Publications by authors named "Pratishtha Singh"

13 Publications

  • Page 1 of 1

Laxative Abuse Cessation Leading to Severe Edema.

Cureus 2021 Jun 23;13(6):e15847. Epub 2021 Jun 23.

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

Stimulant laxatives are a common class of laxatives that is abused by patients with eating disorders. We present a case of a 30-year-old female who presented with dyspnea, peripheral edema and weight gain who had been chronically using laxatives. Her symptoms were consistent with rebound edema caused by sodium and free water shifts with abrupt cessation of excessive stimulant laxative use. This case highlights the use of furosemide as the mainstay treatment for rebound edema and weight gain.
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http://dx.doi.org/10.7759/cureus.15847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299158PMC
June 2021

Underrecognized Zieve's syndrome, A case report.

Ann Med Surg (Lond) 2021 Jun 6;66:102464. Epub 2021 Jun 6.

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

Zieve's syndrome (ZS) is a triad of hemolytic anemia, cholestatic jaundice and hyperlipidemia that presents in the setting of alcohol abuse and liver disease. ZS is not well known and remains underdiagnosed. We present a case of ZS in a 38-year-old female with a history of chronic alcohol abuse and pancreatitis to raise awareness of ZS. It is important for ZS to be recognized promptly to avoid unnecessary and possibly harmful interventions.
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http://dx.doi.org/10.1016/j.amsu.2021.102464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203730PMC
June 2021

A Retrospective Review of Upper Gastrointestinal Bleed Outcomes During Hospital Admission While on Oral Anticoagulation.

Cureus 2021 May 16;13(5):e15061. Epub 2021 May 16.

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

Introduction Direct-acting oral anticoagulants (DOACs) are approved for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism. Most recent guidelines recommend DOACs over warfarin for most diagnoses given their predictable pharmacodynamics, lack of required monitoring, and safety profile. Specific outcomes such as shock, acute renal failure, and blood transfusion requirement while on oral anticoagulation compared to no anticoagulation remain unknown in patients with upper gastrointestinal (GI) bleeds.  Methods This retrospective study used the HCA Healthcare Enterprise Data Warehouse (EDW) to analyze 13,440 patients aged >18 years that were admitted with an upper GI bleed from January 2017 to December 2019. The patients were categorized based on oral anticoagulant (i.e. rivaroxaban, apixaban, dabigatran and warfarin). The control group was patients admitted with an upper GI bleed not on oral anticoagulation. We evaluated the severity of upper GI bleeds while on oral anticoagulation based on the outcomes: mortality rate, length of stay, acute renal failure, shock, and need for packed red blood cell transfusions (pRBC). Comorbid conditions assessed were coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), peripheral vascular disease (PVD), tobacco abuse, alcohol abuse, and chronic kidney disease (CKD). Home use of proton pump inhibitors (PPI), aspirin, and P2Y12 inhibitors were also evaluated.  Results Patients on a DOAC without home PPI have a mortality odds ratio of 3.066 with a confidence interval (CI) greater than 95% (1.48-6.26, p<0.05) compared to patients on a DOAC and home PPI. Patients on warfarin and no home PPI have a mortality odds ratio of 5.55 (95% CI (1.02-30.35), p<0.05) compared to those on warfarin with home PPI use. In the no anticoagulation group, those not on PPI have an odds ratio of 3.28 (95% CI (2.54-4.24), p<0.05) of death compared to home PPI use. There was no statistical difference in mortality between each DOAC and warfarin.  There was no difference in the presence of acute renal failure or shock when comparing each DOAC, warfarin, and no medication. For patients presenting with GI bleed, 0.8414 units of pRBC were transfused. Patients not on oral anticoagulation were found to have statistically significant decrease in pRBC transfusion if they did not report alcohol use, CKD, HF, AF, VTE, PVD. Patients on DOACs and alcohol use have an average pRBC transfusion count that is 0.922 units more than those without reported alcohol use (p=0.006). In the warfarin group, there was no statistical significance noted when comparing pRBC transfusions and also when comparing to baseline comorbidities. Conclusion The retrospective study leads us to conclude that overall, patients taking the DOACs or warfarin had no statistically significant increase in RBC transfusions, length of stay, shock, acute renal failure, or mortality rate compared to patients who were not on oral anticoagulation. Home PPI use was shown to lower odds of mortality in patients on anticoagulation who presented with upper GI bleeding. PPI use had no effect on the need for transfusion or length of stay in patients on anticoagulation. These results can help predict which patients are likely to have higher mortality based on the use of home PPIs.
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http://dx.doi.org/10.7759/cureus.15061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208175PMC
May 2021

Hepatic Artery Pseudoaneurysm Presenting as Gastrointestinal Hemorrhage.

