Publications by authors named "Tariq Siddiqui"

72 Publications

Excess Mortality in COVID-19-Positive Versus COVID-19-Negative Inpatients With Diabetes: A Nationwide Study.

Diabetes Care 2021 Jul 7. Epub 2021 Jul 7.

Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, MD.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2337/dc20-2350DOI Listing
July 2021

A Nation-wide Review of Elective Surgery and COVID-Surge Capacity.

J Surg Res 2021 Jun 19;267:211-216. Epub 2021 Jun 19.

Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland. Electronic address:

Background: The COVID-19 pandemic has resulted in over 225,000 excess deaths in the United States. A moratorium on elective surgery was placed early in the pandemic to reduce risk to patients and staff and preserve critical care resources. This report evaluates the impact of the elective surgical moratorium on case volumes and intensive care unit (ICU) bed utilization.

Methods: This retrospective review used a national convenience sample to correlate trends in the weekly rates of surgical cases at 170 Veterans Affairs Hospitals around the United States from January 1 to September 30, 2020 to national trends in the COVID-19 pandemic. We reviewed data on weekly number of procedures performed and ICU bed usage, stratified by level of urgency (elective, urgent, emergency), and whether an ICU bed was required within 24 hours of surgery. National data on the proportion of COVID-19 positive test results and mortality rates were obtained from the Center for Disease Control website.

Results: 198,911 unique surgical procedures performed during the study period. The total number of cases performed from January 1 to March 16 was 86,004 compared with 15,699 from March 17 to May 17. The reduction in volume occurred before an increase in the percentage of COVID-19 positive test results and deaths nationally. There was a 91% reduction from baseline in the number of elective surgeries performed allowing 78% of surgical ICU beds to be available for COVID-19 positive patients.

Conclusion: The moratorium on elective surgical cases was timely and effective in creating bed capacity for critically ill COVID-19 patients. Further analyses will allow targeted resource allocation for future pandemic planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jss.2021.05.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213966PMC
June 2021

Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study.

World J Surg 2021 Jun 11. Epub 2021 Jun 11.

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.

Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson's correlation test and logistic regression analysis were also performed.

Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39-33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076-5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion.

Conclusions: In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment.

Trial Registration: This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-021-06190-5DOI Listing
June 2021

Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening.

Am J Surg 2021 Apr 14. Epub 2021 Apr 14.

Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA. Electronic address:

Background: The COVID-19 pandemic has necessitated the adoption of protocols to minimize risk of periprocedural complications associated with SARS-CoV-2 infection. This typically involves a preoperative symptom screen and nasal swab RT-PCR test for viral RNA. Asymptomatic patients with a negative COVID-19 test are cleared for surgery. However, little is known about the rate of postoperative COVID-19 positivity among elective surgical patients, risk factors for this group and rate of complications.

Methods: This prospective multicenter study included all patients undergoing elective surgery at 170 Veterans Health Administration (VA) hospitals across the United States. Patients were divided into groups based on first positive COVID-19 test within 30 days after surgery (COVID[-/+]), before surgery (COVID[+/-]) or negative throughout (COVID[-/-]). The cumulative incidence, risk factors for and complications of COVID[-/+], were estimated using univariate analysis, exact matching, and multivariable regression.

Results: Between March 1 and December 1, 2020 90,093 patients underwent elective surgery. Of these, 60,853 met inclusion criteria, of which 310 (0.5%) were in the COVID[-/+] group. Adjusted multivariable logistic regression identified female sex, end stage renal disease, chronic obstructive pulmonary disease, congestive heart failure, cancer, cirrhosis, and undergoing neurosurgical procedures as risk factors for being in the COVID[-/+] group. After matching on current procedural terminology code and month of procedure, multivariable Poisson regression estimated the complication rate ratio for the COVID[-/+] group vs. COVID[-/-] to be 8.4 (C.I. 4.9-14.4) for pulmonary complications, 3.0 (2.2, 4.1) for major complications, and 2.6 (1.9, 3.4) for any complication.

Discussion: Despite preoperative COVID-19 screening, there remains a risk of COVID infection within 30 days after elective surgery. This risk is increased for patients with a high comorbidity burden and those undergoing neurosurgical procedures. Higher intensity preoperative screening and closer postoperative monitoring is warranted in such patients because they have a significantly elevated risk of postoperative complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjsurg.2021.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045424PMC
April 2021

Narrative review in the current role of angiotensin receptor-neprilysin inhibitors.

Ann Transl Med 2021 Mar;9(6):518

Division of Cardiovascular Diseases.

