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Sohal A, Kowdley KV. Novel preclinical developments of the primary sclerosing cholangitis treatment landscape. Expert Opin Investig Drugs 2024; 33:335-345. [PMID: 38480008 DOI: 10.1080/13543784.2024.2330738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease associated with inflammation, fibrosis, and destruction of intra- and extrahepatic bile ducts. Despite substantial recent advances in our understanding of PSC, the only proven treatment of PSC is liver transplantation. There is an urgent unmet need to find medical therapies for this disorder. AREAS COVERED Multiple drugs are currently under evaluation as therapeutic options for this disease. This article summarizes the literature on the various novel therapeutic options that have been investigated and are currently under development for the treatment of PSC. EXPERT OPINION In the next decade, more than one drug will likely be approved for the treatment of the disease, and we will be looking at combination therapies for the optimal management of the disease.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, USA
| | - Kris V Kowdley
- Department of Hepatology, Liver Institute Northwest, Seattle, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, USA
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Bains K, Iqbal H, Attri A, Dhiman M, Singh I, Kohli I, Chaudhry H, Dukovic D, Sohal A, Yang J. Impact of Gender on Gastroesophageal Reflux Disease Complications: Analysis of 27 Million Hospitalizations. J Gastrointestin Liver Dis 2024; 33:19-24. [PMID: 38554413 DOI: 10.15403/jgld-5174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/24/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND AND AIMS Previous studies have reported gender differences in patients with gastroesophageal reflux disease (GERD). These studies have also reported differences based on gender in the rates of complications. In this study, we aim to identify gender disparities in the rates of GERD complications in the United States. METHODS We queried the 2016-2020 National Inpatient Sample database to identify patients with GERD. Patients with eosinophilic esophagitis or missing demographics were excluded. We compared patient demographics, comorbidities and complications based on gender. Multivariate logistic regression analysis was used to identify the impact of gender on complications of GERD. RESULTS 27.2 million patients were included in the analysis. Out of them, 58.4% of the hospitalized patients with GERD were female. Majority of the women were White (75%), aged>65 years (57.5%) and were in the Medicare group (64%). After adjusting for confounders, females were noted to have lower odds of esophagitis (aOR=0.85, 95%CI: 0.84-0.86, p<0.001), esophageal stricture (aOR=0.95, 95%CI: 0.93-0.97, p<0.001), Barrett's esophagus (aOR=0.58, 95%CI: 0.57-0.59, p<0.001) and esophageal cancer (aOR=0.22, 95%CI: 0.21-0.23, p<0.001). CONCLUSIONS Our study confirms the findings of previous literature that females, despite comprising the majority of the study population, had a lower incidence of GERD related complications. Further studies identifying the underlying reason for these differences are required.
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Affiliation(s)
- Kanwal Bains
- Department of Internal Medicine, University of Arizona, AZ, USA. .
| | - Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA.
| | - Amit Attri
- Department of Internal Medicine, Dayanand Medical College and Hospital, India.
| | - Mukul Dhiman
- Department of Internal Medicine, Punjab Institute of Medical Sciences, India.
| | - Ishandeep Singh
- Department of Internal Medicine, Dayanand Medical College and Hospital, India.
| | - Isha Kohli
- Graduate School of Public Health, Icahn School of Medicine, NY, USA.
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA.
| | - Dino Dukovic
- Ross University of Medical Sciences, Miramar, FL, USA.
| | - Aalam Sohal
- Department of internal medicine , University of California San Francisco Fresno, Fresno , California.
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch Galveston, TX, USA.
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Patel J, Khanna T, Sohal A, Dhaliwal A, Chaudhry H, Kalra S, Singh I, Dukovic D, Bains K. Impact of aspirin use on rates of metastasis in patients with esophageal cancer: insights from the National Inpatient Sample. Dis Esophagus 2024:doae022. [PMID: 38525938 DOI: 10.1093/dote/doae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
Despite advancing treatment methods, esophageal cancer (EC) maintains a high mortality rate and poor prognosis. Through various mechanisms, aspirin has been suggested to have a chemopreventive effect on EC. However, the long-term impact, particularly regarding the rate of metastasis, needs to be further elucidated. NIS 2016-2020 was used to identify adult patients (age > 18 years) with EC using ICD-10 codes. Patients with missing demographics and mortality were excluded. Patients were stratified into two groups based on aspirin use. Data were collected on patient demographics, Elixhauser Comorbidity Index (ECI), and comorbidities (hypertension, chronic pulmonary disease, coronary artery disease (CAD), chronic kidney disease (CKD), congestive heart failure (CHF), coagulopathy, alcohol use, smoking, and obesity). The outcomes studied were rates of total metastasis, gastrointestinal (GI) metastasis, non-GI metastasis, and lymphoid metastasis. Multivariate logistic regression analysis was performed to evaluate the impact of aspirin use on various metastases after adjusting for patient demographics, comorbidities, and ECI. Out of 190,655 patients, 20,650 (10.8%) patients were aspirin users. Majority of the patients in the aspirin group were aged > 65 years (74.7%), males (82.1%), White race (84%), and had medicare insurance (71%). There was a higher incidence of diabetes, hypertension, chronic pulmonary disease, CAD, CKD, CHF, and smoking in aspirin users than non-aspirin users. Patients with aspirin users had a lower incidence of metastasis (28.9% vs. 38.7%, P < 0.001), GI metastasis (14.2% vs. 20.6%, P < 0.001), non-GI metastasis (15.1% vs. 22%, P < 0.001), and lymphoid metastasis (8.9% vs. 11.3%, P < 0.001) than non-aspirin users. After adjusting for confounding factors, patients with aspirin use had lower odds of having metastasis (aOR-0.73, 95% CI-0.70-0.77, P < 0.001). Our study noted that aspirin use is associated with a reduction in the rate of metastasis in patients with EC. These studies support the use of aspirin in patients with EC and suggest the need for further studies to understand the mechanism by which aspirin use reduces metastasis in patients with EC.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Tejasvini Khanna
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Shivam Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Dino Dukovic
- Ross University School of Medicine, Miramar, FL, USA
| | - Kanwal Bains
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
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Sohal A, Chaudhry H, Sharma R, Dhillon N, Kohli I, Singla P, Arora K, Dukovic D, Verma M, Roytman M. Recent Trends in Palliative Care Utilization in Patients With Decompensated Liver Disease: 2016-2020 National Analysis. J Palliat Med 2024; 27:335-344. [PMID: 37851991 DOI: 10.1089/jpm.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: Patients with end-stage liver disease (ESLD) have a poor quality of life, which often worsens as disease severity increases. Palliative care (PC) has emerged as a management option in ESLD patients, especially for those who are not candidates for a liver transplant. Objective: To assess the associated factors and trends in PC utilization in recent years. Design: We used the 2016-2020 National Inpatient Sample (NIS) database of the United States to identify patients with decompensated cirrhosis who suffered in-hospital mortality. Information regarding patient demographics, hospital characteristics, etiology and decompensations, Elixhauser comorbidities, and interventions was collected. The multivariate regression model was used to identify factors associated with PC use. Results: Out of 98,160 patients, 52,645 patients (53.6%) received PC consultations. PC utilization increased from 49.11% in 2016 to 56.85% in 2019, with a slight decrease to 54.47% in 2020. Patients with PC use had decreased incidence of blood transfusions (28.85% vs. 36.53%, p < 0.001), endoscopy (18% vs. 20.26%, p 0.0001), liver transplantation (0.28% vs. 0.69%, p < 0.001), and mechanical ventilation (46.22% vs. 56.37%, p < 0.001). African American, Hispanic, and Asian/Pacific Islander patients had 29%, 27%, and 23% lower odds of receiving PC than White patients. Patients in the two lowest income quartiles had 12% and 22% lower odds of receiving PC compared with the highest quartile. Conclusions: PC utilization in patients with ESLD is associated with decreased invasive procedures, shorter lengths of stay, and lower hospitalization charges. Minorities, as well as patients in the lower income quartiles, were less likely to receive PC.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, Fresno, California, USA
| | - Ragini Sharma
- Department of Internal Medicine, Maullana Azad Medical College, New Delhi, India
| | - Nimrat Dhillon
- Department of Internal Medicine, Shri Guru Ram Das Medical College, Amritsar, India
| | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Piyush Singla
- Department of Internal Medicine, Dayanand Medical College, and Hospital, Punjab, India
| | - Kirti Arora
- Department of Internal Medicine, Dayanand Medical College, and Hospital, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Miramar, Florida, USA
| | - Manisha Verma
- Department of Gastroenterology and Hepatology, Einstein Healthcare Network, Philadelphia, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, Fresno, Fresno, California, USA
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Patel J, Sohal A, Chaudhry H, Kalra S, Kohli I, Singh I, Dukovic D, Yang J. Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016-2020. Eur J Gastroenterol Hepatol 2024; 36:298-305. [PMID: 38179867 DOI: 10.1097/meg.0000000000002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD. METHODS National Inpatient Sample 2016-2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics. RESULTS Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P < 0.001). CONCLUSION Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco-Fresno, California, USA
| | - Shivam Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Isha Kohli
- Department of Graduate Public Health, Icahn School of Medicine, Mount Sinai, New York
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, Barbados
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas, USA
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Iqbal H, Patel J, Singh I, Kohli I, Thind N, Dhiman M, Sohal A, Yang J. The impact of Clostridioides difficile infection on outcomes among kidney transplant recipients. Am J Infect Control 2024:S0196-6553(24)00079-8. [PMID: 38395312 DOI: 10.1016/j.ajic.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality among hospitalized patients, particularly those who are immunosuppressed. We aim to assess the outcomes of CDI among kidney transplant (KT) recipients. METHODS Nationwide Inpatient Sample from 2016 to 2020 was used to identify patients with KT and stratify based on the presence of CDI. Data were collected regarding demographics and comorbidities. Outcomes included in-hospital mortality, acute kidney injury, intensive care unit admission, transplant rejection, transplant failure, length of stay, and total hospitalization charges. The relationships between variables of interest and outcomes were analyzed using multivariate regression. RESULTS A total of 557,635 KT recipients were included. CDI prevalence was 2.4%. The majority of patients in the CDI group were age >65 (43.6%), female (51%), White (55.3%), and had Medicare insurance (74.9%). On multivariate regression analysis, CDI was associated with increased odds of acute kidney injury (aOR 2.06, p < 0.001), intensive care unit admission (aOR 2.47, p < 0.001), and mortality (aOR 1.90, p < 0.001). CDI was also associated with longer length of stay (9.35 days vs 5.42 days, p < 0.001) and higher total hospitalization charges ($110,063 vs $100,006, p < 0.001). There was no difference in transplant rejection, complication, failure, or infection among KT recipients with CDI and those without. CONCLUSIONS We found that CDI was associated with worse outcomes and higher costs. KT patients should be monitored closely for signs of CDI in order to initiate appropriate management.
