Publications by authors named "Nabeel Wahid"

15 Publications

  • Page 1 of 1

Identification of Quantifiable Predictors of Relapse in Patients with Alcohol-Associated Liver Disease.

Hepatol Commun 2021 Jul 13;5(7):1156-1164. Epub 2021 Mar 13.

Division of Gastroenterology and Hepatology Weill Cornell Medicine New York NY USA.

Abstinence in patients with alcohol-associated liver disease (ALD) reduces mortality. Most predictors of relapse are not quantifiable, preventing objective analysis of relapse risk and targeted intervention to improve clinical outcomes. We prospectively enrolled patients with ALD from November 2016 to December 2019 and administered a survey with two previously published scales to assess insight into alcohol-use disorder (Hanil Alcohol Insight Scale [HAIS]) and social support (Community Assessment Inventory Scale [CAIS]). Relapse was assessed using surveys and metabolite testing. Unadjusted and prespecified adjusted regression analyses identified predictors of relapse. We enrolled 81% of eligible patients (n = 136), of whom 58 had follow-up data available at the time of analysis. Over a median follow-up of 1 year (interquartile range: 0.5-1.4), 10 patients relapsed (17%). Patients who relapsed were more likely to continue drinking despite either a diagnosis of liver disease or a decompensating event, and were less likely to have been transplanted (all < 0.05). In unadjusted regression, the HAIS and the "support inside the home" subcategory of the CAIS were predictive of relapse, with odds ratio (OR) = 0.84 (95% confidence interval 0.72-0.97) and 0.85 (0.74-0.97). In adjusted regression, the HAIS was no longer significant, with adjusted OR = 0.70 (0.49-1.00, = 0.05), whereas the "support inside the home' subcategory of CAIS remained significant, with adjusted OR = 0.69 (0.51-0.92, = 0.01). : Risk factors for relapse in patients with ALD were identified and quantified prospectively, suggesting opportunities to objectively identify patients at risk for relapse as well as to intervene to prevent relapse.
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http://dx.doi.org/10.1002/hep4.1704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279469PMC
July 2021

Risks and Preventive Strategies for Clostridioides difficile Transmission to Household or Community Contacts during Transition in Healthcare Settings.

Emerg Infect Dis 2021 07;27(7):1776-1782

The burden of Clostridioides difficile infection (CDI) has greatly increased. We evaluated the risks for CDI transmission to community members after hospitalized patients are discharged. We conducted a systematic literature review in MEDLINE/PubMed, EMBASE, CINAHL plus EBSCO, Web of Science, Cochrane Library, and gray literature during January 2000‒February 2019 and identified 4,798 citations were identified. We eliminated 4,554 citations through title and abstract screening; 217 additional citations did not meet full criteria. We reviewed texts for the 27 remaining articles qualitatively for internal/external validity. A few identified studies describing risks to community members lacked accurate risk measurement or preventative strategies. Primary data are needed to assess efficacy of and inform current expertise-driven CDI prevention practices. Raising awareness among providers and researchers, conducting clinical and health services research, linking up integrated monitoring and evaluation processes at hospitals and outpatient settings, and developing and integrating CDI surveillance systems are warranted.
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http://dx.doi.org/10.3201/eid2707.200209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237889PMC
July 2021

Medicaid Expansion Association With End-Stage Liver Disease Mortality Depends on Leniency of Medicaid Hepatitis C Virus Coverage.

Liver Transpl 2021 Jun 12. Epub 2021 Jun 12.

Department of Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY.

The Affordable Care Act expanded Medicaid around the same time that direct-acting antivirals became widely available for the treatment of hepatitis C virus (HCV). However, there is significant variation in Medicaid HCV treatment eligibility criteria between states. We explored the combined effects of Medicaid expansion and leniency of HCV coverage under Medicaid on liver outcomes. We assessed state-level end-stage liver disease (ESLD) mortality rates, listings for liver transplantation (LT), and listing-to-death ratios (LDRs) for adults aged 25 to 64 years using data from United Network for Organ Sharing and Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. States were divided into 4 nonoverlapping groups based on expansion status on January 1, 2014 (expansion versus nonexpansion) and leniency of Medicaid HCV coverage (lenient versus restrictive coverage). Joinpoint regression analysis evaluated the significant changes in slope over time (joinpoints) during the pre-expansion (2009-2013) and postexpansion (2014-2018) time periods. We found significant changes in the annual percent change for population-adjusted ESLD deaths between 2014 and 2015 in all cohorts except for the nonexpansion/restrictive cohort, in which deaths increased at the same annual percent change from 2009 to 2018 (annual percent change of +2.5%; 95% confidence interval [CI], 1.8-3.3]). In the expansion/lenient coverage cohort, deaths increased at an annual percent change of +2.6% (95% CI, 1.8-3.5) until 2014 and then tended to decrease at an annual percent change of -0.4% (95% CI, -1.5 to 0.8). LT listings tended to decrease over time for all cohorts. For LDRs, only the expansion/lenient and expansion/restrictive cohorts had statistically significant joinpoints. Improvements in ESLD mortality and LDRs were associated with both Medicaid expansion and leniency of HCV coverage under Medicaid. These findings suggest the importance of implementing more lenient and widespread public health insurance to improve liver disease outcomes, including mortality.
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http://dx.doi.org/10.1002/lt.26209DOI Listing
June 2021

Intestinal Abnormalities in Patients With SARS-CoV-2 Infection: Histopathologic Changes Reflect Mechanisms of Disease.

