Publications by authors named "Vijay Gayam"

96 Publications

Paget-Schroetter Syndrome in a Young Female.

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211003263

Ashland Bellefonte Cancer Center, Ashland, KY, USA.

Paget-Schroetter syndrome or effort thrombosis is a relatively rare primary spontaneous thrombosis of upper extremity deep veins secondary to entrapment of axillary subclavian veins from an abnormality of the thoracic outlet. It is commonly seen in young adults who lift heavy weights or strenuous use of the upper extremities during athletic activities. Repetitive microtrauma to the subclavian vein secondary to narrow costoclavicular space and strenuous activities leads to intimal layer inflammation, hypertrophy, fibrosis, and coagulation cascade activation. Management of Paget-Schroetter syndrome differs from the venous thrombosis of the lower extremity as treatment includes anticoagulation, thrombolysis, and surgical decompression. Early recognition and timely management are required to prevent significant disability from post-thrombotic syndrome and long-term morbidity from recurrent thromboembolism and pulmonary embolism. Internists and emergency physicians should be aware of the disease's presentation, treatment options, and early referral to vascular surgeons since prompt initiation of appropriate treatment will have better outcomes than delayed treatment. We discussed a case of a 31-year-old female who lifts heavyweight at work, presented with right arm swelling and pain for 2 weeks, and diagnosed with axillary subclavian vein thrombosis secondary to thoracic outlet obstruction. She received a high-dose heparin drip followed by catheter-directed thrombolysis and underwent surgical decompression of axillary subclavian vein via resection of the first rib, subclavius muscle resection, partial anterior scalenectomy, and venolysis. In our review of the literature, randomized controlled studies lack the efficacy and safety of surgical decompression. However, the results are promising based on accumulated experience from vascular surgery experts and small case series. Extensive studies are needed further to delineate the protocol for the management of Paget-Schroetter syndrome.
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http://dx.doi.org/10.1177/23247096211003263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983469PMC
March 2021

The clinical course and management of cervical cancer with splenic metastasis: Case report and review of the literature.

Clin Case Rep 2021 Feb 4;9(2):689-693. Epub 2020 Dec 4.

Division of Gastroenterology and Hepatology, Department of Medicine NYU Langone Health, NYU Grossman School of Medicine Flushing NY USA.

Adenovirus-mediated herpes simplex virus thymidine kinase gene therapy (ADV-TK) in combination with interventional treatment could relieve the symptoms in patients with widespread splenic metastasis.
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http://dx.doi.org/10.1002/ccr3.3621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869355PMC
February 2021

Prevalence and association of iron deficiency with anemia among patients with heart failure in the USA: NHANES 2017-2018.

J Community Hosp Intern Med Perspect 2021 Jan 26;11(1):124-127. Epub 2021 Jan 26.

Department of Cardiology, Aurora St Luke's Medical Center, Milwaukee, WI, USA.

: Heart failure (HF) is a major debilitating disease. HF patients with iron deficiency(ID) have poorer outcomes and treatment significantly improves outcomes. We set out to update the national prevalence of ID in the USA and its association with anemia using data from NHANES 2017-2018. : Diagnosis of HF was self-reported. ID was defined as serum ferritin levels <100 ng/mL or a ferritin level between 100 and 299 ng/mL with transferrin saturation <20%. Anemia was defined as a hemoglobin level of <13 g/dl and <12 g/dl for men and women, respectively. Differences in prevalence of ID across various groups were assessed using Chi-squared test for categorical variables and equality of means for continuous variables with p-values <0.05 considered statistically significant. : A total of 187 persons ≥20 years, corresponding to a 5.57million had HF. The prevalence of ID was 48.17% (95% CI 36.84-59.69) and the prevalence of anemia was 12.08%(95% CI 8.16-17.53). Diabetics (61.03%) were more likely to have ID compared to nondiabetics (35.38%), p 0.022. The prevalence of ID was similar in persons with anemia (47.45%) and persons without anemia (48.27%), p-value 0.983. The prevalence of ID has been constant for at least the past 20 years, making ID in HF an underdiagnose and/or undertreated condition among patients with HF and should be addressed. : One in every two persons with HF has ID. Also, prevalence of ID was similar in patients with anemia and without anemia. Anemia should not be considered a prerequisite for screening for ID in patients with HF.
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http://dx.doi.org/10.1080/20009666.2020.1854927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850437PMC
January 2021

Impact of COVID19 on resident physicians of a community hospital in New York city.

J Community Hosp Intern Med Perspect 2021 Jan 26;11(1):4-8. Epub 2021 Jan 26.

Department of Pulmonary Medicine, Interfaith Medical Center, Brooklyn, NY, USA.

Novel Corona Virus Disease 19 has created unforeseen burden on health care. New York city is one of the epicenters of pandemic and here we explore physical, mental and social impact of COVID 19 on Resident Physicians (RP) working within the center of this epicenter. This is a single-center cross-sectional web-based survey involving RP of a community hospital in Brooklyn, New York. Questionnaire was formulated in online platform. We used a convenient sampling method. Univariate analysis was conducted and presented the distribution of qualitative responses as frequency and percentages. COVID19 related symptoms were reported by 39.8% RP. COVID19 IgG and IgM antibodies, both negative were reported by 34.9%, while only 6% RPs were IgG antibody positive. Symptomatic RP tested for COVID19-PCR was positive in 42.42%. Self-isolation from family during the pandemic was reported by only 14.5%. Financial constraints, lack of accommodation, and emotional reasons were main reasons of not being able to self isolate. Being bothered by 'Anxiety' and 'Nervousness' were reported by 8.5% on 'Almost every day' while 46.3% reported on 'several days in the two weeks duration'. 'Uncontrollable worrying', 'Feeling down', 'Depressed,' or 'Hopeless' was reported as 'Not at all' by 78.8% and 3.7% reported it to 'occur nearly every day for the last two weeks'. Aftermath of fight against pandemic has left RP with significant physical, mental, and social impact. Appropriate stress management and safety interventions are urgently needed. Further studies are needed to explore the detailed impact of COIV19 on RP.
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http://dx.doi.org/10.1080/20009666.2020.1834670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850354PMC
January 2021

Prevalence and control rates of hypertension in the USA: 2017-2018.

