Publications by authors named "Kunjan Udani"

5 Publications

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Acute Plasma Cell Leukemia Presenting as Primary Hyperammonemic Encephalopathy.

J Med Cases 2020 Oct 28;11(10):320-323. Epub 2020 Aug 28.

Department of Hematology/Oncology, Henry Ford Health System, Detroit, MI, USA.

Primary plasma cell leukemia (PPCL) is a rare form of multiple myeloma (MM) and is a rare aggressive disease with a median overall survival of 6 - 11 months. We present a case of acute hyperammonemic encephalopathy as the initial presentation of PPCL in a 78-year-old woman to highlight an atypical presentation of this disorder.
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http://dx.doi.org/10.14740/jmc3559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383598PMC
October 2020

Cardiovascular manifestations in hospitalized patients with hemochromatosis in the United States.

Int J Cardiol 2021 Nov 31;342:117-124. Epub 2021 Jul 31.

Division of Cardiology and Center for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

Background: Heart complications are the main cause of morbidity and mortality in hemochromatosis, but the liver is the main site for iron deposition in these patients. Large multicenter studies have described cardiovascular (CV) manifestations in patients with secondary hemochromatosis. However, the overall prevalence and risk of CV manifestations in patients with hemochromatosis at the population level are unknown.

Objective: To examine the prevalence and risk of CV manifestations in patients with hemochromatosis.

Methods: A retrospective cohort from the National Inpatient Sample database between 2012 and 2014 was studied. We identified hemochromatosis using ICD-9-CM diagnostic codes. CV manifestations were defined by the presence of conduction disorders, arrhythmias, congestive heart failure (CHF), pulmonary hypertension, and non-ischemic cardiomyopathy (NISCM).

Results: Of the 63,846,188 weighted hospitalizations that met the inclusion criteria, 64,590 (0.1%) had hemochromatosis and 13,200,000 (20.7%) had one or more CV manifestations. Of those with hemochromatosis, 5.3% had primary and 94.7% had secondary hemochromatosis. 27.8% of all hemochromatosis patients had one or more CV manifestations, 16% cardiac arrhythmias, 10.6% supraventricular arrhythmias (SVA), 0.8% ventricular arrhythmias, 9.3% CHF, 7.4% pulmonary hypertension, 4.2% NISCM, 2% conduction disorders, and 0.4% cardiac arrest. SVA (14.6% vs 10.4%, P < 0.001) was more prevalent in primary hemochromatosis compared to secondary while pulmonary hypertension (7.7% vs 2.6%, P < 0.001) was more prevalent in secondary hemochromatosis compared to primary. In multivariate modelling, only the adjusted odds of composite CV manifestations (odds ratio [OR] 1.24, 95% confidence interval [CI]: 1.03-1.48, P < 0.05) and SVA (OR 1.59, 95% CI: 1.28-1.96, P < 0.001) were significantly higher in patients with primary hemochromatosis compared with patients without hemochromatosis. In patients with secondary hemochromatosis, the adjusted odds of composite CV manifestations (OR 1.84, 95% CI: 1.74-1.95, P < 0.001), CHF (OR 1.46, 95% CI: 1.35-1.57, P < 0.001), conduction disorder (OR 1.52, 95% CI: 1.33-1.73, P < 0.001), pulmonary hypertension (OR 4.43, 95% CI: 3.97-4.94, P < 0.001), SVA (OR 1.39, 95% CI: 1.29-1.48, P < 0.001), and NISCM (OR 1.98, 95% CI: 1.79-2.20, P < 0.001) were significantly higher compared with patients without hemochromatosis.

Conclusion: Supraventricular arrhythmias, congestive heart failure, and pulmonary hypertension were the most common CV disorders in hemochromatosis patients. Risk-adjusted burden of supraventricular arrhythmias was significantly higher in primary and secondary hemochromatosis while patients with secondary hemochromatosis had a higher risk of congestive heart failure, pulmonary hypertension, conduction disorders, and non-ischemic cardiomyopathy.
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http://dx.doi.org/10.1016/j.ijcard.2021.07.060DOI Listing
November 2021

All-Cause Mortality and Incidence of Major Adverse Cardiac Events in Sickle Cell Nephropathy: A Comparative Study.

Cureus 2021 May 16;13(5):e15059. Epub 2021 May 16.

Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA.