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Affiliation(s)
- Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, CA
| | - Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH
| | - Ishandeep Singh
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Isha Kohli
- Graduate School of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nuhar Thind
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Mukul Dhiman
- Department of Internal Medicine, Punjab Institute of Medical Sciences, Jalandhar, India
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA.
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX
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Iqbal H, Sohal A, Aburayyan K, Hans B, Yang J. Cystic duct disimpaction for acute cholecystitis in the high-risk cholecystectomy patient: Case report. SAGE Open Med Case Rep 2024; 12:2050313X241232262. [PMID: 38357011 PMCID: PMC10865939 DOI: 10.1177/2050313x241232262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Acute cholecystitis is a common cause of Emergency Department presentation and hospital admission. It is usually treated with early surgical removal of the gallbladder; however, some patients may not be fit to undergo the procedure due to critical illness or comorbidities. In these patients, options are limited. Endoscopic retrograde cholangiopancreatography interventions in this population are not well-studied. We present a case of a high-risk 59 year old female patient with a history of end-stage renal disease, heart failure, hypertension, pulmonary hypertension, and type 2 diabetes who presented with acute cholecystitis. She was successfully treated with cystic duct disimpaction without stenting, and continues to do well post-procedure with complete resolution of symptoms and abnormal lab findings.
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Affiliation(s)
- Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | | | - Kanana Aburayyan
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, USA
| | - Bandhul Hans
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, USA
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, USA
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Sohal A, Kayani S, Kowdley KV. Primary Sclerosing Cholangitis: Epidemiology, Diagnosis, and Presentation. Clin Liver Dis 2024; 28:129-141. [PMID: 37945154 DOI: 10.1016/j.cld.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Primary sclerosing cholangitis (PSC) is considered an immunologically mediated disease. However, some of its features are not consistent with the typical profile of autoimmune conditions. PSC is characterized by progressive biliary fibrosis that may ultimately result in the eventual development of cirrhosis. In recent years, multiple studies have reported that the incidence and prevalence of this disease are on the rise. Consequently, patients are often diagnosed without symptoms or signs of advanced liver disease, although many still present with signs of decompensated liver disease. This article discusses the epidemiology, clinical presentation, and diagnostic workup in patients with PSC.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, , 3216 Northeast 45th Place, Suite 212, Seattle, WA 98105, USA
| | - Sanya Kayani
- Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Kris V Kowdley
- Liver Institute Northwest, , 3216 Northeast 45th Place, Suite 212, Seattle, WA 98105, USA; Elson Floyd College of Medicine, Spokane, WA, USA.
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Sohal A, Kohli I, Chaudhry H, Singh I, Arora K, Kalra S, Dukovic D, Roytman M. Vaccine-Preventable Illness Leads to Adverse Outcomes in Liver Transplant Recipients. Dig Dis Sci 2024; 69:588-595. [PMID: 38030833 DOI: 10.1007/s10620-023-08202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Liver transplant recipients (LTR) and patients with chronic liver disease (CLD) are at an increased risk of infections. AIMS The objective of our study was to assess the incidence, and impact of vaccine preventable illness (VPI) on outcomes in LTR. METHODS National Inpatient Sample (NIS) 2016-2020 was used to identify adults (age > 18) hospitalized LTR using ICD-10 codes. Data were collected on patient demographics, hospital characteristics, etiology of liver disease, hepatic decompensations and outcomes. Patients were stratified into two groups based on the presence or absence of VPI. Multivariate logistic regression analysis was performed to identify the association between VPI and outcomes. RESULTS Out of 170,650 hospitalized LTR, 13.5% of the patients had VPI. The most common VPI was noted to be influenza (10.7%), followed by pneumococcal infection (2.7%). Incidence of mortality (6.9% vs. 1.6%, p < 0.001), ICU admissions (14.3% vs. 3.4%, p < 0.001), and acute kidney injury (AKI) (43.7% vs 37.35%, p < 0.001) was higher in the VPI group. CONCLUSION More than 13% of the LT hospitalizations had concomitant VPI. VPI in LTR was associated with worse outcomes. Our data suggests the need to identify factors associated with reduced vaccination rates and identify strategies to improve vaccination rates and responses in these patients.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, 3216 NE 45Th Pl, Suite 212, Seattle, WA, 98105, USA.
| | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA
| | | | - Kirti Arora
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Shivam Kalra
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Dino Dukovic
- Ross University of Medical Sciences, Miramar, FL, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA
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Sohal A, Kowdley KV. A Review of New Concepts in Iron Overload. Gastroenterol Hepatol (N Y) 2024; 20:98-107. [PMID: 38414914 PMCID: PMC10895914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Iron overload disorders are conditions that can lead to increased body iron stores and end-organ damage in affected organs. Increased iron deposition most commonly occurs in the liver, heart, endocrine system, joints, and pancreas. Iron overload disorders may be caused by genetic or acquired causes (transfusion, dyserythropoiesis, and chronic liver disease). The HFE gene C282Y homozygous mutation is the most common cause of hereditary hemochromatosis (HH). Other genes implicated in HH include TFR2, HAMP, HJV, and SLC40A1. In the past 2 decades, there have been major advances in the understanding of genetic iron overload disorders. Furthermore, new novel techniques to measure iron content in organs noninvasively, as well as new therapeutic options for the treatment of HH, are currently under development. This article focuses on the latest concepts in understanding, diagnosing, and managing genetic iron overload disorders, particularly HH.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, Seattle, Washington
| | - Kris V Kowdley
- Liver Institute Northwest, Seattle, Washington
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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Sohal A, Chaudhry H, Roytman M, Kowdley KV. Author response: The impact of COVID-19 on the hospitalization and outcomes of patients with alcohol-related hepatitis. Am J Med Sci 2024; 367:145-146. [PMID: 38040247 DOI: 10.1016/j.amjms.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 12/03/2023]
Affiliation(s)
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco- Fresno, CA, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco- Fresno, CA, USA
| | - Kris V Kowdley
- Liver Institute Northwest, Seattle, WA, USA; Elson Floyd College of Medicine, Washington State University, Spokane, WA, USA.
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Patel J, Sohal A, Bains K, Chaudhry H, Kohli I, Khanna T, Dukovic D, Roytman M. Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database. BMJ Open Gastroenterol 2024; 11:e001224. [PMID: 38237944 PMCID: PMC10870785 DOI: 10.1136/bmjgast-2023-001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES The study aimed to compare the risk of gastrointestinal infections among patients with and without metabolic dysfunction-associated fatty liver disease (MAFLD). METHODS This was a population-based, retrospective, observational study using data from the National Inpatient Sample (NIS), the largest all-payer US inpatient care database. SETTING Hospitalisation of adults aged ≥18 years old admitted in 2020 was identified using the NIS. Patients were stratified by the presence and absence of MAFLD. PARTICIPANTS 26.4 million adults aged ≥18 years old were included in the study. Patients younger than 18 and those with missing demographic or mortality data were excluded. PRIMARY AND SECONDARY OUTCOMES Primary outcome was to assess the overall risk of gastrointestinal infections in patients with and without MAFLD. Secondary outcomes were demographics and comorbidities stratified by the presence or absence of gastrointestinal infection, and the risk of specific gastrointestinal pathogens. RESULTS Of 26.4 million patients admitted in 2020, 755 910 (2.85%) had the presence of MAFLD. There was a higher prevalence of bacterial gastrointestinal infections in patients with MAFLD than those without (1.6% vs 0.9%, p<0.001). The incidence of Clostridioides difficile (1.3% vs 0.8%, p<0.001), Escherichia coli (0.3% vs 0.01%, p<0.001), and Salmonella (0.07% vs 0.03%, p<0.001) was higher in patients with MAFLD. The presence of MAFLD was associated with higher odds of developing gastrointestinal infections (adjusted OR (aOR) -1.75, 95% CI -1.68 to 1.83, p<0.001). After adjusting for confounders, results remained statistically significant (aOR -1.36, 95% CI - 1.30-1.42, p<0.001). CONCLUSION Even after adjusting for confounding factors, our study demonstrates an increased risk of gastrointestinal infections in patients with MAFLD, specifically of C. difficile, E. coli, and Salmonella. The immune and microbiota changes seen within MAFLD potentially contribute to the increased risk of gastrointestinal infections.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aalam Sohal
- Liver Institute Northwest, Seattle, Washington, USA
| | | | - Hunza Chaudhry
- UCSF Fresno Center for Medical Education and Research, Fresno, California, USA
| | - Isha Kohli
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Dino Dukovic
- Ross University School of Medicine, Miramar, California, USA
| | - Marina Roytman
- Department of Gastroenterology & Hepatology, University of California San Francisco, San Francisco, California, USA
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Sohal A, Kowdley KV. Complete Biochemical Remission With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis and High Serum Immunoglobulin G4 Levels. ACG Case Rep J 2024; 11:e01256. [PMID: 38236497 PMCID: PMC10793982 DOI: 10.14309/crj.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease characterized by intrahepatic and extrahepatic bile duct strictures leading to cirrhosis. A subtype with elevated serum immunoglobulin (Ig) G4 levels has been recently identified. Elevated IgG4 titers can be present in 9%-15% of patients with PSC. Currently, liver transplantation is the only effective treatment of PSC, although multiple medical therapies are under evaluation. We report a case of a young adult with PSC and elevated IgG4 levels who had marked serum aminotransferase elevation; the patient had an incomplete response to steroids but achieved complete biochemical remission after initiation of oral vancomycin.