Am J Surg Pathol 2021 Jun 3. Epub 2021 Jun 3.

Department of Pathology and Laboratory Medicine Division of Gastroenterology and Hepatology, Weill Cornell Medicine Department of Medicine, New York-Presbyterian Hospital, New York, NY.

Approximately 20% of patients with symptomatic syndrome-associated coronavirus-2 (SARS-CoV-2) infection have gastrointestinal bleeding and/or diarrhea. Most are managed without endoscopic evaluation because the risk of practitioner infection outweighs the value of biopsy analysis unless symptoms are life-threatening. As a result, much of what is known about the gastrointestinal manifestations of coronavirus disease-2019 (COVID-19) has been gleaned from surgical and autopsy cases that suffer from extensive ischemic injury and/or poor preservation. There are no detailed reports describing any other gastrointestinal effects of SARS-CoV-2 even though >3,000,000 people have died from COVID-19 worldwide. The purpose of this study is to report the intestinal findings related to SARS-CoV-2 infection by way of a small case series including one with evidence of direct viral cytopathic effect and 2 with secondary injury attributed to viral infection. Infection can be confirmed by immunohistochemical stains directed against SARS-CoV-2 spike protein, in situ hybridization for spike protein-encoding RNA, and ultrastructural visualization of viruses within the epithelium. It induces cytoplasmic blebs and tufted epithelial cells without inflammation and may not cause symptoms. In contrast, SARS-CoV-2 infection can cause gastrointestinal symptoms after the virus is no longer detected, reflecting systemic activation of cytokine and complement cascades rather than direct viral injury. Reversible mucosal ischemia features microvascular injury with hemorrhage, small vessel thrombosis, and platelet-rich thrombi. Systemic cytokine elaboration and dysbiosis likely explain epithelial cell injury that accompanies diarrheal symptoms. These observations are consistent with clinical and in vitro data and contribute to our understanding of the protean manifestations of COVID-19.
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http://dx.doi.org/10.1097/PAS.0000000000001755DOI Listing
June 2021

Disparities in Telehealth for Liver Disease: Revealing What Was Hidden in Plain Sight.

Dig Dis Sci 2021 May 4. Epub 2021 May 4.

Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th floor, New York, NY, 10021, USA.

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http://dx.doi.org/10.1007/s10620-021-06996-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096140PMC
May 2021

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States.

Hepatology 2021 Mar 29. Epub 2021 Mar 29.

Weill Cornell Medicin, New York, USA.

The Model for End-Stage Liver Disease score may have eliminated racial disparities on the waitlist for liver transplantation (LT), but disparities prior to waitlist placement have not been adequately quantified. We aimed to analyze differences in patients who are listed for LT, undergo transplantation, and die from end-stage liver disease (ESLD), stratified by state and race/ethnicity. We analyzed two databases retrospectively - the Center for Disease Control Wide-ranging OnLine Data for Epidemiologic Research (CDC WONDER) and the United Network for Organ Sharing (UNOS) databases from 2014-2018. We included patients aged 25-64 years who had a primary cause of death of ESLD and listed for transplant in the CDC WONDER and UNOS databases, respectively. Our primary outcome was the ratio of listing for LT to death from ESLD - listing to death ratio (LDR). Our secondary outcome was the transplant to listing and transplant to death ratios. Chi-squared and multivariable linear regression evaluated for differences between race/ethnicity. 135,367 patients died of ESLD, 54,734 patients were listed for transplant, and 26,571 underwent transplant. Patients were mostly male and White. The national LDR was 0.40, significantly lowest in Black patients (0.30), p<0.001. The national transplant to listing ratio was 0.48, highest in Black patients (0.53), p<0.01. The national transplant to death ratio was 0.20, lowest in Black patients (0.16), p<0.001. States that had an above-mean LDR had a lower transplant to listing ratio, but higher transplant to death ratio. Multivariable analysis confirmed Black race is significantly associated with a lower LDR and transplant to death ratio. Conclusion: Black patients face a disparity in access to LT due to low listing rates for transplant relative to deaths from ESLD.
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http://dx.doi.org/10.1002/hep.31837DOI Listing
March 2021

A Review of the Current State of Liver Transplantation Disparities.