Cureus 2021 Mar 30;13(3):e14190. Epub 2021 Mar 30.

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

A hepatic artery pseudoaneurysm (HAP) is a rare complication of laparoscopic cholecystectomy. It can vary in its clinical presentation; however, given its severe nature, prompt assessment and management are crucial. We report a case of a 73-year-old male who underwent a laparoscopic cholecystectomy complicated by a right hepatic artery injury. This subsequently presented as a life-threatening case of upper gastrointestinal bleeding from HAP, with presumable hemobilia and septic shock from multiple liver abscesses. The diagnosis was made with computed tomography angiography (CTA) of the abdomen and pelvis followed by visceral angiography. The patient ultimately underwent a right hepatectomy for definitive treatment. The primary objective of this case is to highlight a less novel, though rare, case presentation and define a spectrum of treatment options available based on severity.
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http://dx.doi.org/10.7759/cureus.14190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083905PMC
March 2021

Intestinal Dysbiosis Disguised as a Rectal Fistula Treated With Autologous Fecal Microbiota Transplantation.

Cureus 2021 Mar 25;13(3):e14115. Epub 2021 Mar 25.

Gastroenterology, Grand Strand Medical Center, Myrtle Beach, USA.

Fecal microbiota transplantation (FMT) has been efficacious in the treatment of intestinal dysbiosis, derangement of the native intestinal microflora, and the indications for autologous FMT are growing. A 69-year-old Caucasian man with a past medical history of paraplegia secondary to motor vehicle accident and sigmoid-end colostomy presented to his gastroenterologist with the complaint of rectal discharge. A complicated medical course pre-dated his presentation and included multiple decubitus ulcers requiring debridement and several courses of broad-spectrum antibiotics. The rectal discharge was initially presumed to be from a fistula leading to one of his ulcers; however, workup with anoscopy, flexible sigmoidoscopy, and magnetic resonance imaging of the pelvis showed no visible perirectal abscess or connection to the sigmoid colon through a fistula. Intestinal dysbiosis was an alternative theory considered to be the cause of his copious rectal discharge due to his several courses of broad-spectrum antibiotics and prolonged inactivity of his gut. This prompted a trial treatment plan utilizing autologous FMT, with the patient administering enemas containing his own stool to the distal limb of his bowel. As a result of this treatment, the patient's chief complaint completely resolved within days of initiating treatment, although symptoms did eventually return. We would like to propose that further randomized studies should be done to investigate autologous FMT as a treatment for patients suffering from intestinal dysbiosis following sigmoid-end colostomy.
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http://dx.doi.org/10.7759/cureus.14115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075766PMC
March 2021

Gastric Antral Diverticula: A Rare Diverticula with a Unique Presentation.

Case Rep Gastrointest Med 2021 26;2021:6623183. Epub 2021 Mar 26.

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

Gastric diverticula are the least common gastrointestinal diverticula. Patients can be diagnosed incidentally on EGD or present with variable symptoms such as abdominal fullness, anorexia, and perforation. Gastric diverticula can be acquired from malignancy, peptic ulcer disease, or prior surgery or be congenital. Treatment varies based on symptomatology ranging from conservative medical management with proton pump inhibitors to surgical treatment with open or laparoscopic resection. We present a case of a 73-year-old female with acquired gastric diverticulum presenting as a gastric outlet obstruction who was successfully treated with conservative medical therapy.
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http://dx.doi.org/10.1155/2021/6623183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019394PMC
March 2021

A Retrospective Review of Outcomes in Intensive Care Unit Patients Infected With SARS-Cov2 in Correlation to Admission Acute Physiologic Assessment and Chronic Health Evaluation II Scores.

Cureus 2021 Mar 23;13(3):e14051. Epub 2021 Mar 23.

Pulmonary and Critical Care Medicine, Grand Strand Medical Center, Myrtle Beach, USA.