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Affiliation(s)
| | - Kris V. Kowdley
- Liver Institute Northwest, Seattle, WA
- Elson Floyd College of Medicine, Spokane, WA
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14
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Iqbal H, Mehmood BF, Sohal A, Roytman M. Hepatitis E infection: A review. World J Virol 2023; 12:262-271. [PMID: 38187497 PMCID: PMC10768387 DOI: 10.5501/wjv.v12.i5.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023] Open
Abstract
Hepatitis E virus (HEV) is a small non-enveloped virus that is transmitted via the fecal-oral route. It is a highly common cause of acute hepatitis, particularly in low to middle income regions of Asia, Africa, and Central America. Most cases are self-limited, and symptomatic patients usually present with acute icteric hepatitis. A subset of patients including pregnant women, older men, those with pre-existing liver disease and immunocompromised patients however, may develop severe disease and hepatic failure. Immunocompromised patients are also at risk for chronic infection, and their immunosuppression should be decreased in order to facilitate viral clearance. HEV can also present with a variety of extra-intestinal manifestations including neurological, renal, hematological, and pancreatic derangements. The gold standard of diagnosis is HEV ribonucleic acid detection via nucleic acid amplification testing. Currently, there are no approved treatments for Hepatitis E, though ribavirin is the most commonly used agent to reduce viral load. Studies assessing the safety and efficacy of other antiviral agents for HEV are currently underway. HEV vaccination has been approved in China, and is currently being investigated in other regions as well. This review article aims to discuss the epidemiology, pathogenesis, presentation, diagnosis, complications, and treatment of Hepatitis E infection.
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Affiliation(s)
- Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, CA 93701, United States
| | - Bilal Fazal Mehmood
- Department of Internal Medicine, University of California San Francisco, Fresno, CA 93701, United States
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93701, United States
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15
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Iqbal H, Arora GS, Singh I, Kohli I, Chaudhry H, Sohal A, Prajapati D. The impact of aspirin use on outcomes in patients with inflammatory bowel disease: Insights from a national database. Int J Colorectal Dis 2023; 39:6. [PMID: 38117356 PMCID: PMC10733222 DOI: 10.1007/s00384-023-04575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an inflammatory disorder that can increase the risk of mortality. Aspirin is an anti-inflammatory drug used for primary prevention of cardiovascular events. A single center analysis previously reported that aspirin use did not impact major outcomes in IBD. In this study, we aim to assess the impact of aspirin use on mortality and other outcomes in patients with IBD using national data. METHODS National inpatient sample (NIS) 2016-2020 was used to identify adult patients with IBD. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, Intensive Care Unit (ICU) admission, and need for surgery. Multivariate logistic regression analysis was performed. RESULTS A total of 1,524,820 IBD hospitalizations were included. Of these, 137,430 (9%) were long-term aspirin users. The majority of the patients in the aspirin group were aged > 65 years (34.11%), female (56.37%), White (78.83%) and had Medicare insurance (36.77%). Aspirin users had a lower incidence of in-hospital mortality (1.6% vs 1.4%, P = 0.06), sepsis (2.5% vs 2.9%, P < 0.001), shock (2.9% vs 3.4%, P < 0.001), ICU admission (2.6% vs 2.9%, P < 0.001), need for surgery (2.1% vs 4.2%, P < 0.001). After adjusting for confounders, aspirin was associated with a reduction in mortality (adjusted odds ratio: 0.49, 95%CI 0.45-0.55, P < 0.001). CONCLUSION Our study reports that aspirin use among patients with IBD was associated with a lower risk of death, sepsis, and shock. Aspirin use may have a protective effect in patients with IBD. Further studies are needed to confirm these results.
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Affiliation(s)
- Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, USA.
| | | | | | - Isha Kohli
- Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco, Fresno, USA
| | | | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, USA
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16
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Sohal A, Chaudhry H, Dukovic D, Kowdley KV. Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations. JGH Open 2023; 7:848-854. [PMID: 38162842 PMCID: PMC10757492 DOI: 10.1002/jgh3.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States. Methods Patients with HRS were identified from the national inpatient sample 2016-2019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non-teaching hospitals (NTHs), teaching non-transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching/transplant status and in-hospital mortality and transplant-free mortality was examined using multivariable linear and logistic regression analysis. Results A total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non-TTCs (aOR = 0.75, 95% CI: 0.68-0.83, P <0.001). Patients at TTCs had a lower transplant-free mortality risk than those at NTHs (aOR = 0.75, 95% CI: 0.67-0.83, P < 0.001). There was no significant difference in all-cause or transplant-free mortality between TNTCs and NTHs. Conclusion Patients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS.
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Affiliation(s)
- Aalam Sohal
- Department of HepatologyLiver Institute NorthwestSeattleWashingtonUSA
| | - Hunza Chaudhry
- Department of Internal MedicineUniversity of CaliforniaFresnoCaliforniaUSA
| | - Dino Dukovic
- Department of MedicineRoss University School of MedicineMiramarFloridaUSA
| | - Kris V. Kowdley
- Department of HepatologyLiver Institute NorthwestSeattleWashingtonUSA
- Department of Medicine, Elson S. Floyd College of MedicineWashington State UniversityPullmanWashingtonUSA
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17
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Chaudhry H, Sohal A, Iqbal H, Chaudhary U, Roytman M. Unusual sites of hepatocellular carcinoma metastasis: Case report. SAGE Open Med Case Rep 2023; 11:2050313X231211709. [PMID: 38022862 PMCID: PMC10647942 DOI: 10.1177/2050313x231211709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Hepatocellular carcinoma is an increasingly frequent cause of cancer-related death. The majority of patients with hepatocellular carcinoma are asymptomatic. In rare cases, patients may present with symptoms of extrahepatic metastases. Early identification can lead to timely treatment and prevent poor outcomes. We report three cases of patients with hepatocellular carcinoma with unusual sites of metastasis, including clival, mandible, and cardiac involvement.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco—Fresno, Fresno, CA, USA
| | | | - Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco—Fresno, Fresno, CA, USA
| | - Uzair Chaudhary
- Department of Hematology and Oncology, University of California San Francisco—Fresno, Fresno, CA, USA
| | - Marina Roytman
- Division of Gastroenterology, Hepatology and Nutrition, University of California San Francisco—Fresno, Fresno, CA, USA
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18
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Chaudhry H, Sohal A, Patel J, Dukovic D, Singh I, Kalra S, Yang J. Frailty Predicts Perioperative Outcomes in Patients Undergoing Peroral Endoscopic Myotomy. J Gastrointest Surg 2023; 27:2574-2576. [PMID: 37369967 DOI: 10.1007/s11605-023-05745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, 155 N. Fresno St, Fresno, San Francisco, CA, 93701, USA.
| | | | - Jay Patel
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, USA
| | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados
| | | | - Shivam Kalra
- Dayanand Medical College and Hospital, Punjab, India
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of California, Fresno, CA, USA
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19
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Garg A, Sohal A, Kalra S, Singh C, Singh I, Grewal J, Kansal R, Malhotra K, Mahajan R, Midha V, Singh A, Sood A, Bawa A. Inflammatory Bowel Disease and X (Formerly Twitter) Influencers: Who Are They and What Do They Say? Cureus 2023; 15:e47536. [PMID: 38022053 PMCID: PMC10664972 DOI: 10.7759/cureus.47536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective More than half of the population suffering from inflammatory bowel disease (IBD) use the internet as a primary source of information on their condition. X (formerly Twitter) has been increasingly used to disseminate healthcare-related information. In this study, we aimed to identify top influencers on the topic of IBD on X and correlate the relevance of their social media engagements with their professional expertise or academic productivity. Methods X (formerly Twitter) influence scores for the search topic IBD were obtained using Cronycle API, a proprietary software employing multiple algorithms to rank influencers. Data regarding gender, profession, location, and research productivity represented as h-index was collected. Results We collected information on the top 100 IBD influencers on X. The majority of influencers were gastroenterologists, followed by IBD advocates. Of note, 62% of the IBD influencers were from the US followed by the UK and Canada. A positive correlation was observed between the X topic score and the h-index of the influencer (r=+0.488, p<0.001) Conclusions The strong correlation observed between the X topic score and h-index suggests that social media is a viable platform for gaining information regarding IBD. Further research aimed at counteracting misleading information by providing facts and data in a succinct manner about IBD on social media is required to improve disease awareness.