Heart failure (HF) accounts for a tremendous burden on health care systems and the society. Since the landmark PARADIGM-HF trial, sacubitril/valsartan, the first in the class of angiotensin receptor neprilysin inhibitor (ARNI) showed superiority to enalapril in patients with HF with reduced ejection fraction (HFrEF). We performed a narrative literature review, hand-searched the reference lists of included articles and relevant reviews. Inhibition of neprilysin increases bradykinin, natriuretic peptides and adrenomedullin levels counteract the neurohormal activation that leads to sodium retention, vasoconstriction, and cardiac remodeling. In PARADIGM-HF the primary outcome of CV death or HF hospitalization was reduced 20% in the ARNI group (HR 0.80, P<0.001) similar to mortality due to cardiovascular cause (HR 0.80, P<0.001) in patients with HFrEF, rendering a number needed to treat of 21 patients. This effect was consistent across subgroups. The safety of starting ARNI inpatient once the acute decompensation of HF is stabilized was demonstrated in PIONEER-HF trial. With willingness-to-pay thresholds commonly acceptable in the United States, sacubitril/valsartan is likely to be cost effective, which might not be in other health systems. Although its safety has been reassured in some clinical trials, common side effects are hypotension, worsening kidney function, hyperkalemia and angioedema. In HFpEF (PARAGON-HF), sacubitril/valsartan showed decrease in the level of the cardiac biomarkers, with improve functional NYHA and decrease in hospitalizations, predominately in women and patients with borderline ejection fraction. Some ongoing studies aim to demonstrate the effects of ARNI in acute coronary syndrome, stable ischemic heart disease, advanced HF, mitral regurgitation, aortic impedance and pulmonary hypertension. In conclusion, sacubitril/valsartan has proven to be an effective addition to the HFrEF arsenal, with safety comparable to current standard of care. In HFpEF, it improves quality of life, particularly in women and in patients with borderline ejection fraction, with no effect on mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-20-4038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039652PMC
March 2021

Updates in pharmacotherapy of heart failure with reduced ejection fraction.

Ann Transl Med 2021 Mar;9(6):516

Division of Cardiovascular Diseases, Department of Internal Medicine, Texas Tech University Health Science Center El Paso, El Paso, TX, USA.

Heart failure is a common entity encountered in healthcare with a vast socioeconomic impact. Recent advances in pharmacotherapy have led to the development of novel therapies with mortality benefits, improvement in heart failure symptoms and hospitalizations. This article is intended to explore those newer pharmacotherapies and summarize the evidence behind guideline directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). It has been several years since any significant advances in pharmacotherapy of heart failure have resulted in survival benefit. Angiotensin-neprilysin inhibitors through the PARADIGM-HF and PIONEER-HF trials have shown mortality benefits and a reduction in heart failure hospitalizations and are considered landmark trials in heart failure. Vericiguat is an oral guanylate cyclase stimulator that through the recent VICTORIA trial showed a 10% relative difference in death from cardiovascular cause or hospitalization for heart failure. The sodium-glucose transport protein 2 (SGLT2) inhibitors are another class of medications that have shown promise in the treatment of patients with HFrEF and diabetes mellitus. The CANVAS and EMPA-REG OUTCOME trials showed the potential benefit of SGLT2 inhibitors on cardiovascular mortality, DECLARE-TIMI 58 trial showed that treatment with dapagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure to a greater extent in patients with reduced ejection fraction (EF). Although novel pharmacotherapy is the current focus of intense research, there have been numerous studies on potential benefit of iron supplementation in ferropenic patients with heart failure. Another rapidly expanding area of research in the realm of heart failure is precision medicine and its impact on the development, progression, and treatment of heart failure. The field of heart failure is dynamic and with the influx of data from recent and ongoing trials, newer therapies with morbidity and mortality benefits in HFrEF are now available, nonetheless, much work is still needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm-20-4640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039644PMC
March 2021

Periprocedural complications in patients with SARS-CoV-2 infection compared to those without infection: A nationwide propensity-matched analysis.

Am J Surg 2020 Dec 28. Epub 2020 Dec 28.

Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Background: Reports on emergency surgery performed soon after a COVID-19 infection that are not controlled for premorbid risk-factors show increased 30-day mortality and pulmonary complications. This contributed to a virtual cessation of elective surgery during the pandemic surge. To inform evidence-based guidance on the decisions for surgery during the recovery phase of the pandemic, we compare 30-day outcomes in patients testing positive for COVID-19 before their operation, to contemporary propensity-matched COVID-19 negative patients undergoing the same procedures.

Methods: This prospective multicentre study included all patients undergoing surgery at 170 Veterans Health Administration (VA) hospitals across the United States. COVID-19 positive patients were propensity matched to COVID-19 negative patients on demographic and procedural factors. We compared 30-day outcomes between COVID-19 positive and negative patients, and the effect of time from testing positive to the date of procedure (≤10 days, 11-30 days and >30 days) on outcomes.