Int J Cardiol Hypertens 2020 Sep 31;6:100044. Epub 2020 Jul 31.

Aurora St Luke's Medical Center, Milwaukee, WI, USA.

Background: Recent review of hypertension guidelines requires fresh updates of prevalence and control rates. Though retrospective analysis provided burden estimates, control rates were grossly misleading. We set out to update the prevalence and control rates of hypertension in the USA using contemporary NHANES data.

Methods: Persons with mean systolic blood pressure (mSBP) ≥130 mmHg or mean diastolic blood pressure (mDBP) ≥80 mmHg or self-reported current use of antihypertensive medications were classified as hypertensives. Hypertensives on medications with mSBP <130 mmHg and mDBP <80 mmHg were classified as having well-controlled hypertension. Subgroup comparisons of hypertension prevalence were computed using Chi-square test. Predictors of hypertension and well-controlled BP were assessed using multivariable logistic regressions. Two tailed p-values <0.05 were considered statistically significant.

Results: The prevalence of hypertension in the USA in 2017-2018 was 49.64% (95% CI 46.67-52.61) corresponding to 115(95% CI 104-128) million persons. NH Blacks: 58.53% (95% CI 55.39-61.60); Men: 54.46% (95% CI 51.01-57.87); older persons and obese individuals: 61.03% (95% CI 57.31-64.63) as well as persons with diabetes and CKD, comparatively. The overall rate of well-controlled hypertension was 39.64% (95% CI 36.20-42.81). Persons with at least a college degree: OR 2.20(95% CI 1.02-5.04, p=0.049) and persons with incomes ≥3 times the poverty threshold; OR 1.88(95% CI 1.1.8-2.99, p=0.011) had higher rates of well-controlled hypertension when compared to lowest categories.

Conclusion: One in every two persons ≥20 years in the USA has hypertension with only 39.64% on medications having well-controlled hypertension. Significant discrepancies exist in the burden and control rates in different subpopulation categories. Targeted interventions could help improve the prevalence and hypertension control rates in the USA.
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http://dx.doi.org/10.1016/j.ijchy.2020.100044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803011PMC
September 2020

COVID-19 Pediatric Patients: Gastrointestinal Symptoms, Presentations, and Disparities by Race/Ethnicity in a Large, Multicenter US Study.

Gastroenterology 2021 04 6;160(5):1842-1844. Epub 2021 Jan 6.

Department of Medicine, Howard University College of Medicine, Washington DC. Electronic address:

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http://dx.doi.org/10.1053/j.gastro.2020.12.078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787077PMC
April 2021

Outcomes of diverticulitis in patients with tobacco smoking: a propensity-matched analysis of nationwide inpatient sample.

Int J Colorectal Dis 2021 May 7;36(5):1033-1042. Epub 2021 Jan 7.

Department of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA.

Background: Recent data shows a significantly increased risk of diverticulosis among smokers. There is limited data on the association between tobacco smoking and diverticulitis. We aim to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of diverticulitis patients based on tobacco smoking status.

Methods: A retrospective analysis was performed by utilizing the National Inpatient Sample database (2016 and 2017) and the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of diverticulitis and smoking. We assessed all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of tobacco smokers vs. nonsmokers with diverticulitis.

Results: We identified 442,273 diverticulitis patients, of whom 96,864 were tobacco smokers, and 345,409 were nonsmokers. Between the two groups, in-hospital mortality was not significant (OR 1.09, 95% CI 0.38-2.6; P = 0.98). Tobacco smokers with diverticulitis have higher odds of lower gastrointestinal bleeding (LGIB) (OR 1.6, 95% CI 1.4-3.8; P = 0.01), peritonitis (OR 1.5, 95% CI 1.9-3.3; P = 0.00), intestinal obstruction (OR 1.6, 95% CI 2.8-7.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05-4.4; P = 0.03), and shock requiring vasopressor (OR 1.5, 95% CI 1.2-2.2; P = 0.00). In tobacco smokers with complicated diverticulitis, there were higher odds of LGIB (OR 1.4, 95% CI 1.2-1.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05-4.4; P = 0.03), and colectomy (OR 1.2, 95% CI 1.1-1.2; P = 0.00). In-hospital mortality was not significant in smokers with complicated diverticulitis (OR 1.2, 95% CI 0.78-1.9; P = 0.3).

Conclusions: In this propensity-matched analysis, there was no difference in in-hospital mortality between tobacco smokers vs. nonsmokers with diverticulitis. Smoking has been associated with an increased incidence of complications in diverticulitis with a higher length of hospital stay and resource utilization.
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http://dx.doi.org/10.1007/s00384-020-03805-6DOI Listing
May 2021

Outcomes of oesophageal variceal bleeding among patients with atrial fibrillation: a propensity-matched analysis of a nationwide inpatient sample.