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Affiliation(s)
- Ayushi Garg
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Shivam Kalra
- Internal Medicine, Trident Medical Center, North Charleston, USA
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Carol Singh
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Jasneet Grewal
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Rohin Kansal
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Kashish Malhotra
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ramit Mahajan
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Vandana Midha
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Arshdeep Singh
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ajit Sood
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ashvind Bawa
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
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20
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Patel J, Bains K, Kalra S, Singh I, Kohli I, Dukovic D, Chaudhry H, Sohal A, Yang J, Tringali S. The Effects of Malnutrition on Inpatient Outcomes in Patients With Gastroparesis: A Nationwide Analysis. Cureus 2023; 15:e47082. [PMID: 38022097 PMCID: PMC10645593 DOI: 10.7759/cureus.47082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Gastroparesis (GP) is a chronic debilitating gastric motility disorder defined as delayed emptying of the stomach content without mechanical obstruction. It can result in nutritional deficiencies, leading to poor overall outcomes. We assessed the impact of malnutrition on in-hospital outcomes in patients with gastroparesis. Methods Patients with a primary discharge diagnosis of GP between January 2016 and December 2019 were included in the National Inpatient Sample (NIS) database. Data on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and the etiology of gastroparesis were collected. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), were analyzed using the multivariate regression model. Results A total of 182,580 patients with gastroparesis were included in the analysis. Patients with gastroparesis and malnutrition had a higher risk of mortality (adjusted odds ratio {aOR}, 3.29; p<0.001), sepsis (aOR, 0.43; p<0.001), DVT (aOR, 2.34; p<0.001), and PE (aOR, 2.68; p<0.001) compared to patients with gastroparesis without malnutrition. No significant difference was noted in the rates of AKI. Patients with malnutrition also had a prolonged LOS (2.96 days; p<0.001) and higher THC ($22,890; p<0.001) compared to patients without malnutrition. Conclusion Gastroparesis patients with malnutrition are at a greater risk of worse outcomes than those without malnutrition. The early identification of malnutrition in gastroparesis patients can predict morbidity and mortality and assist in risk stratification to enhance outcomes. Further studies are encouraged to identify factors associated with malnutrition in gastroparesis and the impact of interventions to prevent and treat malnutrition.
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Affiliation(s)
- Jay Patel
- Internal Medicine, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, USA
| | - Kanwal Bains
- Internal Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Shivam Kalra
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Isha Kohli
- Public Health Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dino Dukovic
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Hunza Chaudhry
- Internal Medicine, University of California, Fresno, USA
| | - Aalam Sohal
- Hepatology, Liver Institute Northwest, Seattle, USA
| | - Juliana Yang
- Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, USA
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21
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Sohal A, Chaudhry H, Patel J, Dhillon N, Kohli I, Dukovic D, Roytman M, Kowdley KV. Impact of COVID-19 pandemic on alcohol-related hepatitis admissions: Analysis of nationwide data 2016-2020. Am J Med Sci 2023; 366:209-218. [PMID: 37315782 PMCID: PMC10259164 DOI: 10.1016/j.amjms.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/27/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic was a public health crisis affecting medical, social, and psychological wellness. In a previous study, we reported a rise in alcohol-related hepatitis (ARH) cases between 2019 and 2020 in the central valley of California. Our goal in the current study was to assess the impact of COVID-19 on ARH at a national level. MATERIALS AND METHODS We used data from the 2016 to 2020 National Inpatient Sample. All adult patients diagnosed with ARH (ICD10 K70.1 and K70.4) were included. Information was collected regarding patient demographics, hospital characteristics, and severity of hospitalization. We analyzed the annual percentage changes (PC) between 2016-2019 and 2019-2020 to assess the impact of COVID-19 on hospitalizations. Multivariate logistic regression analysis was performed to identify factors associated with increased ARH admissions between 2016 and 2020. RESULTS A total of 823,145 patients were admitted with ARH. The total number of cases increased from 146,370 in 2016 to 168,970 in 2019 (annual percentage change (PC) 5.1%), while the cases increased to 190,770 in 2020 (PC 12.4%). The PC in women was 6.6% between 2016 and 2019, which increased to 14.2% between 2019 and 2020. In men, PC increased by 4.4% between 2016 and 2019 to 12.2% between 2019 and 2020. On multivariate analysis, after adjusting for patient demographics and hospital characteristics, there was 46% increased odds of admission with ARH in 2020, compared to 2016. The total number of deaths increased from 8725 in 2016 to 9190 in 2019 (PC 1.7%), while the total number of deaths increased to 11,455 in 2020 (PC 24.6%). CONCLUSIONS A sharp rise in the cases of ARH between 2019 and 2020 was noted, which aligned with the COVID-19 pandemic. Not only did total hospitalization increase, but an increase in mortality was also noted, reflecting higher severity in the patients admitted during the COVID-19 pandemic.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, Seattle, WA, United States
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco Fresno, San Francisco, CA, United States
| | - Jay Patel
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, United States
| | - Nimrat Dhillon
- Sri Guru Ram Das Institute of Medical Sciences, Punjab, India
| | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, United States
| | - Dino Dukovic
- Ross University School of Medicine, Miramar, FL, United States
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco Fresno, San Francisco, CA, United States
| | - Kris V Kowdley
- Liver Institute Northwest, Seattle, WA, United States; Elson Floyd College of Medicine, Washington State University, Spokane, WA, United States.
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22
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Khanna T, Patel J, Singh I, Kalra S, Dhiman M, Kohli I, Chaudhry H, Dukovic D, Sohal A, Yang J. The Impact of Type 2 Myocardial Infarction in Acute Pancreatitis: Analysis of 1.1 Million Hospitalizations and Review of the Literature. Cureus 2023; 15:e44113. [PMID: 37750110 PMCID: PMC10518190 DOI: 10.7759/cureus.44113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Introduction Acute pancreatitis (AP) is a common inflammatory disorder with acute onset and rapid progression. Studies have reported cardiac injury in patients with AP. It is often thought that stress cardiomyopathy can induce these changes leading to type 2 myocardial infarction (type 2 MI) in AP. Our study aims to assess the prevalence as well as the impact of type 2 MI on outcomes in patients with AP. Methods National Inpatient Sample (NIS) 2016-2020 was used to identify adult patients (age>18) with acute pancreatitis. We excluded patients with STEMI, NSTEMI, pancreatic cancer, or chronic pancreatitis. Patients with missing demographics and mortality were also excluded. Patients were stratified into two groups, based on the presence of type 2 MI. Multivariate logistic regression analysis was performed to assess the impact of concomitant type 2 MI on mortality, sepsis, acute kidney injury (AKI), ICU admission, deep venous thrombosis (DVT), and pulmonary embolism (PE) after adjusting for patient demographics, hospital characteristics, etiology of AP and the Elixhauser comorbidities. Results Of the 1.1 million patients in the study population, only 2315 patients had type 2 MI. The majority of the patients in the type 2 MI group were aged >65 years (49.2%, p<0.001), males (54.6%, p=0.63), White (67.6%, p=0.19), had Medicare insurance (55.5%, p<0.001), and were in the lowest income quartile (34.8%, p=0.12). Patients in the type 2 MI group had a higher incidence of mortality (5.4% vs 0.6%, p<0.001), sepsis (7.1% vs 3.7%, p<0.001), shock (9.3% vs 0.9%, p<0.001), AKI (42.9% vs. 11.8%, p<0.001) and ICU admission (12.1% vs 1.4%, p<0.001). After adjusting for confounding factors, patients in the type 2 MI group were noted to be at higher odds of mortality (aOR=2.4; 95% CI 1.5-3.8, p<0.001). Patients in the type 2 MI group had a longer length of stay (adjusted coefficient=2.1 days; 95% CI 1.4-2.8; p<0.001) and higher total hospitalization charges (adjusted coefficient=$45,088; 95% CI $30,224-$59,952; p<0.001). Conclusion Although the prevalence of type 2 MI in AP is low, the presence of type 2 MI is associated with increased mortality and worse outcomes. Physicians should be aware of this association and these patients should be monitored carefully to prevent worse outcomes.
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Affiliation(s)
| | - Jay Patel
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Punjab, IND
| | - Shivam Kalra
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Mukul Dhiman
- Internal Medicine, Punjab Institute of Medical Sciences, Punjab , IND
| | - Isha Kohli
- Public Health Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hunza Chaudhry
- Internal Medicine, University of California, San Francisco, USA
| | - Dino Dukovic
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Aalam Sohal
- Hepatology, Liver Institute Northwest, Seattle, USA
| | - Juliana Yang
- Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, USA
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23
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Bains K, Kalra S, Singh I, Patel J, Kohli I, Dhiman M, Dukovic D, Sohal A, Aggarwal A. Prevalence and Impact of Malnutrition in Hospitalizations Among Celiac Diseases: A Nationwide Analysis. Cureus 2023; 15:e44247. [PMID: 37772221 PMCID: PMC10524785 DOI: 10.7759/cureus.44247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND/AIMS Celiac disease (CD) is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. We assessed the impact of malnutrition on in-hospital outcomes in patients with CD. MATERIALS AND METHODS Patients with a primary discharge diagnosis of CD between January 2016 and December 2019 were included in the National Inpatient Sample Database. Data were collected on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and concomitant comorbidities. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), was analyzed using the multivariate regression model. RESULTS A total of 187310 patients with CD were included in the analysis. Patients with CD and malnutrition had a higher risk of mortality (adjusted odds ratio [aOR], 2.08; p<0.001), AKI (aOR=1.18, p=0.003), and DVT (aOR=1.53; p<0.001) compared to patients with CD without malnutrition. No significant difference was noted in the rates of sepsis and PE. Patients with malnutrition also had a prolonged LOS (2.89 days; p<0.001) and higher THC ($22252.18; p<0.001) compared to patients without malnutrition. DISCUSSION Patients with CD and malnutrition are at high risk of worse outcomes. Early identification of malnutrition in CD can help prevent morbidity and mortality. Even strict adherence to a gluten-free diet has been associated with malnutrition. Further studies identifying factors associated with malnutrition in CD and the impact of interventions to prevent and treat malnutrition are encouraged.