Results: Between March 1 and August 15, 2020, 449 COVID-19 positive and 51,238 negative patients met inclusion criteria. Propensity matching yielded 432 COVID-19 positive and 1256 negative patients among whom half underwent elective surgery. Infected patients had longer hospital stays (median seven days), higher rates of pneumonia (20.6%), ventilator requirement (7.6%), acute respiratory distress syndrome (ARDS, 17.1%), septic shock (13.7%), and ischemic stroke (5.8%), while mortality, reoperations and readmissions were not significantly different. Higher odds for ventilation and stroke persisted even when surgery was delayed 11-30 days, and for pneumonia, ARDS, and septic shock >30 days after a positive test.

Discussion: 30-day pulmonary, septic, and ischaemic complications are increased in COVID-19 positive, compared to propensity score matched negative patients. Odds for several complications persist despite a delay beyond ten days after testing positive. Individualized risk-stratification by pulmonary and atherosclerotic comorbidities should be considered when making decisions for delaying surgery in infected patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjsurg.2020.12.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836786PMC
December 2020

Antithrombotic / Antiplatelet Therapy in Patients with Stable Coronary Artery Disease and after Acute Coronary Syndrome.

Cardiovasc Hematol Agents Med Chem 2020 Dec 7. Epub 2020 Dec 7.

Division of Cardiovascular Diseases, Texas Tech University Health Science Center El Paso, El Paso,. United States.

The major physiopathological mechanism underlying acute coronary syndromes (ACS) is atherosclerotic plaque rupture with resultant coronary thrombosis, posing a big burden in health care systems. Dual anti-platelet therapy (DAPT) can improve CV outcome with a prolonged regimen, albeit at the cost of increased bleeding rates. We performed a narrative literature review on the topic, in which we explore databases through April 15th, 2020, with no restrictions on language. Key words of antiplatelet therapy, P2Y12 inhibitor, aspirin and DAPT were utilized. Randomized clinical trials, large prospective studies, systematic reviews and metanalysis were included. We hand-searched the reference lists of included articles and relevant reviews. The review revealed that when choosing antiplatelet agents, the decision should be driven by pharmacodynamic properties as well as demonstrated efficacy and safety. Additionally, it was noted that in patients undergoing percutaneous coronary intervention, prasugrel and ticagrelor are preferred. In patients with high risk of bleeds or receiving thrombolysis, or when cost or specific patient issues exist, clopidogrel is considered though is a second-line therapy. Due to an elevated risk of bleeds, triple therapy should be avoided, as evidence shows effectiveness and safety with regimens without ASA. Furthermore, multiple studies have also shown that regimens shorter than 12 months of DAPT could be adequate for many patients, and newer guidelines are likely going to reflect it. There are specific recommendations for switching among antiplatelets, mostly based on registries and pharmacodynamic studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871525718666201207201552DOI Listing
December 2020

Epidemiological and clinical characteristics of fall-related injuries: a retrospective study.

BMC Public Health 2020 Jul 29;20(1):1186. Epub 2020 Jul 29.

Department of Surgery, Trauma &Vascular Surgery Section, HGH, Doha, Qatar.

Background: Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center.

Method: A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes.

Results: A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population. Although the rate of fall-related injuries decreased over the years, the average number of patients per year remained high accounting for 32% of the hospitalized patients with moderate to severe injuries. Most of the injuries affected the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and have polytrauma than females. The working age-group (20-59 years) constituted the majority of injured (73%) and were more likely to fall at workplace, and to fall from higher heights compared to the older adults who sustained more fall at home. Overall in-hospital mortality was 3%. Outcomes including longer hospital length of stay and mortality were generally correlated with the height of fall except for the fall at home.

Conclusion: Fall-related injuries remain as significant burden even in a level 1 trauma center. Variations in the pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-020-09268-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388431PMC
July 2020

Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes.

BMJ Open Diabetes Res Care 2020 05;8(1)

Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA.

Objective: To evaluate whether increased glucose variability (GV) during the last day of inpatient stay is associated with increased risk of 30-day readmission in patients with diabetes.

Research Design And Methods: A comprehensive list of clinical, pharmacy and utilization files were obtained from the Veterans Affairs (VA) Central Data Warehouse to create a nationwide cohort including 1 042 150 admissions of patients with diabetes over a 14-year study observation period. Point-of-care glucose values during the last 24 hours of hospitalization were extracted to calculate GV (measured as SD and coefficient of variation (CV)). Admissions were divided into 10 categories defined by progressively increasing SD and CV. The primary outcome was 30-day readmission rate, adjusted for multiple covariates including demographics, comorbidities and hypoglycemia.