Arch Med Sci Atheroscler Dis 2020 14;5:e255-e262. Epub 2020 Sep 14.

Westchester Medical Centre and New York Medical College, Valhalla, NY, USA.

Introduction: We aimed to determine the influence of atrial fibrillation (AF) on mortality, morbidity, length of hospital stay, and resource utilisation in patients with oesophageal variceal bleeding (OVB).

Material And Methods: The National Inpatient Sample database (2016 and 2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify patients with the principal diagnosis of OVB and AF. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS), and total costs between propensity-matched groups of OVB with AF vs. OVB alone.

Results: We identified 80,325 patients with OVB, of whom 4285 had OVB with AF, and 76,040 had OVB only. The in-hospital mortality was higher in OVB with AF (OR = 1.4, 95% CI: 1.09-1.83; < 0.001). OVB with AF had higher odds of sepsis (OR = 1.4, 95% CI: 1.1-1.8; = 0.007), acute kidney injury (OR = 1.2, 95% CI: 1.12-1.32; < 0.001), and mechanical ventilation (OR = 1.2, 95% CI: 1.12-1.32; < 0.001). Advanced age (OR = 1.06, 95% CI: 1.05-1.07; < 0.001), congestive heart failure (OR = 1.7, 95% CI: 1.3-2.3; < 0.001), coronary artery disease (OR = 1.4, 95% CI: 1.03-1.92; = 0.02), and sepsis (OR = 1.3, 95% CI: 1.06-1.70; = 0.01) were identified as predictors of mortality in OVB with AF. Mean LOS (7.5 ±7.4 vs. 6.0 ±7.2, < 0.001) and mean total costs ($25,452 vs. $21,109, < 0.001) were also higher.

Conclusions: In this propensity-matched analysis, OVB with AF was associated with higher odds of in-hospital mortality, sepsis, acute kidney injury, and mechanical ventilation.
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http://dx.doi.org/10.5114/amsad.2020.98949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717439PMC
September 2020

In-hospital outcomes of angiography versus intravascular ultrasound-guided percutaneous coronary intervention in ST-elevation myocardial infarction patients.

J Community Hosp Intern Med Perspect 2020 Sep 3;10(5):436-442. Epub 2020 Sep 3.

Division of Cardiology, Mount Sinai Hospital, New York, NY, USA.

Background: We compared the in-hospital complications, outcomes, cost, and length of stay (LOS) between angiography-guided percutaneous coronary intervention (PCI) and intravascular ultrasound (IVUS)-guided PCI in patients with ST-elevation myocardial infarction (STEMI) in the USA.

Methods: A nationwide inpatient database was queried to identify patients >18 years with STEMI who underwent angiography-guided and IVUS-guided PCI from January 2016 to December 2016. We compared the in-hospital mortality, complications, cost, and LOS between the two groups.

Results: We identified 100,485 patients who underwent angiography-guided PCI and 5,460 patients who underwent IVUS-guided PCI. In-hospital mortality was not statistically different (odds ratio [OR] 0.76, 95% CI 0.46 - 1.22, P = 0.24). Patients who underwent PCI with IVUS were more likely to have coronary artery dissection (OR 4.26, 95% CI 2.34 - 7.7, p = <0.01), and both groups had a similar incidence of acute kidney injury requiring hemodialysis. The mean LOS was similar, but the mean total cost was higher in the group that underwent PCI under IVUS guidance.

Conclusions: The in-hospital mortality, hemodialysis, and the use of support devices did not reach a statistical difference between the two groups. However, we observed higher rates of coronary dissection with the use of IVUS in STEMI management.
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http://dx.doi.org/10.1080/20009666.2020.1800970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671732PMC
September 2020

Bacteremia Secondary to Uncommon Gram-Negative Bacilli Transmitted From the Canine in a Patient With Multiple Myeloma.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620969500

The Nephrology Group, Fresno, CA, USA.

is a gram-negative rod found in the environment and rarely associated with human infections. is the causative agent of infections in an immunocompromised host in most cases. We report a rare case of cellulitis in an immunocompromised host by .
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http://dx.doi.org/10.1177/2324709620969500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691896PMC
November 2020

Back to basics: review on vitamin D and respiratory viral infections including COVID-19.

J Community Hosp Intern Med Perspect 2020 Oct 29;10(6):529-536. Epub 2020 Oct 29.

Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, CA, USA.

Importance: As the scientific community is in a marathon in finding out the cure for COVID-19, in this crisis, it is essential for the physicians not to forget about the basics. Due to the pandemic crisis, in many nursing homes and hospitals, there established new policies on decreasing unnecessary medications to minimize cross-contamination. Sometimes these policies are making providers avoid essential drugs such as Vitamins, including Vitamin D. In this paper, we try to emphasize the importance of Vitamin D in COVID-19 and respiratory viral patients.

Relevance: Vitamin D helps in decreasing the 'pro-inflammatory cytokines' in the lungs and acts in immunomodulatory function, and 'also it will increase the anti-inflammatory, antiviral responses of the respiratory epithelial cells during infection.'

Conclusion: Due to the highly contagious nature of COVID-19 and the increased morbidity and mortality with no appropriate therapy and vaccine, one must be cautious and do everything to help COVID-19 patients. In hospitals and other health care settings to decrease cross-contamination, holding other non-essential medications is taking place. Discontinuing Vitamins could increase the mortality and morbidity of those affected, especially in deficient/insufficient individuals. Obtaining serum 25 (OH) D levels in all patients with viral respiratory infections, especially COVID-19, could help in the detection and treatment of Vitamin D deficiency and potentially decrease recovery time and improve outcome. Even though evidence suggests that vitamin D has the anti-inflammatory, antiviral properties, randomized double-blinded controlled trials are needed to verify this further, and to understand Vitamin D and COVID-19 better.