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Affiliation(s)
- Kanwal Bains
- Internal Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Shivam Kalra
- Internal Medicine, Trident Medical Center, North Charleston, USA
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Jay Patel
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Isha Kohli
- Public Health Sciences, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Mukul Dhiman
- Internal Medicine, Punjab Institute of Medical Sciences, Jalandhar, IND
| | - Dino Dukovic
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Aalam Sohal
- Hepatology, Liver Institute Northwest, Seattle, USA
| | - Avin Aggarwal
- Gastroenterology and Hepatology, University of Arizona, Tucson, USA
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Chaudhry H, Sohal A, Dukovic D, Kohli I, Sharma R, Singla P, Prajapati D, Yang J. Does use of long-term aspirin impact outcomes in patients with acute pancreatitis? Eur J Gastroenterol Hepatol 2023; 35:721-727. [PMID: 37272503 DOI: 10.1097/meg.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Although the effect of rectal indomethacin in post-endoscopic retrograde cholangiopancreatography pancreatitis is well established, the effect of aspirin on acute pancreatitis (AP) is not well studied. We investigate the effect of aspirin on AP. METHODS We collected data from the National Inpatient Sample database from 2016 to 2020, to identify adult patients with acute pancreatitis. Patients were stratified into 2 groups, based on the presence of aspirin use. The primary outcome was mortality, while other outcomes were sepsis, shock, acute kidney injury (AKI), ICU admission, deep venous thrombosis (DVT), pulmonary embolism (PE), portal vein thrombosis (PVT), pseudocyst and ileus. RESULTS A total of 2.09 million patients met the inclusion criteria, of which 197 170 (9.41%) had long-term aspirin use. The majority of the patients with aspirin use were aged >65 years, male, White and had Medicare insurance. There was a higher incidence of biliary pancreatitis while rates of alcohol-induced pancreatitis were lower in patients with aspirin use. There was a lower incidence of mortality, sepsis, shock, PE, DVT, PVT and pseudocyst in patients with aspirin use. There was no difference in the incidence of ileus, while the incidence of AKI was higher. After adjusting for confounding factors, patients with aspirin use had a 23.6% lower risk of mortality. DISCUSSION Our results reveal a significant finding of aspirin's protective effect on AP in the US population. Our study is the largest study revealing an association between aspirin and AP. Further studies assessing the role of aspirin use in AP are warranted.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco-Fresno, California
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington
| | - Dino Dukovic
- Department of Medicine, Ross University School of Medicine, Florida
| | - Isha Kohli
- Department of Public Health, Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Raghav Sharma
- Department of Medicine, Punjab Institute of Medical Sciences
| | - Piyush Singla
- Department of Medicine, Dayanand Medical College and Hospital, India
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, San Francisco-Fresno, California, USA
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of California, San Francisco-Fresno, California, USA
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Sohal A, Kowdley KV. Primary Biliary Cholangitis: Promising Emerging Innovative Therapies and Their Impact on GLOBE Scores. Hepat Med 2023; 15:63-77. [PMID: 37312929 PMCID: PMC10259525 DOI: 10.2147/hmer.s361077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
Primary biliary cholangitis (PBC), previously referred to as primary biliary cirrhosis, is an autoimmune disorder leading to the destruction of intra-hepatic bile ducts. If untreated, progressive bile duct damage and cholestasis can lead to ductopenia and result in cirrhosis. Ursodiol, the first drug approved for PBC, has changed the natural history of this disease and improved patient outcomes. Subsequently, several new prediction models incorporating a response to ursodiol were developed. These include the GLOBE score, which was shown to predict long-term outcomes in patients with PBC. In 2016, obeticholic acid (OCA) became the second drug to be approved by the FDA, predominantly based on improvement in alkaline phosphatase (ALP) levels. This trial has subsequently influenced the design of clinical trials. Several drugs are currently being evaluated as therapeutic options for PBC, with improvement in ALP being a main endpoint. In this review, we will discuss the impact of new therapies on GLOBE scores in patients with PBC.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA, USA
| | - Kris V Kowdley
- Department of Hepatology, Liver Institute Northwest, Seattle, WA, USA
- Department of Gastroenterology and Hepatology, Elson Floyd College of Medicine, Spokane, WA, USA
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Dhaliwal A, Sohal A, Bains K, Chaudhry H, Singh I, Kalra E, Arora K, Dukovic D, Boiles AR. Impact of Aspirin Use on Outcomes in Patients With Hepatocellular Cancer: A Nationwide Analysis. World J Oncol 2023; 14:195-204. [PMID: 37350804 PMCID: PMC10284635 DOI: 10.14740/wjon1601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
Background Despite the use of new immunotherapies, hepatocellular carcinoma (HCC) has a poor survival rate. Through multiple molecular mechanisms, aspirin (ASA) has demonstrated a reduced incidence of HCC, however, the impact of long-term ASA use on in-hospital outcomes has not been studied. Methods We queried the National Inpatient Sample (NIS) database from 2016 to 2020 to identify patients with HCC. Patients were stratified into two groups, based on long-term ASA use. Information was collected regarding patient demographics, Elixhauser comorbidities, interventions, etiology, and decompensations of liver disease. Outcomes studied included sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and in-hospital mortality. The association between long-term ASA use and outcomes was studied using multivariate analysis. Results A total of 224,735 patients were included in the study. Of them, 18,835 (8.4%) patients were on long-term ASA. The majority of the patients with ASA use were White (61.3%), men (78.2%), and aged > 65 years old (68.8%). Patients in the ASA group had a higher incidence of non-alcoholic steatohepatitis (NASH) and decreased rates of hepatic decompensation than those not on ASA. Patients with ASA use had lower incidence of sepsis (2.76% vs. 3.54%), shock (4.86% vs. 8.23%), AKI (30.9% vs. 33.4%), ICU admission (3.88% vs. 7.4%) and in-hospital mortality (5.18% vs. 9.87%). After adjusting for confounding factors, ASA use was associated with a 30% lower risk of in-hospital mortality (adjusted odds ratio (aOR): 0.70, 95% confidence interval (CI): 0.60 - 0.82, P < 0.001). ASA users also had 21% lower odds of developing shock (aOR: 0.79, 95% CI: 0.67 - 0.94, P = 0.007) and 31% lower odds of requiring ICU admission (aOR: 0.69, 95% CI: 0.54 - 0.78, P < 0.001). Conclusions Our study noted that patients on long-term ASA use had better in-hospital outcomes such as mortality, shock, and ICU admissions compared to non-ASA users. These findings are of interest, and further randomized clinical trials confirming the benefits of ASA in improving outcomes in HCC patients need to be conducted.
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Affiliation(s)
- Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus, Tuscon, AZ, USA
- These authors contributed equally to this work
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA, USA
- These authors contributed equally to this work
| | - Kanwal Bains
- Department of Internal Medicine, University of Arizona, South Campus, Tuscon, AZ, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Eva Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kirti Arora
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, Barbados
| | - Alejandro Recio Boiles
- Department of Hematology & Medical Oncology, University of Arizona Cancer Center, Tuscon, AZ, USA
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Hochberg JT, Sohal A, Handa P, Maliken BD, Kim TK, Wang K, Gochanour E, Li Y, Rose JB, Nelson JE, Lindor KD, LaRusso NF, Kowdley KV. Serum miRNA profiles are altered in patients with primary sclerosing cholangitis receiving high-dose ursodeoxycholic acid. JHEP Rep 2023; 5:100729. [PMID: 37179785 PMCID: PMC10172698 DOI: 10.1016/j.jhepr.2023.100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 05/15/2023] Open
Abstract
Background & Aims Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic liver disease that can lead to end-stage liver disease and cholangiocarcinoma. High-dose ursodeoxycholic acid (hd-UDCA, 28-30 mg/kg/day) was evaluated in a previous multicentre, randomised placebo-controlled trial; however, the study was discontinued early because of increased liver-related serious adverse events (SAEs), despite improvement in serum liver biochemical tests. We investigated longitudinal changes in serum miRNA and cytokine profiles over time among patients treated with either hd-UDCA or placebo in this trial as potential biomarkers for PSC and response to hd-UDCA, as well as to understand the toxicity associated with hd-UDCA treatment. Methods Thirty-eight patients with PSC were enrolled in a multicentred, randomised, double-blinded trial of hd-UDCA vs. placebo. Results Significant alterations in serum miRNA profiles were found over time in both patients treated with hd-UDCA or placebo. Additionally, there were striking differences between miRNA profiles in patients treated with hd-UDCA compared with placebo. In patients treated with placebo, the changes in concentration of serum miRNAs miR-26a, miR-199b-5p, miR-373, and miR-663 suggest alterations of inflammatory and cell proliferative processes consistent with disease progression. However, patients treated with hd-UDCA exhibited a more pronounced differential expression of serum miRNAs, suggesting that hd-UDCA induces significant cellular miRNA changes and tissue injury. Pathway enrichment analysis for UDCA-associated miRNAs suggested unique dysregulation of cell cycle and inflammatory response pathways. Conclusions Patients with PSC have distinct miRNAs in the serum and bile, although the implications of these unique patterns have not been studied longitudinally or in relation to adverse events related to hd-UDCA. Our study demonstrates marked changes in miRNA serum profiles with hd-UDCA treatment and suggests mechanisms for the increased liver toxicity with therapy. Impact and implications Using serum samples from patients with PSC enrolled in a clinical trial comparing hd-UDCA with placebo, our study found distinct miRNA changes in patients with PSC who are treated with hd-UDCA over a period of time. Our study also noted distinct miRNA patterns in patients who developed SAEs during the study period.
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Affiliation(s)
- Jessica T. Hochberg
- Liver Institute Northwest, Seattle, WA, USA
- Seattle Children’s Hospital/University of Washington, Seattle, WA, USA
- Miami Transplant Institute at University of Miami, Miami, FL, USA
| | | | - Priya Handa
- Benaroya Research Institute, Seattle, WA, USA
| | | | | | - Kai Wang
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Yu Li
- Benaroya Research Institute, Seattle, WA, USA
| | | | | | - Keith D. Lindor
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA
| | | | - Kris V. Kowdley
- Liver Institute Northwest, Seattle, WA, USA
- Corresponding author. Address: Liver Institute Northwest, 3216 NE 45th Pl Suite 212, Seattle, WA 98105, USA; Tel.: +1(206) 536-3030.