Results: As GV increased, there was an overall increase in the 30-day readmission rate ratio. In the fully adjusted model, admissions with CV in the 5th-10th CV categories and admissions with SD in the 4th-10th categories had a statistically significant progressive increase in 30-day readmission rates, compared with admissions in the 1st (lowest) CV and SD categories. Admissions with the greatest CV and SD values (10th category) had the highest risk for readmission (rate ratio (RR): 1.08 (95% CI 1.05 to 1.10), p<0.0001 and RR: 1.11 (95% CI 1.09 to 1.14), p<0.0001 for CV and SD, respectively).

Conclusions: Patients with diabetes who exhibited higher degrees of GV on the final day of hospitalization had higher rates of 30-day readmission.

Trial Registration Number: NCT03508934, NCT03877068.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjdrc-2019-000990DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222883PMC
May 2020

Recurrent Phyllodes Tumour of the Breast Transforming to a Fibrosarcoma.

Cureus 2020 Mar 29;12(3):e7457. Epub 2020 Mar 29.

Pathology, Ziauddin University Hospital, Karachi, PAK.

Phyllodes tumours of the breast are characterized by having both an epithelial as well as stromal component and these usually comprise almost 3% of all fibroepithelial tumours. They are exceptional in this aspect to convert into a stromal sarcoma of the breast after multiple recurrences. To the best of our knowledge, there are only three case reports regarding this in the available literature as it is an exceptional change. In this case report, we present a case of recurrent phyllodes transforming into a breast fibrosarcoma in a middle age postmenopausal woman. Histopathological examination and immunohistochemistry of the lesion were performed to confirm the diagnosis of breast fibrosarcoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.7457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187999PMC
March 2020

A Meta-Analysis Comparing Aspirin Alone Versus Dual Antiplatelet Therapy for the Prevention of Venous Graft Failure Following Coronary Artery Bypass Surgery.

Cardiovasc Revasc Med 2020 06 25;21(6):792-796. Epub 2019 Oct 25.

Department of Medicine, University of Tennessee, Memphis, TN, USA; Department of Cardiology, Gulf Coast Regional Medical Center, Panama City, FL, USA. Electronic address:

Background: Aspirin (ASA) monotherapy is the current standard of care after coronary artery bypass grafting (CABG) to prevent saphenous vein graft (SVG) failure. Several small, randomized clinical trials (RCTs) have suggested that dual antiplatelet therapy (DAPT) may be more effective at preventing SVG failure than ASA alone; however, it is unclear whether some P2Y12 inhibitors are more effective than others for the prevention of SVG failure.

Methods: Scientific databases and websites were searched to find RCTs. Both traditional pairwise meta-analysis using random-effect model and network meta-analysis using mixed-treatment comparison models were performed to compare the efficacy of various anti-platelet strategies for the prevention of SVG failure.

Results: Nine RCTs, which included a total of 1677 patients, were analyzed. Compared to ASA alone, DAPT decreased the risk of graft failure by 37% (RR: 0.63, 95% CI: 0.47-0.86; p = 0.003). In the moderator analysis, the decreased risk of graft failure with DAPT was not significantly different in the ASA + clopidogrel group than in the ASA + ticagrelor group (P-interaction = 0.17). The results of the network meta-analysis were consistent with those from pairwise analyses. The risk of major bleeding was not statistically significantly different between DAPT and ASA alone (RR: 1.35, 95% CI: 0.62-2.94; p = 0.45).

Conclusion: In post-CABG patients, DAPT seems to be more effective at preventing graft failure than ASA alone. This strategy does not seem to significantly increase major bleeding risk. Clopidogrel- and ticagrelor-based DAPT seem to be equally effective for this indication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carrev.2019.10.022DOI Listing
June 2020

An Updated Meta-analysis of Radial versus Femoral Access for Percutaneous Coronary Intervention in the Context of Aggressive Bleeding Avoidance Strategies.

Cardiovasc Revasc Med 2020 02 2;21(2):242-244. Epub 2019 Sep 2.

Department of Medicine, University of Tennessee, Memphis, TN, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carrev.2019.08.079DOI Listing
February 2020

Text preprocessing for improving hypoglycemia detection from clinical notes - A case study of patients with diabetes.

Int J Med Inform 2019 09 9;129:374-380. Epub 2019 Jul 9.