Abbreviations: Vitamin D receptor-VDR; 25(OH)D- 25 hydroxyvitamin D; 1,25 (OH)D-1,25 dihydroxy Vitamin D; 1α,25-dihydroxy Vitamin D-1,25[OH] D or calcitriol; IU- International Units; Interferons stimulated genes- ISG; ARI- acute respiratory infection; RSV- respiratory syncytial virus; RTI- Respiratory tract infections; COPD-Chronic obstructive pulmonary disease; BMI-Basal metabolic index; USA-USA.
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http://dx.doi.org/10.1080/20009666.2020.1811074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599018PMC
October 2020

Outcomes of in Patients with Vitamin D Deficiency: A Propensity-Matched National Inpatient Sample Analysis.

South Med J 2020 Nov;113(11):593-599

From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California.

Objectives: We aimed to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of infection (CDI) and vitamin D deficiency (VDD).

Methods: The National Inpatient Sample database for 2016 and 2017 was used for data analysis using () codes to identify the patients with the principal diagnosis of CDI and VDD. We assessed the all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of CDI without VDD versus CDI with VDD.

Results: We identified 202,234 patients with CDI, 4515 of whom were patients with VDD and 197,719 of whom were without VDD. After propensity matching, there was no difference in the in-hospital mortality between the two groups (odds ratio [OR] 1.5, 95% confidence interval [CI] 0.58-4.3; = 0.90). CDI with VDD has a higher odds of sepsis (OR 1.6, 95% CI 1.3-1.9; = 0.0), and peritonitis (OR 1.6, 95% CI 1.4-3.8; = 0.01). Mean LOS (5.9 ± 1.8 vs 5.4 ± 2, < 0.01) and mean total charges ($11,500 vs $9971, < 0.04) were higher in CDI with VDD. The factors affecting the LOS were acute coronary syndrome ( = 0.04), mechanical ventilation ( = 0.03), obesity ( = 0.004), acute kidney injury ( = 0.04), and sepsis ( = 0.05).

Conclusions: In this large cohort in a propensity-matched analysis, VDD does not increase the in-hospital mortality in CDI. VDD increases the odds of complications with a higher LOS and resource utilization. These findings may be clinically relevant to guide clinicians to routinely monitor vitamin D status and supplement in patients at risk of CDI.
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http://dx.doi.org/10.14423/SMJ.0000000000001168DOI Listing
November 2020

Massive Upper Gastrointestinal Bleeding Following LAMS (Lumen-Apposing Metal Stent) Placement.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620965800

Interfaith Medical Center, Brooklyn, NY, USA.

Pancreatic pseudocyst is a common complication of pancreatitis. Pseudocysts may require decompression when they become painful, infected, or start compressing surrounding organs. Decompression is achieved by endoscopic cystogastrostomy. Recently, the use of lumen-apposing metal stent (LAMS) for cystogastrostomy has gained popularity due to ease of use and high technical success. LAMS has a wider lumen, which allows for direct endoscopic necrosectomy in the cases of walled-off necrosis. Our patient is a 30-year-old male who presented with massive hematemesis and dizziness. He had a history of chronic alcohol-induced pancreatitis. Three weeks before the presentation, he underwent a cystogastrostomy with LAMS placement to treat a 10-cm walled-off necrosis. Urgent computed tomography (CT) scan did not reveal any acute finding suggestive of bleeding. Esophagogastroduodenoscopy showed blood protruding from the LAMS with a large clot formation. Attempts to stop bleeding were unsuccessful. He underwent CT angiography of the abdomen. CT angiography showed a bleeding pseudoaneurysm (PA) believed to be a complication of the LAMS. Subsequently, multiple coils were placed in the splenic artery near the PA. The patient continued to improve without a further drop in hemoglobin and was eventually discharged. PA formation and subsequent rupture is a rare delayed complication of LAMS. It may lead to massive gastrointestinal bleeding with a high mortality rate. Diagnostic delays have resulted in increased mortality by 60%. In this article, we present a case of massive gastrointestinal bleeding due to a ruptured splenic artery PA presenting as a delayed complication of LAMS.
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http://dx.doi.org/10.1177/2324709620965800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570288PMC
October 2020

Late presenters among minority patients with chronic hepatitis C infection in the USA.

Int J Public Health 2020 Sep 29;65(7):1181-1191. Epub 2020 Aug 29.

St. John's University, Jamaica, NY, USA.

Objectives: Minority patients are under-screened for chronic hepatitis C (CHC) in the USA, and limited data exist for minority patients with advanced fibrosis.

Methods: In this cross-sectional study, CHC patients who were prescribed direct-acting antiviral agents were divided into White patients and minority patient groups. Primary measurements were the mean fibrosis scores and percentages of patients with stage III-IV fibrosis (late presenters) for the two groups.

Results: Among the 1421 patients with self-reported ethnicity, 697 were White patients, and 724 were minority patients (484 Hispanic, 175 Black, 65 Asians). Compared to the White, minority patients had significantly higher mean fibrosis score (p < 0.001) and a higher percentage of late presenters (p < 0.001). In subgroup analyses, the mean fibrosis scores for Hispanic, Black and Asian patients were 2.58 ± 1.38, 2.28 ± 1.41 and 2.28 ± 1.40, respectively.

