%) were the most common histological types almost contributing more than 2/3(rd) of all tumors. Craniopharyngiomas (11.8%) and ependymomas (6.6%) were the third and fourth most common tumors, respectively.

Conclusion: Astrocytomas and medulloblastomas are the most common tumors among children and adolescents in our region, which needs special attention from the neurosurgical department of our institute. Demographic and histopathologic profile of cohort in the present study do not differ substantially from that found in other hospital-based and population-based studies except for slight higher frequency of craniopharyngiomas.
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http://dx.doi.org/10.4103/2278-330X.173165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756492PMC
March 2016

Coronary Atherectomy in the United States (from a Nationwide Inpatient Sample).

Am J Cardiol 2016 Feb 6;117(4):555-562. Epub 2015 Dec 6.

Cardiology Department, Detroit Medical Center, Detroit, Michigan.

Contemporary real-world data on clinical outcomes after utilization of coronary atherectomy are sparse. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from year 2012. Percutaneous coronary interventions including atherectomy were identified using appropriate International Classification of Diseases, 9th Revision diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The primary outcome was a composite of in-hospital mortality and periprocedural complications; the secondary outcome was in-hospital mortality. Hospitalization costs were also assessed. A total of 107,131 procedures were identified in 2012. Multivariate analysis revealed that atherectomy utilization was independently predictive of greater primary composite outcome of in-hospital mortality and complications (odds ratio 1.34, 95% confidence interval 1.22 to 1.47, p <0.001) but was not associated with any significant difference in terms of in-hospital mortality alone (odds ratio 1.22, 95% confidence interval 0.99 to 1.52, p 0.063). In the propensity-matched cohort, atherectomy utilization was again associated with a higher rate of complications (12.88% vs 10.99%, p = 0.001), in-hospital mortality +a ny complication (13.69% vs 11.91%, p = 0.003) with a nonsignificant difference in terms of in-hospital mortality alone (3.45% vs 2.88%, p = 0.063) and higher hospitalization costs ($25,341 ± 353 vs $21,984 ± 87, p <0.001). Atherectomy utilization during percutaneous coronary intervention is associated with a higher rate of postprocedural complications without any significant impact on in-hospital mortality.
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http://dx.doi.org/10.1016/j.amjcard.2015.11.041DOI Listing
February 2016

In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

Am J Cardiol 2016 Feb 7;117(4):676-684. Epub 2015 Dec 7.

Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address:

Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications.
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http://dx.doi.org/10.1016/j.amjcard.2015.11.025DOI Listing
February 2016

Intravascular papillary endothelial hyperplasia (Masson's tumor) of the scalp with intracranial extension.

J Pediatr Neurosci 2014 Sep-Dec;9(3):260-2

Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.

Intravascular papillary endothelial hyperplasia (IPEH) (Masson's tumor) is an unusual benign vascular lesion of the skin and subcutaneous tissue, consisting of papillary formations related to a thrombus and covered by a single layer of plump endothelial cells. The lesion is often mistaken with angiosarcoma and a group of other benign and malignant vascular lesions. The clinical and radiological findings are not specific, and the diagnosis is based on the histological examination. Intracranial lesions are extremely rare with only 32 cases been reported in the literature. Only two cases of IPEH presenting as scalp swelling have been reported in the literature. We report a case of a 3-month-old boy with IPEH of scalp in the left parietal region, which was involving the skull bone and extending intracranially.
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http://dx.doi.org/10.4103/1817-1745.147584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302549PMC
January 2015

Census 2: isobaric labeling data analysis.

Bioinformatics 2014 Aug 28;30(15):2208-9. Epub 2014 Mar 28.

Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA 92037, USA.

Motivation: We introduce Census 2, an update of a mass spectrometry data analysis tool for peptide/protein quantification. New features for analysis of isobaric labeling, such as Tandem Mass Tag (TMT) or Isobaric Tags for Relative and Absolute Quantification (iTRAQ), have been added in this version, including a reporter ion impurity correction, a reporter ion intensity threshold filter and an option for weighted normalization to correct mixing errors. TMT/iTRAQ analysis can be performed on experiments using HCD (High Energy Collision Dissociation) only, CID (Collision Induced Dissociation)/HCD (High Energy Collision Dissociation) dual scans or HCD triple-stage mass spectrometry data. To improve measurement accuracy, we implemented weighted normalization, multiple tandem spectral approach, impurity correction and dynamic intensity threshold features.

Availability And Implementation: Census 2 supports multiple input file formats including MS1/MS2, DTASelect, mzXML and pepXML. It requires JAVA version 6 or later to run. Free download of Census 2 for academic users is available at http://fields.scripps.edu/census/index.php.

Contact: [email protected]

Supplementary Information: Supplementary data are available at Bioinformatics online.
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http://dx.doi.org/10.1093/bioinformatics/btu151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155478PMC
August 2014

Successful partial pancreatotomy as a salvage procedure for massive intraoperative bleeding during head coring for chronic pancreatitis. Report of a case.

JOP 2007 Sep 7;8(5):609-12. Epub 2007 Sep 7.

Department of Surgery, Jaslok and Bhatia General Hospital, Mumbai, India.

Context: Chronic pancreatitis is a continuous inflammatory disease of the pancreas resulting in scarring and fibrosis with consequent decline in exocrine and endocrine function. The inflammatory process leads to the development of a head mass, and strictures and stones in the pancreatic duct which present as pain, or loco regional complications such as duodenal obstruction and biliary obstruction. The gold standard for the treatment of pain and loco regional complications remains surgery, which is usually a combination of drainage and partial resection (coring). This can be hazardous due to adhesions, inflammation or portal hypertension.

Case Report: We report a case in which severe bleeding from the pancreatic duct was encountered during a Frey procedure. It was from the superior mesenteric vein/splenic vein confluence and would have warranted a Whipple procedure.

Conclusion: We describe a pancreatotomy for exposure and control of the bleeding, with re-suturing of the cut pancreas and completion of the pancreaticojejunostomy.
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September 2007