University of Maryland School of Medicine, Department of Medicine, United States. Electronic address:

Background And Objective: Hypoglycemia is a common safety event when attempting to optimize glycemic control in diabetes (DM). While electronic medical records provide a natural ground for detecting and analyzing hypoglycemia, ICD codes used in the databases may be invalid, insensitive or non-specific in detecting new hypoglycemic events. We developed text preprocessing methods to improve automatic detection of hypoglycemia from analysis of clinical encounter text notes.

Methods: We set out to improve hypoglycemia detection from clinical notes by introducing three preprocessing methods: stop word filtering, medication signaling, and ICD narrative enrichment. To test the proposed methods, we selected clinical notes from VA Maryland Healthcare System, based on various combinations of three criteria that are suggestive of hypoglycemia, including ICD-9 code of diabetes and hypoglycemia, laboratory glucose values < 70 md/dL, and text reference to a proximate hypoglycemia event. In addition, we constructed one dataset of 395 clinical notes from year 2009 and another of 460 notes from year 2014 to test the generality of the proposed methods. For each of the datasets, two physician judges manually reviewed individual clinical notes to determine whether hypoglycemia was present or absent. A third physician judge served as a final adjudicator for disagreements.

Results: Each of the proposed preprocessing methods contributed to the performance of hypoglycemia detection by significantly increasing the F1 score in the range of 5.3∼7.4% on one dataset (p < .01). Among the methods, stop word filtering contributed most to the performance improvement (7.4%). Combining all the preprocessing methods led to greater performance gain (p < .001) compared with using each method individually. Similar patterns were observed for the other dataset with the F1 score being increased in the range of 7.7%∼9.4% by individual methods (p < .001). Nevertheless, combining the three methods did not yield additional performance gain.

Conclusion: The proposed text preprocessing methods improved the performance of hypoglycemia detection from clinical text notes. Stop word filtering achieved the most performance improvement. ICD narrative enrichment boosted the recall of detection. Combining the three preprocessing methods led to additional performance gains.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijmedinf.2019.06.020DOI Listing
September 2019

Overview of the Mutational Landscape in Primary Myelofibrosis and Advances in Novel Therapeutics.

Asian Pac J Cancer Prev 2019 06 1;20(6):1691-1699. Epub 2019 Jun 1.

Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Primary Myelofibrosis is a BCR-ABL negative myeloproliferative neoplasm with a variety of hematological presentations, including thrombosis, bleeding diathesis and marrow fibrosis. It is estimated to have an incidence of 1.5 per 100,000 people each year. Although JAK2 or MPL mutations are seen in PMF, several other mutations have recently been documented, including mutations in CALR, epigenetic regulators like TET, ASXL1, and 13q deletions. The identification of these mutations has improved the ability to develop novel treatment options. These include JAK inhibitors like ruxolitinib, heat shock protein-90 inhibitors like ganetespib, histone deacetylase inhibitors including panobinostat, pracinostat, vorinostat and givinostat, hypomethylating agents like decitabine, hedgehog inhibitors like glasdegib, PI3K, AKT and mTOR inhibitors like everolimus as well as telomerase inhibitors like imtelstat. Research on novel therapeutic options is being actively pursued in order to expand treatment options for primary myelofibrosis however currently, there is no curative therapy other than allogenic hematopoietic stem cell transplantation (ASCT) which is possible in select patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31557/APJCP.2019.20.6.1691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021616PMC
June 2019

Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality: A Nationwide Cohort Study.

J Clin Endocrinol Metab 2019 09;104(9):3679-3691

Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Baltimore, Maryland.

Context: Low blood glucose concentrations during the discharge day may affect 30-day readmission and posthospital discharge mortality rates.

Objective: To investigate whether patients with diabetes and low glucose values during the last day of hospitalization are at increased risk of readmission or mortality.

Design And Outcomes: Minimum point of care glucose values were collected during the last 24 hours of hospitalization. We used adjusted rates of 30-day readmission rate, 30-, 90-, and 180-day mortality rates, and combined 30-day readmission/mortality rate to identify minimum glucose thresholds above which patients can be safely discharged.

Patients And Setting: Nationwide cohort study including 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals 14 years.

Results: The rate ratios (RRs) increased progressively for all five outcomes as the minimum glucose concentrations progressively decreased below the 90 to 99 mg/dL category, compared with the 100 to 109 mg/dL category: 30-day readmission RR, 1.01 to 1.45; 30-day readmission/mortality RR, 1.01 to 1.71; 30-day mortality RR, 0.99 to 5.82; 90-day mortality RR, 1.01 to 2.40; 180-day mortality RR, 1.03 to 1.91. Patients with diabetes experienced greater 30-day readmission rates, 30-, 90- and 180-day postdischarge mortality rates, and higher combined 30-day readmission/mortality rates, with glucose levels <92.9 mg/dL, <45.2 mg/dL, 65.8 mg/dL, 67.3 mg/dL, and <87.2 mg/dL, respectively.