Conclusions: Minority populations with CHC in the USA experience disparities in access to treatment in the early stages of liver fibrosis. Public health strategies are necessitated to address the inequality, as late presenters are at risk of hepatocellular carcinoma.
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http://dx.doi.org/10.1007/s00038-020-01467-3DOI Listing
September 2020

COVID-19 in Renal Transplant Patient Presenting With Active Typical Symptoms and Resolved Atypical Symptoms.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620949307

Phoebe Putney Memorial Hospital, Albany, GA, USA.

The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.
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http://dx.doi.org/10.1177/2324709620949307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424610PMC
August 2020

Cannabis Vaping-Induced Acute Pulmonary Toxicity: Case Series and Review of Literature.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620947267

Adventist Medical Center, Hanford, CA, USA.

The use of cannabis for recreational as well as medicinal use is on the rise recently with more states legalizing it. We conducted a review analysis of the literature published on acute respiratory failure from vaping cannabis oil. We have also summarized the clinical details (age, length of stay, mode of ventilation, common clinical findings, and steroid use) along with common laboratory abnormalities. This article aims to educate health care providers on the clinical manifestations and management strategies for vaping-induced acute respiratory failure. We also discussed the different available formulations of cannabis oil and key ingredients responsible for the vaping-associated lung injury.
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http://dx.doi.org/10.1177/2324709620947267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543135PMC
August 2020

Review article: preventing hepatitis B graft infection in hepatitis B patients after liver transplantation: immunoglobulin vs anti-virals.

Aliment Pharmacol Ther 2020 09 3;52(6):944-954. Epub 2020 Aug 3.

Division of Gastroenterology and Hepatology, Department of Medicine, NYU School of Medicine, NYU Langone Health, New York, NY, USA.

Background: A critical aspect of liver transplantation in hepatitis B patients is to prevent graft reinfection with hepatitis B virus. The use of hepatitis B immune globulin after transplant was a significant milestone, which allowed prolonged graft and patient survival by controlling hepatitis B reinfection in liver grafts. The development of anti-viral treatments with oral nucleos(t)ide analogues, led to a further reduction in graft reinfection and improvement in patient survival. The combination of the aforementioned two therapies has been widely used in hepatitis B-associated liver transplants.

Aims: To address the post-transplant management of hepatitis B and provide updates on preventing graft reinfection.

Methods: We performed a literature search on Ovid and PubMed for randomised controlled trials or cohort studies in English, which investigated the effectiveness of hepatitis B immune globulin and anti-viral therapy on hepatitis B-associated transplants (1/2000-1/2020). Studies that met pre-established criteria were reviewed.

Results: Based on currently available evidence, an algorithm for post-transplant management with anti-viral therapy is proposed. Also, the management of recipients who received grafts from hepatitis B core antibody-positive donors is discussed.

Conclusions: The development of hepatitis B immune globulin and anti-viral treatments led to substantial improvement in graft and patient survival. The prevention of hepatitis B graft reinfection is complex and involves a broad interdisciplinary team.
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http://dx.doi.org/10.1111/apt.15999DOI Listing
September 2020

End-stage renal disease and lower gastrointestinal bleeding-A propensity-matched analysis of nationwide inpatient sample.

Int J Clin Pract 2021 Feb 4;75(2):e13633. Epub 2020 Dec 4.

Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA.

Aims: We aim to determine the influence of lower gastrointestinal bleeding (LGIB) on mortality, morbidity, length of hospital stay and resource utilisation in end-stage renal disease (ESRD) patients.

Material And Methods: The National Inpatient Sample database (2016 &2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of ESRD and LGIB. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS) and total costs between propensity-matched groups of ESRD patients with LGIB versus ESRD patients.

Results: We identified 2 187 954 ESRD patients, of whom 242 075 has LGIB, and 1 945 879 were ESRD patients. The in-hospital mortality was higher in ESRD with LGIB (OR 2.5, 95% CI 1.5-2.2; P = .00). ESRD with LGIB has higher odds of mechanical ventilation (OR 1.4, 95% CI 6.4-16.4; P = .00), and shock requiring vasopressor (OR 1.2, 95% CI 4.9-5.4; P = .002). Advanced age (OR 1.02 CI 1.02-1.03 P = .00), anaemia (OR 1.04 CI 1.59-1.91 P = .006), acute coronary syndrome (OR 1.8 CI 1.6-2.1, P = .00), acute respiratory failure (OR 1.29 CI 2.0-2.6, P = .00), mechanical ventilation (OR 1.9, CI 3.5-4.4, P = .00) and sepsis (OR 1.5, CI 4.1-5.08, P = .00) were identified as predictors of mortality in ESRD with LGIB. Mean LOS (10.8 ± 14.9 vs 6.3 ± 8.5, P < .01) and mean total charges (37 054 $ vs 18 080 $, P < .01) were also higher.

Conclusions: In this propensity-matched analysis, ESRD with LGIB was associated with higher odds of in-hospital mortality, mechanical ventilation and shock requiring vasopressor. Mean LOS and resource utilisation were also higher.
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http://dx.doi.org/10.1111/ijcp.13633DOI Listing
February 2021

Gastrointestinal Manifestations in COVID-19 Infection and Its Practical Applications.

Cureus 2020 Jun 21;12(6):e8750. Epub 2020 Jun 21.

Internal Medicine, Interfaith Medical Center, Brooklyn, USA.