Liver Transpl 2021 02;27(3):434-443

Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY.

Equity in access is one of the core goals of the Organ Procurement and Transplant Network (OPTN). However, disparities in liver transplantation have been described since the passage of the National Organ Transplant Act, which established OPTN in the 1980s. During the past few decades, several efforts have been made by the United Network for Organ Sharing (UNOS) to address disparities in liver transplantation with notable improvements in many areas. Nonetheless, disparities have persisted across insurance type, sex, race/ethnicity, geographic area, and age. African Americans have lower rates of referral to transplant centers, females have lower rates of transplantation from the liver waiting list than males, and public insurance is associated with worse posttransplant outcomes than private insurance. In addition, pediatric candidates and older adults have a disadvantage on the liver transplant waiting list, and there are widespread regional disparities in transplantation. Given the large degree of inequity in liver transplantation, there is a tremendous need for studies to propose and model policy changes that may make the liver transplant system more just and equitable.
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http://dx.doi.org/10.1002/lt.25964DOI Listing
February 2021

Using Digital Tablets to Humanize Patient Care During the COVID-19 Pandemic.

Acad Med 2021 Feb;96(2):e9-e10

Associate professor of medicine, Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Center for Global Health, Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York., First published online December 10, 2020.

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http://dx.doi.org/10.1097/ACM.0000000000003792DOI Listing
February 2021

Evaluation of Alcohol Taxes as a Public Health Opportunity to Reduce Liver Transplant Listings for Alcohol-Related Liver Disease.

Alcohol Clin Exp Res 2020 11 16;44(11):2307-2315. Epub 2020 Oct 16.

Department of Healthcare Policy & Research, (BRS), Weill Cornell Medicine, New York, New York.

Background: Alcohol-related liver disease (ALD) is a leading indication for liver transplantation.

Methods: State consumption of spirits, wine, and beer was determined from published sources. Excise and ad valorem alcohol taxes of spirits, wine, and beer were calculated following standard practices and correlated using multiple logistic regression models to 2002 to 2015 ALD transplant listing data from the United Network for Organ Sharing database.

Results: 21.22% (29,161/137,440) of transplant listings were for ALD. Increased consumption of spirits was associated with increased ALD transplant listings (odds ratio [OR]: 1.67; 95% CI: 1.12 to 2.49, p = 0.01), but wine and beer consumption did not have a statistically significant association with ALD transplant listings. Spirits excise taxes on- and off-premise were inversely associated with ALD transplant listing (OR: 0.79 and 0.82, respectively, both p < 0.02). Beer and wine taxes were not significantly associated with ALD transplant listings.

Conclusions: Transplant listings for ALD are directly associated with spirit consumption and inversely associated with spirits excise taxes. These findings suggest a possible public health benefit of increasing excise taxes for spirits.
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http://dx.doi.org/10.1111/acer.14454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061744PMC
November 2020

Never judge a book by its cover: how NICU evaluators reach conclusions about quality of care.

J Perinatol 2018 06 28;38(6):751-758. Epub 2018 Mar 28.

Department of Pediatrics, Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Stanford University School of Medicine, Stanford, CA, USA.

Objective: To identify key features in the NICU care delivery context that influence quality of care delivery.

Study Design: Qualitative study using in-depth, semi-structured interviews with 10 NICU quality experts with extensive experience conducting NICU site visits and evaluating quality of care. Analyses were performed using the method of constant comparison based on grounded theory.

Results: Qualitative analysis yielded three major themes: (1) the foundation for high quality care is a cohesive unit culture, characterized by open communication, teamwork, and engagement of families; (2) effective linkages between measurement and improvement action is necessary for continuous improvement; and (3) NICU capacity for improvement is sustained by active support, exchange of skills, and resources from the hospital.

Conclusions: Team cohesion, engagement of families, culture of improvement supported by measurement and institutional support from the hospital are some of the key contextual and managerial features critical to high-quality NICU care.
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http://dx.doi.org/10.1038/s41372-018-0092-0DOI Listing
June 2018

Clinical response of clozapine as a treatment for delirious mania.

Ment Illn 2017 Oct 23;9(2):7182. Epub 2017 Oct 23.

Department of Psychiatry, University of California, Irvine, Orange, CA, USA.

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http://dx.doi.org/10.4081/mi.2017.7182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661144PMC
October 2017

Psychostimulant Use in Schizophrenia for Treatment of Negative Symptoms and Weight Loss.

Prim Care Companion CNS Disord 2017 Jul 27;19(4). Epub 2017 Jul 27.

Department of Psychiatry, University of California, Irvine, California, USA.

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http://dx.doi.org/10.4088/PCC.17l02093DOI Listing
July 2017