Conclusion: Patients with diabetes who had hypoglycemia or near-normal glucose values during the last day of hospitalization had higher rates of 30-day readmission and postdischarge mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1210/jc.2018-02575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642668PMC
September 2019

Physiology-Guided Management of Serial/Diffuse Coronary Artery Disease.

Curr Cardiol Rep 2019 03 7;21(4):25. Epub 2019 Mar 7.

Section of Cardiology, Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, NY, USA.

Purpose Of Review: Just over four decades ago, the management of coronary artery disease (CAD) witnessed a major breakthrough with the advent of minimally invasive treatment modalities like angioplasty followed by coronary stenting. Dr. Andreas Gruentzig pioneered this field in 1977 by adding a balloon to the Dotter catheter. From its inception, he was cognizant of the need for measuring pressures before and after balloon inflation in the treated coronary artery, device placement in the treated coronary artery. However, for decades subsequently, emphasis was placed primarily on preprocedural non-invasive tests and angiographic assessment of lesions based on percent diameter stenosis to guide therapeutic interventions. We review the progress of these physiologic advancements in management over the last 20 years, as well as the current state and prospects for the future.

Recent Findings: More recently, clinical features heavily drive the decision whether or not to stent the diseased segment. A little more than two decades ago, a new approach to facilitate the decision whether or not to intervene on intermediate stenoses began to evolve. It became clear that other features besides angiography are important when considering benefit of mechanical intervention. The emphasis shifted to assessment of the physiological significance of coronary lesions, rather than solely anatomical identification of lesions at angiography. Physiological assessments have served to better discriminate potentially flow-limiting lesions, utilizing cutoff measurements to determine which patients would benefit from intervention in addition to medical therapy. We have found that there is still need for arrival at a consensus as regards the best practice in the context of physiological assessment of serial stenotic lesions, but that studies do show that techniques currently available are non-inferior to each other, and highly effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11886-019-1105-0DOI Listing
March 2019

Low flow in the left atrial appendage assessed by transesophageal echocardiography is associated with increased stroke severity-Results of a single-center cross-sectional study.

Int J Stroke 2019 06 27;14(4):423-429. Epub 2018 Nov 27.

1 Clinic for Neurology, University Medical Center Göttingen, Germany.

Background: About 25% of strokes are thought to be cryptogenic. There is growing evidence that most of these cryptogenic strokes are thromboembolic and caused by an undetected atrial fibrillation. Measured slow flow in the left atrial appendage has been proposed to be an indicator for the thromboembolic risk since it is possibly associated with undetected atrial fibrillation.

Methods: We evaluated all patients (n = 909; mean of 62 years, 39% female) admitted with an ischemic stroke (84%) or transient ischemic attack to our university medical center who underwent transesophageal echocardiography examination 2012-2014. Baseline characteristics, cardio-/neurovascular risk factors, electrocardiogram monitoring data, National Institute of Health Stroke Scale values, the localization of the stroke, as well as transesophageal echocardiography findings were analyzed.

Results: Stroke severity measured by the National Institute of Health Stroke Scale in patients with a low flow in the left atrial appendage was significantly higher than in patients without left atrial appendage low flow (p < 0.001). There was a threshold phenomenon in flow velocity at about 60 cm/s above which no significant change in National Institute of Health Stroke Scale values could be observed. These patients were significantly different concerning incidence of heart failure (10.6% vs. 2.3%; p < 0.001) and atrial fibrillation (32.2% vs. 8.8%; p < 0.001). However, threshold phenomenon of left atrial appendage flow was unchanged when excluding atrial fibrillation and heart failure patients.

Conclusions: A low flow in the left atrial appendage was associated with clinically elevated stroke severity and could be indicated as an independent stroke risk factor. Further prospective studies are warranted to evaluate beneficial effects of therapeutic options in these patients also in the assumed absence of atrial fibrillation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1747493018816511DOI Listing
June 2019

Designing the Glucose Telemetry for Hospital Management: From Bedside to the Nursing Station.

Curr Diab Rep 2018 08 29;18(10):87. Epub 2018 Aug 29.

Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, 827 Linden Avenue, Baltimore, MD, 21201, USA.

Purpose Of The Review: Hospitalized patients with diabetes are monitored with point-of-care glucose testing. Continuous glucose monitoring (CGM) devices represent an alternative way to monitor glucose values; however, the in-hospital CGM use is still considered experimental. Most inpatient studies used "blinded" CGM properties and only few used the real-time/unblinded CGM features. One major limitation of the CGM devices is that they need to be placed at the patients' bedside, limiting any therapeutic interventions. In this article, we review the real-time/unblinded CGM use and share our thoughts about the development of future inpatient CGM systems.