The latest novel coronavirus (COVID-19) outbreak, which emerged in December 2019 in Wuhan, Hubei, China, is a significant cause of the pandemic. This outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is also commonly known as COVID-19. A typical symptom includes cough and fever, but a considerable number of patients can manifest gastrointestinal (GI) symptoms, including diarrhea, which can be the initial presentations and may or may not present with respiratory symptoms or fever. COVID-19 virus may be present in stool samples of patients infected with COVID-19, and angiotensin-converting enzyme 2 (ACE2) is a receptor for this virus, which is substantially present in GI epithelial cells. The wide availability of this receptor facilitates COVID-19 infection to be proactive and multiply in the GI tract. Although no antiviral treatments have been approved, several approaches have been proposed, and at present, optimized supportive care remains the mainstay of therapy. Elective endoscopic procedures should be delayed, but the urgent procedures should be performed as indicated. Due to the rapidly evolving data on COVID-19, it is difficult to keep up with the outpouring of information. We reviewed the mechanisms, clinical manifestation, impact on pre-existing liver diseases, and recommendations endorsed by the several GI societies for the management and prevention of its transmission.
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http://dx.doi.org/10.7759/cureus.8750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377012PMC
June 2020

Acute Kidney Injury in a Case Series of Patients with Confirmed COVID-19 (Coronavirus Disease 2019): Role of Angiotensin-Converting Enzyme 2 and Renin-Angiotensin System Blockade.

Case Rep Nephrol 2020 29;2020:8811931. Epub 2020 Jun 29.

Department of Internal Medicine, Division of Nephrology, Adventist Medical Center, Hanford 93230, CA, USA.

The renin-angiotensin system plays a very critical role in hypertension, diabetes, and kidney and heart diseases. The blockade of the renin-angiotensin system results in the prevention of progression of renal and cardiac damage. There have been controversial hypotheses raised regarding the safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in COVID-19 (coronavirus disease 2019). We present the case series of four patients (2 men and 2 women; 1 Caucasian and 3 African Americans; two survived and two died) with confirmed COVID-19, presenting with respiratory symptoms and acute kidney injury, who have been on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Membrane-bound angiotensin-converting enzyme 2 (ACE2) has been implicated as the gateway for viral entry into the human cell in causing the infection. The factors contributing to acute kidney injury are diuretics, iodinated contrast administration, hemodynamic instability apart from ACE inhibitors, and angiotensin receptor blockers. The ACE inhibitors and ARBs were stopped in these patients due to acute kidney injury. We also discussed the role of ACE2 and the renin-angiotensin system (RAS) blockade in patients with COVID-19 infection along with pathogenesis.
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http://dx.doi.org/10.1155/2020/8811931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341421PMC
June 2020

Clinical characteristics and predictors of mortality in African-Americans with COVID-19 from an inner-city community teaching hospital in New York.

J Med Virol 2021 02 5;93(2):812-819. Epub 2020 Oct 5.

Department of Medicine, Interfaith Medical Center, Brooklyn, New York.

There is limited data on the clinical presentation and predictors of mortality in the African-American (AA) patients hospitalized with coronavirus disease 2019 (COVID-19) despite the disproportionately higher burden and mortality. The aim of this study is to report on the clinical characteristics and the predictors of mortality in hospitalized AA patients with COVID-19 infection. In this retrospective cohort review, we included all AA patients with confirmed COVID-19 infection admitted to an inner-city teaching community hospital in New York city. Demographics, clinical presentation, baseline co-morbidities, and laboratory data were compared between survivors and non-survivors. The predictors of mortality were assessed using multivariate logistic regression analysis. Of the 408 (median age, 67 years) patients included, 276 (66.65%, median age 63 years) survived while 132 (33.35%, median age 71 years) died. The most common presenting symptoms were cough, myalgia, fever/chills, shortness of breath, and gastrointestinal symptoms (nausea, vomiting, diarrhea, and abdominal pain), with a prevalence of 62.50%, 43.87%, 53.68%, and 27.21%, respectively. Age (odds ratio [OR], 1.06; confidence interval [CI], 1.04-1.08; P < .001), body mass index (OR, 1.07; CI, 1.04-1.11; P < .001), elevated serum ferritin (OR, 1.99; CI, 1.08-3.66; P < .02), C-reactive protein (OR, 2.42; CI, 1.36-4.33; P < .01), and D-dimers (OR, 3.79; CI, 2.21-6.50; P < .001) at the time of presentation were identified as the independent predictors of mortality. Cough, shortness of breath, fever/chills, gastrointestinal symptoms, and myalgia were the predominant presentation among AAs hospitalized with COVID-19 infection. Advanced age, higher body mass index, elevated serum ferritin, C-reactive protein, and D-dimers are independent predictors of mortality among hospitalized AAs with COVID-19 infection.
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http://dx.doi.org/10.1002/jmv.26306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405133PMC
February 2021

COVID-19 Pandemic Causing Acute Kidney Injury and Impact on Patients With Chronic Kidney Disease and Renal Transplantation.

J Clin Med Res 2020 Jun 4;12(6):352-361. Epub 2020 Jun 4.

Division of Medical Oncology, Department of Internal Medicine, Ashland Bellefonte Cancer Center, Ashland, KY 41169, USA.