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Sohal A, Chaudhry H, Kohli I, Arora K, Patel J, Dhillon N, Singh I, Dukovic D, Roytman M. Frailty as a risk-stratification tool in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). J Frailty Sarcopenia Falls 2023; 8:83-93. [PMID: 37275658 PMCID: PMC10233326 DOI: 10.22540/jfsf-08-083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. Results A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Conclusion Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, USA
| | - Isha Kohli
- Department of Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Kirti Arora
- Dayanand Medical College and Hospital, India
| | - Jay Patel
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, Florida, USA
| | | | | | - Dino Dukovic
- Ross University School of Medicine, Barbados, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, USA
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Chaudhry H, Sohal A, Iqbal H, Roytman M. Alcohol-related hepatitis: A review article. World J Gastroenterol 2023; 29:2551-2570. [PMID: 37213401 PMCID: PMC10198060 DOI: 10.3748/wjg.v29.i17.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023] Open
Abstract
Alcohol-related hepatitis (ARH) is a unique type of alcohol-associated liver disease characterized by acute liver inflammation caused by significant alcohol use. It ranges in severity from mild to severe and carries significant morbidity and mortality. The refinement of scoring systems has enhanced prognostication and guidance of clinical decision-making in the treatment of this complex disease. Although treatment focuses on supportive care, steroids have shown benefit in select circumstances. There has been a recent interest in this disease process, as coronavirus disease 2019 pandemic led to substantial rise in cases. Although much is known regarding the pathogenesis, prognosis remains grim due to limited treatment options. This article summarizes the epidemiology, genetics, pathogenesis, diagnosis and treatment of ARH.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA 93701, United States
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
| | - Humzah Iqbal
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA 93701, United States
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA 93701, United States
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Sohal A, Chaudhry H, Kowdley KV. Genetic Markers Predisposing to Nonalcoholic Steatohepatitis. Clin Liver Dis 2023; 27:333-352. [PMID: 37024211 DOI: 10.1016/j.cld.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
The growing prevalence of nonalcoholic fatty liver disease (NAFLD) has sparked interest in understanding genetics and epigenetics associated with the development and progression of the disease. A better understanding of the genetic factors related to progression will be beneficial in the risk stratification of patients. These genetic markers can also serve as potential therapeutic targets in the future. In this review, we focus on the genetic markers associated with the progression and severity of NAFLD.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, 3216 Northeast 45th Place Suite 212, Seattle, WA 98105, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, UCSF Fresno, 155 North Fresno Street, Fresno, CA 93722, USA
| | - Kris V Kowdley
- Liver Institute Northwest, 3216 Northeast 45th Place Suite 212, Seattle, WA 98105, USA; Elson S. Floyd College of Medicine, Washington State University, WA, USA.
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Chaudhry H, Sohal A, Bains K, Dhaliwal A, Dukovic D, Singla P, Sharma R, Kohli I, Chintanaboina J. Incidence and factors associated with portal vein thrombosis in patients with acute pancreatitis: A United States national retrospective study. Pancreatology 2023:S1424-3903(23)00072-8. [PMID: 37012176 DOI: 10.1016/j.pan.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND/OBJECTIVE Portal vein thrombosis (PVT) is a well-known complication in patients with acute pancreatitis (AP). Limited data exist on the incidence and factors of PVT in patients with AP. We investigate the incidence and clinical predictors of PVT in AP. METHODS We queried the 2016-2019 National Inpatient Sample database to identify patients with AP. Patients with chronic pancreatitis or pancreatic cancer were excluded. We studied demographics, comorbidities, complications, and interventions in these patients and stratified the results by the presence of PVT. A multivariate regression model was used to identify factors associated with PVT in patients with AP. We also assessed the mortality and resource utilization in patients with PVT and AP. RESULTS Of the 1,386,389 adult patients admitted with AP, 11,135 (0.8%) patients had PVT. Women had a 15% lower risk of developing PVT (aOR-0.85, p < 0.001). There was no significant difference between the age groups in the risk of developing PVT. Hispanic patients had the lowest risk of PVT (aOR-0.74, p < 0.001). PVT was associated with pancreatic pseudocyst (aOR-4.15, p < 0.001), bacteremia (aOR-2.66, p < 0.001), sepsis (aOR-1.55, p < 0.001), shock (aOR-1.68, p < 0.001) and ileus (aOR-1.38, p < 0.001). A higher incidence of in-hospital mortality and ICU admissions was also noted in patients with PVT and AP. CONCLUSION This study demonstrated a significant association between PVT and factors such as pancreatic pseudocyst, bacteremia, and ileus in patients with AP.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, California, USA
| | - Aalam Sohal
- Liver Institute Northwest, Seattle, WA, USA.
| | - Kanwal Bains
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | | | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, NewYork, NY, USA
| | - Jayakrishna Chintanaboina
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, California, USA
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Chaudhry H, Sohal A, Kohli I, Dukovic D, Sharma R, Singla P, Hu B, Prajapati D, Yang J. The burden of acute pancreatitis on COVID-19 in the United States. Ann Gastroenterol 2023; 36:208-215. [PMID: 36864935 PMCID: PMC9932859 DOI: 10.20524/aog.2023.0782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Background Although SARS-CoV-2 primarily affects the respiratory system, gastrointestinal symptoms were also seen. Our study analyzed the prevalence and impact of acute pancreatitis (AP) on COVID-19 hospitalizations in the United States. Methods The 2020 National Inpatient Sample database was used to identify patients with COVID-19. The patients were stratified into 2 groups based on the presence of AP. AP as well as its impact on COVID-19 outcomes were evaluated. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) admissions, shock, acute kidney injury (AKI), sepsis, length of stay, and total hospitalization charges. Univariate and multivariate logistic/linear regression analyses were performed. Results The study population comprised 1,581,585 patients with COVID-19, from which 0.61% of people had AP. Patients with COVID-19 and AP had a higher incidence of sepsis, shock, ICU admissions, and AKI. On multivariate analysis, patients with AP had higher mortality (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.03-1.38; P=0.02). We also noted a higher risk of sepsis (aOR 1.22, 95%CI 1.01-1.48; P=0.04), shock (aOR 2.09, 95%CI 1.83-2.40; P<0.001), AKI (aOR 1.79, 95%CI 1.61-1.99; P<0.001), and ICU admissions (aOR 1.56, 95%CI 1.38-1.77; P<0.001). Patients with AP also had a longer length of stay (+2.03 days, 95%CI 1.45-2.60; P<0.001), and higher hospitalization charges ($44,088.41, 95%CI $33,198.41-54,978.41; P<0.001). Conclusions Our study revealed that the prevalence of AP in patients with COVID-19 was 0.61%. Although this was not strikingly high, the presence of AP is associated with worse outcomes and higher resource utilization.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA (Hunza Chaudhry)
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA, USA (Aalam Sohal)
| | - Isha Kohli
- Department of Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA (Isha Kohli)
| | - Dino Dukovic
- Ross University School of Medicine, Barbados, USA (Dino Dukovic)
| | - Raghav Sharma
- Punjab Institute of Medical Sciences, India (Raghav Sharma)
| | - Piyush Singla
- Dayanand Medical College and Hospital, India (Piyush Singla)
| | - Bing Hu
- China West Medical Center, China (Bing Hu)
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA (Devang Prajapati, Juliana Yang)
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA (Devang Prajapati, Juliana Yang)