Recent Findings: We recently reported that glucose values can be wirelessly transmitted to the nursing station, providing remote continuous glucose monitoring. Future inpatient CGM devices may be utilized for patients at risk for hypoglycemia similarly to the way that we use cardiac telemetry to monitor hospitalized patients who are at increased risk for cardiac arrhythmias.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11892-018-1067-4DOI Listing
August 2018

Painful Bladder Syndrome/Interstitial Cystitis Successful Treatment with Montelukast: A Case Report and Literature Review.

Cureus 2018 Jun 25;10(6):e2876. Epub 2018 Jun 25.

Internal Medicine, Maharashtra Institute of Medical Education & Research, Talegaon, IND.

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic condition characterized by pelvic pain, urinary frequency, and urgency for more than six months in the absence of urinary tract infections. The etiology of PBS/IC is still an enigma. PBS/IC is challenging for doctors to diagnose because its symptoms overlap with other diseases such as urinary tract infection, overactive bladder, or endometriosis. Hence, it is diagnosed after excluding those diseases. The prognosis of PBS/IC may vary because of multiple treatment options. In this study, we are documenting a 26-year-old female patient who was successfully treated with montelukast after diagnosed with PBS/IC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.2876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110420PMC
June 2018

Subacute Infective Endocarditis of Aortic Valve During Pregnancy.

Cureus 2018 Jun 5;10(6):e2748. Epub 2018 Jun 5.

Internal Medicine, Maharashtra Institute of Medical Education & Research, Talegaon, IND.

Bacterial infective endocarditis is a rare but a life-threatening infection during pregnancy. Infective endocarditis during pregnancy is often associated with a congenital heart condition or an earlier history of rheumatic heart disease. In pregnant women with infective endocarditis, the maternal and fetal mortality rate can reach as high as 33% and 29%, respectively. In most cases, infective endocarditis runs a subacute course and involves the mitral valve, nonetheless, rarely it can involve the aortic valve as well. We are documenting a rare case of subacute infective endocarditis in a 26-year-old pregnant female with severe aortic stenosis with associated multiple systemic emboli. The patient was managed by urgent cesarean section at 35 weeks of gestation followed by aortic valve replacement; there was no maternal or fetal mortality. This case report highlights the importance of early diagnosis, and timely management of infective endocarditis in pregnant women to prevent maternal and fetal death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.2748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075646PMC
June 2018

Energy Drinks and Myocardial Infarction.

Cureus 2018 May 21;10(5):e2658. Epub 2018 May 21.

Internal Medicine, Maharashtra Institute of Medical Education & Research, Talegaon, IND.

The popularity and use of energy drinks have accelerated over the past decade and are a health concern worldwide. The key ingredients of energy drinks include caffeine, guarana, taurine, ginseng, and sugar. Most of the well-known side effects due to consumption of energy drinks include tachycardia, headache, anxiety, and palpitations and are frequently attributed to caffeine. Recently, a few cases of life-threatening cardiovascular events in individuals who overdosed massive quantities of caffeinated energy drinks have been reported. In this case report, we are documenting a case of myocardial infarction in a 25-year-old man who presented to the emergency department with chest pain. The patient had been consuming massive quantities of caffeinated energy drinks daily for the past week. This case report and the few previously documented studies support a possible connection between caffeinated energy drinks and myocardial infarction. The purpose of this case report is to promote awareness in the general population and the medical staff about cardiac mortality due to overdosing of massive quantities of caffeinated energy drinks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.2658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054366PMC
May 2018

Anaphylactic Reaction to Cyanocobalamin: A Case Report.

Cureus 2018 May 5;10(5):e2582. Epub 2018 May 5.

Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Punjab, PAK.

Vitamin B12 is essential for the development of healthy nerves and red blood cells. Vitamin B12 deficiency is becoming widespread and most commonly affects elderly, pregnant women, vegetarians, and patients with renal or intestinal diseases. Either parenteral vitamin B12 treatment or high-dose oral vitamin B12 treatment is an effective therapy regardless of etiology. Parenteral therapy using the intramuscular route is considered the most familiar treatment for vitamin B12 deficiency. Anaphylactic reaction after intramuscular injection is an uncommon and potentially serious side effect. In this study, we are documenting a case of anaphylactic reaction in a 55-year-old woman after her second dose of intramuscular injection of cyanocobalamin. The purpose of this case report is to highlight the need to understand the rare life-threatening side effect of intramuscular cyanocobalamin. Health care providers should be vigilant while administering the intramuscular injection of cyanocobalamin to vitamin B12 deficient patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.2582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034758PMC
May 2018

Anabolic androgenic steroid-induced acute myocardial infarction with multiorgan failure.