Background Sickle cell disease (SCD) is an autosomal recessive disease resulting in hemolytic anemia and recurrent vaso-occlusive events. Consequently, it can result in a broad range of functional and structural renal and cardiac alterations. Chronic kidney disease (CKD), in SCD, is associated with proteinuria, microalbuminuria, and hemoglobinuria. Cardiac complications in SCD include pulmonary hypertension, left ventricular diastolic heart disease, dysrhythmia, and sudden death. In patients with advancing age, cardio-renal dysfunction can have substantial effects on morbidity and mortality. Our primary aim was to compare the incidence of major adverse cardiac events (MACE) and all-cause mortality in sickle cell nephropathy (SCN). Methods In this retrospective study, we used International Classification of Diseases (ICD)-10 codes to identify admissions in 2019 with a diagnosis of MACE with a prior diagnosis of SCD and/or SCN. Our search of the HCA Healthcare Enterprise Data Warehouse for adult patients >18 years yielded 6,693 patients with SCD, of which 658 patients (9.8%) had SCN. Primary endpoints were incidence of MACE and all-cause mortality. Patients with MACE encompassed those with nonfatal stroke, nonfatal myocardial infarction, and congestive heart failure (CHF) exacerbations. A secondary endpoint was length of stay (LOS). Logistic regression analysis was used for MACE and all-cause mortality. LOS was analyzed using multiple linear regression analysis. Results were considered statistically significant for analyses showing p <0.05. All outcomes were adjusted for demographic variables and comorbidities. Results Logistic regression, after adjustment for comorbidities, demonstrated that SCN patients had significantly higher odds of all-cause mortality (odds ratio [OR] 2.343, p = 0.035, 95% confidence interval [CI] 1.063-5.166) compared to patients without SCN. Compared to those without SCN, those with SCN did not have a higher odds of MACE (OR 1.281, p = 0.265, 95% CI 0.828-1.982). Linear regression for LOS did not reveal a significant association with SCN (p = 0.169, 95% CI 0.157-0.899). Conclusion Based on the analysis of 6,693 patients with SCD, SCN was associated with significantly higher odds of all-cause mortality. SCN was not associated with significantly higher odds of MACE or prolonged LOS.
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http://dx.doi.org/10.7759/cureus.15059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205106PMC
May 2021

Impact of hyperthyroidism on in-hospital outcomes of patients with heart failure.

J Community Hosp Intern Med Perspect 2021 Jan 26;11(1):158-162. Epub 2021 Jan 26.

Department of Internal Medicine, Grand Strand Medical Center, Myrtle Beach, SC, USA.

Congestive heart failure (CHF) exacerbations are a frequent cause of hospitalization. Thyroid hormones impact myocardial function; elevated levels of thyroxine, as seen in hyperthyroidism (HT), can worsen CHF symptoms. We retrospectively evaluated the Hospital Corporation of America (HCA) Enterprise Data Warehouse and examined mortality and length of stay (LOS) in patients hospitalized with CHF with and without a diagnosis of HT. 55,031 patients with CHF were identified. The presence of HT was not significantly associated with mortality (p = 0.24) nor LOS (p = 0.32). A significant difference in the distribution of sex (p = 0.001) and age (p = 0.002) was noted, with a higher percentage of females and a lower median age in patients with HT. There was a significant difference in LOS (p = 0.04) for patients with a cardiovascular comorbidity, who had a mean LOS of 6.33 days versus 5.31 days for patient without HT.
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http://dx.doi.org/10.1080/20009666.2020.1840739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850370PMC
January 2021

Atrioesophageal fistula with meningitis: A rare complication of atrial fibrillation ablation, case report and literature review.

Ann Med Surg (Lond) 2020 Sep 16;57:91-94. Epub 2020 Jul 16.

Department of Internal Medicine. Grand Strand Medical Center, Myrtle Beach, SC, USA.

Atrioesophageal fistula is a rare, devastating complication of atrial fibrillation ablation, reportedly occurring in 0.015-0.04% of catheter ablations. A 66-year-old African American male with a past medical history of chronic atrial fibrillation status post recent radiofrequency ablation and on chronic anticoagulation with rivaroxaban presented with left upper extremity numbness, tingling, and transient weakness. He was admitted for a cerebrovascular accident workup; a 12-lead electrocardiogram revealed atrial fibrillation and magnetic resonance imaging of the brain was consistent with multifocal embolic infarcts. Hospital course was further complicated by persistent high-grade fevers, gram-positive bacteremia, and worsening mental status requiring mechanical ventilation. Lumbar puncture was consistent with bacterial meningitis. Transthoracic echocardiogram was negative for vegetations. Computed tomography angiography of the chest with intravenous contrast revealed an outpouching off the posterior wall of the left atrium at the level of the inferior pulmonary vein, consistent with an atrioesophageal fistula. We present this case to highlight the clinical features of a rare but potentially fatal complication from a commonly performed procedure requiring prompt recognition and life-saving intervention.
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http://dx.doi.org/10.1016/j.amsu.2020.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381424PMC
September 2020
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