Coronavirus disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) has caused significant mortality and has been declared as a global pandemic by the World Health Organization. The infection mainly presents as fever, cough, and breathing difficulty, and few patients develop very severe symptoms. The purpose of this review is to analyze the impact of the virus on the kidney. COVID-19 infection causes acute kidney injury (AKI) and is an independent risk factor for mortality. Angiotensin-converting enzyme 2 (ACE2) receptors, direct viral damage, and immune-mediated damage play important roles in the pathogenesis. AKI in COVID-19 infection could be from the synergistic effect of virus-induced direct cytotropic effect and cytokine-induced systemic inflammatory response. AKI caused in the viral infection has been analyzed from the available epidemiological studies. The proportion of patients developing AKI is significantly higher when they develop severe disease. Continuous renal replacement therapy (CRRT) is the most used blood purification technique when needed. The impact of COVID-19 infection on chronic kidney disease (CKD) and renal transplant patients is also discussed in the manuscript. No vaccine has been developed against the 2019-nCoV virus to date. The critical aspect of management is supportive care. Several investigative drugs have been studied, drugs approved for other indications have been used, and several clinical trials are underway across the globe. Recently remdesivir has received emergency use authorization by the Food and Drug Administration (FDA) in the USA for use in patients hospitalized with COVID-19. Prevention of the infection holds the key to management. The patients with underlying kidney problems and renal transplant patients are vulnerable to developing COVID-19 infection.
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http://dx.doi.org/10.14740/jocmr4200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295554PMC
June 2020

Medical Management of COVID-19: Evidence and Experience.

J Clin Med Res 2020 Jun 4;12(6):329-343. Epub 2020 Jun 4.

Divison of Medical Oncology, Department of Internal Medicine, Ashland Bellefonte Cancer Center, Ashland, KY 41169, USA.

Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and this infectious disease is termed COVID-19 in short. On a global scale, as of June 1, 2020, the World Health Organization (WHO) published statistics of 6,057,853 infected patients and 371,166 deaths worldwide. Despite reported observational data about the experimental use of certain drugs, there is no conclusively proven curative therapy for COVID-19 as of now; however, remdesivir received emergency use authorization (EUA) by the Food and Drug Administration (FDA) recently for use in patients hospitalized with COVID-19. There are several ongoing clinical trials related to the pharmacological choices of therapy for COVID-19 patients; however, drug trials related to observational studies so far have yielded mixed results and therefore have created a sense of confusion among healthcare professionals (HCPs). In this review article, we seek to collate and provide a summary of treatment strategies for COVID-19 patients with a variable degree of illness and discuss pharmacologic and other therapies intended to be used either as experimental medicine/therapy or as part of supportive care in complicated cases of COVID-19.
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http://dx.doi.org/10.14740/jocmr4201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295552PMC
June 2020

Incidence, Predictors, Causes, and Cost of 30-Day Hospital Readmission in Chronic Obstructive Pulmonary Disease Patients Undergoing Bronchoscopy.

Cureus 2020 Jun 13;12(6):e8607. Epub 2020 Jun 13.

Pulmonary Medicine, Interfaith Medical Center, Brooklyn, USA.

Introduction Chronic obstructive pulmonary disease (COPD) has a significant disease burden and is among the leading causes of hospital readmissions, adding a significant burden on healthcare resources. The association between 30-day readmission in a COPD patient undergoing bronchoscopy and a wide range of modifiable potential risk factors, after adjusting for sociodemographic and clinical factors, has been assessed, and comparison has been made with COPD patients not undergoing bronchoscopy. Methods We conducted a comprehensive analysis of the 2016 Nationwide Readmission Database (NRD) of 30-day all-cause readmission among COPD patients undergoing bronchoscopy. A Cox's proportional hazards model was used to obtain independent relative risks of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy. Our primary outcome was the 30-day all-cause readmission rate in both groups. Other secondary outcomes of interest were the 10 most common reasons for readmission, resource utilization, independent predictors of readmission, and relative proportion of comorbidities between the index admission (IA) and the readmission in both groups. Results The overall rate of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy was 17.32% and 15.87%, respectively. The final multivariate model in the bronchoscopy group showed that the variables found to be an independent predictor of readmission were: pulmonary hypertension (hazard ratio [HR] 2.35; 95% confidence interval [CI] 1.26-4.25; P < .01), adrenal insufficiency (HR 4.47; 95% CI 1.44-13.85; P = .01) and discharge to rehab status. Independent predictor variables of admission in Group B were gender (women < men; HR 0.91; 95% CI 0.88-0.93; P < .01), and type of insurance (Medicaid > Medicare > private insurance). For all patients undergoing bronchoscopy, the mean length of stay (LOS) for IA was 11.91 ± 20.21 days, and LOS for readmission was 5.87 ± 5.48 days. The mean total cost of IA for patients undergoing bronchoscopy was much higher than that of readmission ($26,916 vs. $12,374, respectively). The entire LOS for readmission was 1,265 days, with a total cost of $2.66 million. For patients not undergoing bronchoscopy during the IA, mean LOS for IA was 4.26 ± 4.27 days, and mean LOS for readmission was 5.39 ± 5.51 days, which was longer than the IA in Group B but still shorter than LOS for readmission in Group A (patients undergoing bronchoscopy). The mean total cost of readmission was higher than the IA ($8,137 for IA vs. $10,893 for readmission). The total LOS in this group of patients was 313,287 days, with the total cost of readmission at $628 million. Conclusions Patients undergoing bronchoscopy have a slightly higher rate of 30-day readmissions as compared to patients not undergoing bronchoscopy, and the LOS is also slightly higher in this group during subsequent readmissions as compared to readmission in patients not undergoing bronchoscopy in IA. The readmission rate in COPD patients is impacted by a variety of social, personal, and medical factors. Patients with multiple medical comorbidities have a higher risk of readmission. In our understanding, bronchoscopy in a patient with acute exacerbation of COPD should be reserved for selected patients, and the rationale should be clarified, as it affects the overall LOS and healthcare expenditure.
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http://dx.doi.org/10.7759/cureus.8607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294856PMC
June 2020

Coronavirus Disease 2019 (COVID-19) in a Renal Transplant Patient.