Proc (Bayl Univ Med Cent) 2018 Jul 15;31(3):334-336. Epub 2018 May 15.

Division of General Medicine, Department of Internal Medicine, Texas Tech University Health Science Center Paul L. Foster School of Medicine, El Paso, Texas.

The abuse of anabolic androgenic steroids (AAS) has remained on the rise despite their well-known deleterious effects. We describe a case of AAS-induced multisystem failure following an extensive history of abuse in a 41-year-old bodybuilder. Furthermore, we review pertinent literature and discuss the different pathophysiologic mechanisms through which AAS affect the heart and other organs. This case points to the possibility of multiorgan involvement and severe cardiac effects of AAS abuse in young individuals who may not have any past medical history.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08998280.2018.1460130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997056PMC
July 2018

The Effect of Continuous Glucose Monitoring in Preventing Inpatient Hypoglycemia in General Wards: The Glucose Telemetry System.

J Diabetes Sci Technol 2018 01 13;12(1):20-25. Epub 2017 Dec 13.

1 Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.

Background: Few studies have examined the use of continuous glucose monitoring (CGM) devices in the general wards. The aim of this pilot study was to examine whether CGM readings can be successfully transmitted from the bedside to a central monitoring device in the nursing station, and whether a glucose telemetry system can prevent hypoglycemic events.

Methods: We present pilot data on 5 consecutive insulin treated general medicine patients with type 2 diabetes (T2DM) whose glucose values were observed with CGM (DEXCOM) and the results were transmitted to a central nursing station monitoring system using DEXCOM Follow and Share 2 software. CGM alarms were set-up at glucose <85 mg/dl.

Results: Duration of CGM observation was 4.0 ± 1.6 days (mean ± SD). During CGM, the overall time spent within blood glucose (BG) target of 70-179 mg/dl was 64.68 ± 15% (mean ± SD), on hypoglycemia (<70 mg/dl) was 0.30% ± 0.39, and time spent on hyperglycemia (≥180 mg/dl) was 35.02% ± 15.5. Two patients had 3 actions of prevention of potential hypoglycemia (CGM BG <70 mg/dl for >20 minutes) captured by alarm. No patients had CGM glucose value <54 mg/dl.

Conclusions: This pilot study indicates that the use of CGM values in hospitalized patients can be successfully transmitted to a monitoring device in the nursing station, improving patient surveillance in insulin treated patients with diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1932296817748964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761998PMC
January 2018

A case for setting-up dedicated peritoneal surface malignancy centers in Pakistan.

J Pak Med Assoc 2017 Nov;67(11):1780-1781

Medical Oncology, Dr Ziauddin Hospital, Karachi.

View Article and Find Full Text PDF

Download full-text PDF

Source
November 2017

Clinical Relevance of Patent Foramen Ovale and Atrial Septum Aneurysm in Stroke: Findings of a Single-Center Cross-Sectional Study.

Eur Neurol 2017 28;78(5-6):264-269. Epub 2017 Sep 28.

Department of Cardiology and Pneumology/Heart Center, University Medical Center Göttingen, Göttingen, Germany.

Background: A significant proportion of ischemic strokes are cryptogenic. In this context, the clinical pertinence of patent foramen ovale (PFO) with and without atrial septum aneurysm (ASA) remains controversial. The aim of this study was to identify how PFO +/-ASA and cryptogenic stroke are associated in a representative sample of stroke patients.

Methods: We enrolled all patients (n = 909) with ischemic stroke or transient ischemic attack admitted to the certified stroke unit or neurological intensive care unit of our university medical center who underwent transesophageal echocardiography (TEE) between 2012 and 2014. The baseline characteristics, cardio-/neurovascular risk factors, clinical parameters and TEE findings were analyzed.

Results: PFO was present in 26.2%, and PFO was combined with an ASA in 9.9%. In cryptogenic stroke, the prevalence of PFO was higher compared to other etiologies (30.9 vs. 21.9%; p < 0.002). Patients with PFO had lower National Institute of Health Stroke Score (NIHSS) values at admission than those without (2 [0-5] vs. 3 [1-7]; p = 0.001; 95% CI [0.62-0.88]). No difference was found in NIHSS values of PFO patients with or without ASA (2 [0-5] vs. 2 [0-5]; p = 0.683; 95% CI 0.94 [0.68-1.28]).

Conclusions: Our study indicates that a detected PFO +/-ASA could exhibit a stroke-relevant finding, if classical risk factors for the stroke were lacking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000479962DOI Listing
December 2018
-->