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Sohal A, Khalid S, Green V, Hagino J, Chaudhry H, Gulati A, Roytman M. Soaring rates of alcohol-related hepatitis in the latter phase of the COVID-19 pandemic: A new normal? JGH Open 2023; 7:148-151. [PMID: 36852146 PMCID: PMC9958332 DOI: 10.1002/jgh3.12864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Background Studies have reported that the COVID-19 pandemic has led to an increase in alcohol consumption and alcohol-associated health problems in the general population. Our previous study documented a rise in severe alcohol-related hepatitis cases requiring inpatient admission in our hospital system in the early pandemic (2019 vs. 2020). This study assesses the rates of severe alcohol-related hepatitis in the latter part of the pandemic (2021). Methods We performed a retrospective chart review via an electronic medical record to evaluate the number of cases of alcohol-related hepatitis in patients presenting to three community hospitals in Fresno, California, between 2019 (pre-pandemic) and 2021. A total of 547 patients were included in the study. We compared the demographics, clinical course, and outcomes of patients with alcohol-related hepatitis pre-pandemic (2019), early pandemic (2020), and during the later phase of the pandemic (2021). Results The number of cases increased from 131 in 2019 to 201 in 2020 and 215 in 2021 (53% and 64% increase, respectively). The number of young patients (age <40 years) increased from 30 in 2019 to 61 in 2020 and 71 in 2021 (103% and 136% increase, respectively) (p = 0.13). The number of admissions of women increased from 24 in 2019 to 55 in 2020 and 67 in 2021 (129% and 179% increase, respectively) (p = 0.026). Deaths during hospitalization increased from 20 in 2019 to 26 in 2021 (p = 0.674). The number of rehospitalizations within 3 months increased 4.5 times from 18 in 2019 to 80 in 2021 (p < 0.001). Conclusion Our study revealed that the admissions for alcohol-related hepatitis remained significantly above the pre-pandemic levels through the end of 2021. We believe this sustained increase in cases of alcohol-related hepatitis in our hospital system reflects a much larger national problem. Alcohol-related hepatitis is associated with significant morbidity, mortality, and societal cost. Urgent public health interventions are needed at a national level to prevent this rise in cases from becoming a new normal.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine University of California Fresno California USA
| | - Sameeha Khalid
- Department of Internal Medicine University of California Fresno California USA
| | - Victoria Green
- Department of Internal Medicine University of California Fresno California USA
| | - Jeffrey Hagino
- Department of Internal Medicine University of California Fresno California USA
| | - Hunza Chaudhry
- Department of Internal Medicine University of California Fresno California USA
| | - Alakh Gulati
- Department of Gastroenterology and Hepatology University of California Fresno California USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology University of California Fresno California USA
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Sohal A, Chaudhry H, Singla P, Sharma R, Kohli I, Dukovic D, Prajapati D. The burden of Clostridioides difficile on COVID-19 hospitalizations in the USA. J Gastroenterol Hepatol 2023; 38:590-597. [PMID: 36662626 DOI: 10.1111/jgh.16128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM Clostridioides difficile infection (CDI) is the leading cause of hospital acquired-infectious diarrhea in the USA. In this study, we assess the prevalence and impact of CDI in COVID-19 hospitalizations in the USA. METHODS We used the 2020 National Inpatient Sample database to identify adult patients with COVID-19. The patients were stratified into two groups based on the presence of CDI. The impact of CDI on outcomes such as in-hospital mortality, ICU admission, shock, acute kidney injury (AKI), and sepsis rates. Multivariate regression analysis was performed to assess the effects of CDI on outcomes. RESULTS The study population comprised 1581 585 patients with COVID-19. Among these, 0.65% of people had a CDI. There was a higher incidence of mortality in patients with COVID-19 and CDI compared with patients without COVID-19 (23.25% vs 13.33%, P < 0.001). The patients with COVID-19 and CDI had a higher incidence of sepsis (7.69% vs 5%, P < 0.001), shock (23.59% vs 8.59%, P < 0.001), ICU admission (25.54% vs 12.28%, P < 0.001), and AKI (47.71% vs 28.52%, P < 0.001). On multivariate analysis, patients with CDI had a statistically significant higher risk of mortality than those without (aOR = 1.47, P < 0.001). We also noted a statistically significant higher risk of sepsis (aOR = 1.47, P < 0.001), shock (aOR = 2.7, P < 0.001), AKI (aOR = 1.55, P < 0.001), and ICU admission (aOR = 2.16, P < 0.001) in the study population. CONCLUSIONS Our study revealed the prevalence of CDI in COVID-19 patients was 0.65%. Although the prevalence was low, its presence is associated with worse outcomes and higher resource utilization.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, Seattle, Washington, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, California, USA
| | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India
| | | | - Isha Kohli
- Graduate School of Public Health, Icahn School of Medicine, New York, New York, USA
| | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, California, USA
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Sohal A, Chaudhry H, Kohli I, Gupta G, Singla P, Sharma R, Dukovic D, Prajapati D. Hospital frailty risk score predicts worse outcomes in patients with chronic pancreatitis. Ann Gastroenterol 2023; 36:73-80. [PMID: 36593805 PMCID: PMC9756028 DOI: 10.20524/aog.2022.0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background Chronic pancreatitis (CP) is a pathological fibroinflammatory response to persistent inflammation or stress to the pancreas. The effect of frailty on outcomes in patients with CP has not been previously examined. In this study, we examined the effect of frailty on outcomes in hospitalized patients with CP. Methods Records of patients with a primary or secondary discharge diagnosis of CP (ICD10-CM codes K86.0, K86.1) between January 2016 and December 2019 were obtained from the National Inpatient Sample database. Data were collected on patient demographics, hospital characteristics, comorbidities, and etiology of CP. The relationship between frailty and outcomes, including mortality, intensive care unit (ICU) admission, sepsis, shock, length of stay (LOS), and total hospitalization charges (THC), were analyzed using multivariate analysis. Results 722,160 patients were included in the analysis. Patients with a high hospital frailty risk score had a higher mortality risk (adjusted odds ratio [aOR] 12.57, 95% confidence interval [CI] 10.42-15.16; P<0.001) compared to patients with low frailty scores. Patients with high frailty scores also had a higher risk of sepsis (aOR 5.75, 95%CI 4.97-6.66; P<0.001), shock (aOR- 26.25, 95%CI-22.83-30.19; P<0.001), ICU admission (aOR 25.86, 95% CI-22.58-29.62; P<0.001), and acute kidney injury (aOR 24.4, 95%CI 22.39-26.66; P<0.001). They also had a longer LOS (7.04 days, 95%CI 6.57-7.52; P<0.001) and higher THC ($72,200, 95%CI 65,904.52-78,496.66; P<0.001). Conclusions Frail patients, as determined by their hospital frailty risk score, are at high risk of worse outcomes. This data suggests opportunities for physicians to risk-stratify patients and predict outcomes.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, Seattle, WA (Aalam Sohal)
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA (Hunza Chaudhry)
| | - Isha Kohli
- Department of Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA (Isha Kohli)
| | - Gagan Gupta
- Dayanand Medical College and Hospital, Punjab, India (Gagan Gupta, Piyush Singla)
| | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India (Gagan Gupta, Piyush Singla)
| | - Raghav Sharma
- Punjab Institute of Medical Sciences, Punjab, India (Raghav Sharma)
| | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados (Dino Dukovic)
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA (Devang Prajapati)
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Aby ES, Moafa G, Latt N, Sultan MT, Cacioppo PA, Kumar S, Chung RT, Bloom PP, Gustafson J, Daidone M, Reinus Z, Debes JD, Sandhu S, Sohal A, Khalid S, Roytman M, Catana AM, Wegermann K, Carr RM, Saiman Y, Kassab I, Chen VL, Rabiee A, Rosenberg C, Nguyen V, Gainey C, Zhou K, Chavin K, Lizaola-Mayo BC, Chascsa DM, Varelas L, Moghe A, Dhanasekaran R. Long-term clinical outcomes of patients with COVID-19 and chronic liver disease: US multicenter COLD study. Hepatol Commun 2023; 7:e8874. [PMID: 36633476 PMCID: PMC9827967 DOI: 10.1097/01.hc9.0000897224.68874.de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/03/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND COVID-19 is associated with higher morbidity and mortality in patients with chronic liver diseases (CLDs). However, our understanding of the long-term outcomes of COVID-19 in patients with CLD is limited. METHODS We conducted a multicenter, observational cohort study of adult patients with CLD who were diagnosed with COVID-19 before May 30, 2020, to determine long-term clinical outcomes. We used a control group of patients with CLD confirmed negative for COVID-19. RESULTS We followed 666 patients with CLD (median age 58 years, 52.8% male) for a median of 384 (interquartile range: 31-462) days. The long-term mortality was 8.1%; with 3.6% experiencing delayed COVID-19-related mortality. Compared to a propensity-matched control group of patients with CLD without COVID-19 (n=1332), patients with CLD with COVID-19 had worse long-term survival [p<0.001; hazards ratio (HR): 1.69; 95% CI: 1.19-2.41] and higher rate of hospitalization (p<0.001, HR: 2.00, 1.62-2.48) over a 1-year follow-up period. Overall, 29.9% of patients reported symptoms of long-COVID-19. On multivariable analysis, female sex (p=0.05, HR: 2.45, 1.01-2.11), Hispanic ethnicity (p=0.003, HR: 1.94, 1.26-2.99), and severe COVID-19 requiring mechanical ventilation (p=0.028, HR: 1.74, 1.06-2.86) predicted long-COVID-19. In survivors, liver-related laboratory parameters showed significant improvement after COVID-19 resolution. COVID-19 vaccine status was available for 72% (n=470) of patients with CLD and history of COVID-19, of whom, 70% (n=326) had received the COVID-19 vaccine. CONCLUSIONS Our large, longitudinal, multicenter study demonstrates a high burden of long-term mortality and morbidity in patients with CLD and COVID-19. Symptoms consistent with long-COVID-19 were present in 30% of patients with CLD. These results illustrate the prolonged implications of COVID-19 both for recovering patients and for health care systems.