Introduction Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic that has placed an unprecedented burden on intensive care services worldwide. Identification of a reliable risk-stratification tool for COVID-19 patients is necessary for appropriate resource allocation, selection of clinical management pathways, and guidance of goals of care conversations with families and caregivers in the critical care setting. The Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scoring system is one of several predictive models used to classify illness severity and estimate mortality risk on admission to the intensive care unit (ICU). Our retrospective study sought to evaluate the prognostic ability of the APACHE II score in COVID-19 patients according to endpoints of mortality and length of stay (LOS) as well as unfavorable clinical outcomes, including development of acute renal failure (ARF) requiring renal replacement therapy (RRT) and acute venous thromboembolic events (VTE). Methods This multicenter retrospective cohort study evaluated a randomized sample of 3,102 patients with confirmed COVID-19 disease admitted to the ICU from January 2020 to May 2020. A total of 395 patients with complete data points for appropriate APACHE II score calculation, absence of the preexisting comorbidities end-stage renal disease, and history of VTE were included. Linear and logistic regression models were employed to evaluate primary outcomes of mortality and LOS as well as secondary outcomes of VTE and ARF requiring continuous renal replacement therapy (CRRT) or hemodialysis (HD). Key results Among the 395 patients enrolled, total percent mortality and mean LOS were 37.0% and 12.92 days, respectively. Primary outcome analysis revealed a statistically significant increase in odds of mortality as well as in mean LOS with every additional point increase in APACHE II score from a baseline of zero. Specifically, for every point increase in the APACHE II score, odds of mortality increased by 12% (p value < 0.001), and average LOS increased by 0.2 days (p value < 0.001). In our secondary outcome analysis, 14.43% and 62.2% of the total sample population developed ARF requiring RRT and VTE, respectively. For every additional point increase in APACHE II score from a baseline of zero, odds of requiring CRRT or HD increased by 10% on average (95% CI (1.06, 1.15); p value < 0.001). Similarly, for every additional point increase in the APACHE II score from a baseline of zero, there was a corresponding increase in odds of VTE by 19% (95% CI (1.14, 1.24); p value < 0.001). Conclusions The APACHE II score is an effective predictive model of in-hospital mortality and unfavorable clinical outcomes, including prolonged LOS, ARF requiring CRRT or HD, and development of VTE. As therapeutic interventions for COVID-19 evolve, application of this risk-stratification tool may guide clinical management decisions in the critical care setting.
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http://dx.doi.org/10.7759/cureus.14051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985663PMC
March 2021

Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome.

Case Reports Hepatol 2020 16;2020:8836329. Epub 2020 Sep 16.

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

Subcapsular liver hematoma (SLH) is a rare complication of HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. We report a previously healthy 16-year-old female presenting with pre-eclampsia requiring emergent C-section, who developed immediate postoperative bleeding and abdominal distention. Abdominal computed tomography angiography (CTA) revealed a large encapsulated liver hematoma with active extravasation. The patient was successfully treated with a multidisciplinary approach with medical and surgical management.
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http://dx.doi.org/10.1155/2020/8836329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516696PMC
September 2020

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

Naringenin ameliorates diabetic neuropathic pain by modulation of oxidative-nitrosative stress, cytokines and MMP-9 levels.

Food Funct 2020 May 13;11(5):4548-4560. Epub 2020 May 13.

University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh-160014, India.

Diabetes mellitus is a serious debilitating epidemic affecting all social strata, imposing huge health, social and economic burdens. Diabetic neuropathic pain, an important microvascular complication of diabetes mellitus, characterized by allodynia and hyperalgesia, is recognized as one of the most difficult types of pain to treat. The development of tolerance, inadequate relief and potential toxicity of classical antinociceptives warrant the investigation of newer agents to relieve this pain. Reactive oxygen/nitrogen species, cytokines and matrix metalloproteinases (MMPs) are implicated in the pathogenesis of diabetic neuropathy. The present study was designed to explore the effect of naringenin, a citrus flavonoid, on streptozotocin induced diabetic neuropathic pain in Wistar rats. After 8 weeks of diabetes induction, rats developed neuropathy which was evident from marked hyperalgesia and allodynia associated with enhanced oxidative-nitrosative stress, release of inflammatory mediators (TNF-α, TGF-1β), MMP-9 activation and decreased motor nerve conduction velocity. Treatment with naringenin (25, 50, 100 mg kg) for 4 weeks starting from the 5th week of streptozotocin injection significantly attenuated behavioral, biochemical and molecular changes, along with alterations in motor nerve conduction velocity in a dose-dependent manner. Moreover, diabetic rats treated with insulin-naringenin combination produced a more pronounced effect as compared to individual drugs. The major finding of the study is that insulin alone corrected the hyperglycemia and partially reversed the pain response in diabetic rats. However, combination with naringenin not only attenuated the diabetic condition but also reversed neuropathic pain through modulation of oxidative-nitrosative stress, inflammatory cytokine release and MMP inhibition in the diabetic rats. Modulation of MMP-9 by a natural flavonoid like naringenin seems to be a novel approach to target diabetic neuropathic pain.
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http://dx.doi.org/10.1039/c9fo00881kDOI Listing
May 2020

Molecular Interaction between Distal C-Terminal Domain of the CB Cannabinoid Receptor and Cannabinoid Receptor Interacting Proteins (CRIP1a/CRIP1b).

J Chem Inf Model 2019 12 10;59(12):5294-5303. Epub 2019 Dec 10.

School of Life Sciences , Jawaharlal Nehru University , New Delhi - 110067 , India.