Cureus 2020 May 9;12(5):e8038. Epub 2020 May 9.

Nephrology, Kaweah Delta Medical Center, Visalia, USA.

Coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. Transplant patients are particularly at a higher risk of contracting COVID-19 because of their immunosuppressed state, and they have the propensity to develop opportunistic infections. The pre-immunosuppressed state, along with other existing comorbidities, can influence the outcomes of COVID-19 in transplant patients. We describe a case of a renal transplant patient who developed COVID-19. Real-time nucleic acid testing (NAT) should be done in deceased and living donors. The most common management strategy is the modification of immunosuppression along with current experimental strategies for COVID-19.
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http://dx.doi.org/10.7759/cureus.8038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282362PMC
May 2020

A Case Series of Patients Coinfected With Influenza and COVID-19.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620934674

Interfaith Medical Center, Brooklyn, NY, USA.

Coronavirus disease 2019, also called COVID-19, is a global pandemic resulting in significant morbidity and mortality worldwide. In the United States, influenza infection occurs mainly during winter and several factors influence the burden of the disease, including circulating virus characteristics, vaccine effectiveness that season, and the duration of the season. We present a case series of 3 patients with coinfection of COVID-19 and influenza, with 2 of them treated successfully and discharged home. We reviewed the literature of patients coinfected with both viruses and discussed the characteristics, as well as treatment options.
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http://dx.doi.org/10.1177/2324709620934674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290261PMC
June 2020

Reply to Comment on "An Unusual Case of Acquired Angioedema and Monoclonal Gammopathy of Renal Significance in a Middle-Aged Caucasian Female".

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620929478

Lynchburg Nephrology Physicians, Lynchburg, VA, USA.

We sincerely thank Dr Andrew Whyte, who keenly reviewed our case report and came up with critical reasoning to justify his thoughts and critique with regard to our published article, "An Unusual Case of Acquired Angioedema and Monoclonal Gammopathy of Renal Significance in a Middle-Aged Caucasian Female." We agree with the author that hypocomplementemic urticarial vasculitis can be a reasonable contender as a diagnosis in this case. There are indeed some features in this case that do not entirely fit either classic presentation of acquired angioedema or hypocomplementemic urticarial vasculitis. Both diseases being equally rare, we tried to focus on the association of proliferative glomerulonephritis with angioedema-like features in this patient and considered acquired angioedema as the unifying diagnosis.
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http://dx.doi.org/10.1177/2324709620929478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273557PMC
September 2020

A Comprehensive Approach Is Vital for Diagnosing COVID-19: A Case of False Negative.

J Clin Med Res 2020 May 8;12(5):315-319. Epub 2020 May 8.

Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, KY 41169, USA.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading at a rapid pace throughout the world, and the World Health Organization (WHO) declared it as pandemic on March 11, 2020. We present a case of COVID-19 patient whose reverse transcription-polymerase chain reaction (RT-PCR) initially was false negative and later turned positive, which will stress the importance of a comprehensive approach while evaluating a patient with a differential of COVID-19. The clinicians should be aware of the sensitivity and specificities of these tests which can have grave implications on the patient and community if the diagnosis is missed just based on the laboratory tests due to the highly contagious nature of the disease.
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http://dx.doi.org/10.14740/jocmr4173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239581PMC
May 2020

COVID-19 and Renal Failure: Challenges in the Delivery of Renal Replacement Therapy.

J Clin Med Res 2020 May 8;12(5):276-285. Epub 2020 May 8.

Division of Nephrology, Lynchburg Nephrology Physicians, Lynchburg, VA, USA.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first officially reported in December 2019 in Wuhan City, Hubei province, China, and has since lead to a pandemic. Most cases result in minor symptoms such as cough, fever, sore throat, myalgia, fatigue, nausea, diarrhea, loss of smell, and abdominal pain. As of April 8, 2020, more than 1,485,000 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in over 90,000 deaths. Outcomes are worse in elderly patients, particularly males, and those with comorbidities, but can affect any age group. The incidence of acute kidney injury in patients with COVID-19 infection is about 3-15%; and in patients with severe infection requiring care in the intensive care unit, the rates of acute kidney injury increased significantly from 15% to 50%. Acute kidney injury is an independent risk factor for mortality in COVID-19 patients. The nephrologists, as well as intensivists, are facing immense daily challenges while providing care for these patients in the inpatient setting as well as end-stage renal disease patients on chronic dialysis in both inpatient and outpatient settings. In the current review article, we discussed the epidemiology and etiology of acute kidney injury, management of acute kidney injury including renal replacement therapy options (both hemodialysis and peritoneal dialysis) for inpatient floor, as well as intensive care unit settings. We also discussed the challenges faced by the outpatient dialysis units with COVID-19 infection. We discussed measures required to limit the spread of infection, as well as summarized the guidance as per the Centers for Disease Control and Prevention (CDC), American Society of Nephrology (ASN), American Society of Diagnostic and Interventional Nephrology (ASDIN) and the Vascular Access Society of the Americas (VASA).
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http://dx.doi.org/10.14740/jocmr4160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239583PMC
May 2020