We have investigated the structure of the distal C-terminal domain of the of the CB cannabinoid receptor (CB1R) to study its interactions with CRIP1a and CRIP1b using computational techniques. The amino acid sequence from the distal C-terminal domain of CB1R (G-L) was found to be unique, as it does not share sequence similarity with other protein structures, so the structure was predicted using modeling. The computed model of the distal C-terminal region of CB1R has a helical region between positions 441 and 455. The CRIP1a and CRIP1b were modeled using Rho-GDI 2 as a template. The three-dimensional model of the distal C-terminal domain of the CB1R was docked with both CRIP1a as well as CRIP1b to study the crucial interactions between CB1R and CRIP1a/b. The last nine residues of CB1R (STDTSAEAL) are known to be a CRIP1a/b binding site. The majority of the key interactions were identified in this region, but notable interactions were also observed beyond theses nine residues. The multiple interactions between Thr418 (CB1R) and Asn61 (CRIP1a) as well as Asp430 (CB1R) and Lys76 (CRIP1a) indicate their importance in the CB1R-CRIP1a interaction. In the case of CRIP1b, multiple hydrogen bond interactions between Asn437 (CB1R) and Glu77 (CRIP1b) were observed. These interactions can be critical for CB1R's interaction with CRIP1a/b, and targeting them for further experimental studies can advance information about CRIP1a/b functionality.
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http://dx.doi.org/10.1021/acs.jcim.9b00948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271255PMC
December 2019

In silico interaction analysis of cannabinoid receptor interacting protein 1b (CRIP1b) - CB1 cannabinoid receptor.

J Mol Graph Model 2017 10 6;77:311-321. Epub 2017 Sep 6.

School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India. Electronic address:

Cannabinoid Receptor Interacting Protein isoform 1b (CRIP1b) is known to interact with the CB receptor. Alternative splicing of the CNRIP1 gene produces CRIP1a and CRIP1b with a difference in the third exon only. Exons 1 and 2 encode for a functional domain in both proteins. CRIP1a is involved in regulating CB receptor internalization, but the function of CRIP1b is not very well characterized. Since there are significant identities in functional domains of these proteins, CRIP1b is a potential target for drug discovery. We report here predicted structure of CRIP1b followed by its interaction analysis with CB receptor by in-silico methods A number of complementary computational techniques, including, homology modeling, ab-initio and protein threading, were applied to generate three-dimensional molecular models for CRIP1b. The computed model of CRIP1b was refined, followed by docking with C terminus of CB receptor to generate a model for the CRIP1b- CB receptor interaction. The structure of CRIP1b obtained by homology modelling using RHO_GDI-2 as template is a sandwich fold structure having beta sheets connected by loops, similar to predicted CRIP1a structure. The best scoring refined model of CRIP1b in complex with the CB receptor C terminus peptide showed favourable polar interactions. The overall binding pocket of CRIP1b was found to be overlapping to that of CRIP1a. The Arg82 and Cys126 of CRIP1b are involved in the majority of hydrogen bond interactions with the CB receptor and are possible key residues required for interactions between the CB receptor and CRIP1b.
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http://dx.doi.org/10.1016/j.jmgm.2017.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816684PMC
October 2017

Matrix metalloproteinases: potential therapeutic target for diabetic neuropathic pain.

Expert Opin Ther Targets 2015 Feb 22;19(2):177-85. Epub 2014 Sep 22.

Panjab University, University Institute of Pharmaceutical Sciences, Pharmacology Research Laboratory, UGC Centre of Advanced Study , Chandigarh - 160 014 , India +91 9915173064 ; +91 172 2534101 ;

Introduction: MMPs are zinc-dependent endopeptidases that play a key role in the remodeling of extracellular matrix (ECM). Various pathogenic mediators trigger abnormal MMP activity that leads to ECM abnormality. Hyperglycemia is one of the strong stimuli among oxidative stress and inflammation that upregulate MMP expression in the central and peripheral nervous system. MMP-mediated ECM abnormality hypersensitizes peripheral as well as central nerves that precipitate neuropathic pain in diabetic patients.

Areas Covered: Molecular mechanisms associated with MMP-mediated diabetic neuropathic pain have been discussed. Various endogenous, natural and synthetic MMP inhibitors are also explored.

Expert Opinion: In diabetes, hyperglycemia activates MMPs that along with the other pathogenic mediators cause neuronal injury and precipitates neuropathic pain. Thus, MMPs play a crucial role in the development of neuropathic pain among diabetics. However, MMPs are not only responsible for deleterious ECM abnormalities but are also required for beneficial remodeling of ECM under normal physiological conditions. Therefore, highly selective and specific inhibitors must be designed and explored for their clinical potential for treatment/prevention of diabetic neuropathic pain.
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http://dx.doi.org/10.1517/14728222.2014.960844DOI Listing
February 2015
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