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Affiliation(s)
- Elizabeth S. Aby
- Hennepin County Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Ghady Moafa
- Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Nyan Latt
- Ochsner Medical Center, New Orleans, Louisiana, USA
| | | | | | - Sonal Kumar
- Weill Cornell Medical Center, New York, New York, USA
| | | | | | | | | | - Zoe Reinus
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jose D. Debes
- Hennepin County Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Sunny Sandhu
- University of California San Francisco, Fresno, California, USA
| | - Aalam Sohal
- University of California San Francisco, Fresno, California, USA
| | - Sameeha Khalid
- University of California San Francisco, Fresno, California, USA
| | - Marina Roytman
- University of California San Francisco, Fresno, California, USA
| | | | | | | | - Yedidya Saiman
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ihab Kassab
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | - Kali Zhou
- University of Southern California, Los Angeles, California, USA
| | - Kenneth Chavin
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Lee Varelas
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Akshata Moghe
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Chaudhry H, Sohal A, Sharma R, Dukovic D, Lee D, Gamboa A, Yang J. Increased mortality in patients with alcohol-induced pancreatitis during the COVID-19 pandemic. Ann Gastroenterol 2023; 36:68-72. [PMID: 36593806 PMCID: PMC9756021 DOI: 10.20524/aog.2022.0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background COVID-19 pandemic affected millions of people worldwide. Alcohol consumption increased during the pandemic, leading to rising numbers of cases of alcohol-related pancreatitis. We aimed to assess the mortality of alcohol-induced pancreatitis during the COVID-19 pandemic in the United States. Methods We analyzed the National Vital Statistical System's (NVSS) provisional multiple causes of death data, provided by the Centers for Disease Control and Prevention, to assess the mortality of alcohol-induced pancreatitis during the pandemic. Patients with alcohol-induced pancreatitis as a cause of death were analyzed between 2018 and 2021. Patient demographics such as age, sex, ethnicity, and location were studied. Results During 2018-2021, there were 2547 deaths from alcohol-induced pancreatitis. The total cases and age-adjusted rates of alcohol-induced pancreatitis per 100,000 were similar in 2018 (n=515) and 2019 (n=501) (crude rate=0.1). The number increased to 747 in 2020 and 784 in 2021 (crude rate=0.2). A statistically significant increase in mortality rates was noted in all age groups except 75-84. An increase in mortality in both males and females was noted (48% increase and 64% increase, respectively, P<0.001). The number of deaths increased in both Hispanics (59%, P<0.001) and non-Hispanics (48%, P<0.001). Conclusions Our analysis demonstrated a substantial increase in the mortality of patients with alcohol-induced pancreatitis during the first 2 years of the COVID-19 pandemic. The increase in alcohol consumption and the burden on mental health caused massive collateral damage to society. Urgent public health interventions are needed at state and national levels to prevent further rise in cases.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA (Hunza Chaudhry)
| | - Aalam Sohal
- Liver Institute Northwest, Seattle, WA (Aalam Sohal)
| | | | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados (Dino Dukovic)
| | - David Lee
- Methodist Digestive Institute, Methodist Dallas Medical Center, Dallas, TX (David Lee)
| | - Anthony Gamboa
- Department of Gastroenterology and Hepatology, Vanderbilt University, Nashville, TN (Anthony Gamboa)
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA (Juliana Yang)
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Chaudhry H, Dhaliwal A, Bains K, Sohal A, Singla P, Sharma R, Dukovic D, Kohli I, Gupta G, Prajapati D. Hospitalization Outcomes of Acute Pancreatitis in Hematopoietic Stem Cell Transplant Recipients. Gastroenterology Res 2022; 15:334-342. [PMID: 36660472 PMCID: PMC9822663 DOI: 10.14740/gr1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022] Open
Abstract
Background Acute pancreatitis (AP) carries a significant morbidity and mortality worldwide. AP is a potential complication of hematopoietic stem cell transplantation (HSCT) although its incidence remains unclear. HSCT recipients are at increased risk of AP due to various factors but the effect of AP on mortality and resource utilization in the adult population has not been studied. We investigated the impact of AP on hospitalization outcomes among patients following HSCT. Methods We queried the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-10 codes. All adult patients with a diagnosis or procedure code of HSCT were included in the study. Patients were divided into those with a diagnosis of AP and those without. Sensitivity analysis was performed for patients with a length of stay greater than 28 days. The relationship between AP and mortality, length of stay, total hospitalization cost, and charges was assessed using univariate analysis followed by multivariate analysis. Results Of the 140,130 adult patients with HSCT, 855 (0.61%) patients developed AP. There was 1.74 times higher risk of mortality in patients with AP as compared to controls (adjusted odds ratio (aOR): 1.74, P = 0.0055). There was no statistically significant difference in the length of stay, hospitalization charge, or cost before sensitivity analysis. After sensitivity analysis, 13,240 patients were included, from which 125 (0.94%) had AP. There was 3.85 times higher risk of mortality in patients who developed AP as compared to controls (aOR: 3.85, P = 0.003). There was a statistically significant increase noted in the length of stay (adj coeff: 20.3 days, P = 0.002), hospital charges (+$346,616, P = 0.017), and cost (+$121,932.4, P = 0.001) in patients with AP as compared to those who did not develop AP. Conclusion Recipients of HSCT who develop AP have shown to have higher mortality on sensitivity analysis. This study highlights that AP in HSCT patients is associated with worse outcomes and higher resource utilization. Physicians should be aware of this association as the presence of pancreatitis portends a poor prognosis.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA,Corresponding Author: Hunza Chaudhry, Department of Internal Medicine, University of California, San Francisco, Fresno, CA 93722, USA.
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus, Tucson, AZ, USA
| | - Kanwal Bains
- Department of Internal Medicine, University of Arizona, South Campus, Tucson, AZ, USA
| | | | | | | | | | - Isha Kohli
- Graduate School of Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Gagan Gupta
- Dayanand Medical College and Hospital, India
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA
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Abstract
BACKGROUND AND AIMS Esophageal variceal bleeding is a common reason for hospitalization in patients with cirrhosis. The main objective of this study was to analyze the effects of gender differences on outcomes in hospitalizations related to Esophageal variceal bleeding in the United States. METHODS A retrospective observational cohort study was performed using the National Inpatient Sample (NIS) database for all hospitalizations with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. The primary outcome was in-hospital mortality, while secondary outcomes included rate of early endoscopy (defined as less than 1 day), AKI, blood transfusion, sepsis, ICU admission and TIPS (Transjugular Intrahepatic Portosystemic Shunt). We also compared the length of stay and total hospitalization charges. RESULTS We identified a total of 166,760 patients with variceal bleeding of which 32.7% were females. In-hospital mortality was higher in males, 9.91%, compared to females, 8.31% (adjusted odds ratio (aOR): 0.88, p-value=.008, when adjusted for confounding factors). The odds of undergoing an EGD, length of stay, or total hospitalization charges did not differ between the two groups. Compared to men, women had lower odds of receiving TIPS (aOR = 0.83, p-value=.002). CONCLUSION Women hospitalised with esophageal variceal bleeding are at a lower risk of death compared to males. Further research is needed to elucidate the factors associated with this lower risk.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus-Tucson, AZ, USA
| | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India
| | - Gagan Gupta
- Dayanand Medical College and Hospital, Punjab, India
| | | | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, Fresno, CA, USA
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Sohal A, Chaudhry H, Li L. Hydronephrosis: An Unusual Complication of a Diverticular Abscess. Cureus 2022; 14:e31016. [DOI: 10.7759/cureus.31016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/05/2022] Open
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Yagnik VD, Kaur B, Dawka S, Sohal A, Menon GR, Garg P. Non-Locatable Internal Opening in Anal Fistula Associated with Acute Abscess and Its Definitive Management by Garg Protocol. Clin Exp Gastroenterol 2022; 15:189-198. [PMID: 36186926 PMCID: PMC9525211 DOI: 10.2147/ceg.s374848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Definitive management of acute fistula-abscess (anal fistulas associated with acute abscess) is gaining popularity against the two-staged approach (early abscess drainage with deferred fistula management). However, locating an internal opening (IO) in acute fistula-abscess can be difficult. A recent protocol (Garg protocol) has been shown to be effective in managing anal fistulas with non-locatable IO. Purpose To test the efficacy of the Garg protocol in managing acute fistula-abscess with non-locatable IO. Methods Patients with acute fistula-abscess operated by a definitive procedure were included. A preoperative MRI was done in all patients. Patients in whom the IO was non-locatable after clinical, MRI, and intraoperative examination were managed by the three-step Garg protocol. Garg protocol: 1) Reassessment of MRI; 2) In non-horseshoe fistulas, the IO was assumed to be at the point where the fistula tract reached closest to the sphincter-complex; 3) In horseshoe fistulas, the IO was assumed to be located in the midline (anterior or posterior as per the horseshoe location). Low fistulas were treated by fistulotomy and high fistulas by a sphincter-sparing procedure. The long-term healing rate and change in continence (Vaizey scores) were evaluated. Results A total of 201 patients with acute fistula-abscess were operated over six years, and 19 were lost to follow-up. A total of 182 patients (154-males) were followed up (median-37 months). The IO was locatable in 133/182 (73.1%) (control group) and was non-locatable in 49/182 (26.9%) (study group). The study group was managed as per the Garg protocol. The age, sex-ratio, and fistula parameters were comparable in both groups. The long-term healing rate was 112/133(84.2%) in the IO-locatable group and 43/49 (87.8%) in the IO-non-locatable group (p=0.64, not-significant). The objective continence scores did not change significantly after surgery in both groups. Conclusion Acute fistula-abscess with non-locatable IO can be managed successfully by the Garg protocol without any risk of incontinence.
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Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan, Gujarat, India
| | - Baljit Kaur
- Department of Radiology, SSRD Magnetic Resonance Imaging Institute, Chandigarh, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
| | - Aalam Sohal
- Department of Internal Medicine, University of California San Francisco (UCSF), Fresno, CA, USA
| | - Geetha R Menon
- Department of Statistics, Indian Council of Medical Research, New Delhi, India
| | - Pankaj Garg
- Department of Colorectal Surgery, Indus International Hospital, Mohali, Punjab, India.,Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, Haryana, India
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Garg P, Sohal A, Mittal S. Mucormycosis presenting as dental pain. Cleve Clin J Med 2022; 89:553-555. [PMID: 36192023 DOI: 10.3949/ccjm.89a.22001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Garg P, Sohal A, Yagnik V, Kaur B, Menon G, Dawka S. Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence? Pol Przegl Chir 2022; 95:1-5. [PMID: 36805994 DOI: 10.5604/01.3001.0015.9820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AimFistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods Patients operated by fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/day for one year postoperatively. Incontinence (solid, liquid, gas and urge) was evaluated objectively (Vaizeys scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group] and at 6-months follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results101 MRI-documented low anal-fistula patients were included. There were 79 males (mean age 39.412.9 years) and median follow-up was 12 months (6-18months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5/99 patients (mean incontinence scores-0.130.63) preoperatively and occurred in 20/99 (mean incontinence scores-1.032.18) patients postoperatively (Pre-KE Group). With KE, the incontinence improved completely in 10 and partially improved in other 10 (mean incontinence scores-0.311.09). Urge and gas incontinence accounted for most cases (80%). The mean incontinence scores deteriorated significantly after fistulotomy (pre-op vs pre-KE, p=0.000059, significant) but continence improved significantly with KE, thus the scores between pre-op and post-KE became comparable (pre-op vs post-KE, p=0.07, not significant).ConclusionsFistulotomy, even in low fistulas, can lead to significant increase in gas and urge incontinence. Regular Kegel exercises postoperatively can help recover lost sphincter function and can bring back continence comparable to preoperative levels.
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Affiliation(s)
- Pankaj Garg
- 1. Chief Colorectal Surgeon, Indus Hospital, Mohali, India 2. Chief Colorectal Surgeon, Garg Fistula Research Institute, Panchkula, India
| | - Aalam Sohal
- University of California San Francisco (UCSF), Fresno, USA
| | - Vipul Yagnik
- Chief Surgeon, Nishtha Surgical Hospital and Research Center, Patan, Gujarat, India
| | - Baljit Kaur
- Chief Radiologist, SSRD Imaging Centre, Chandigarh, India
| | - Geetha Menon
- Principal Research Officer, Indian Council of Medical Research, New Delhi, India
| | - Sushil Dawka
- Professor of Surgery, SSR Medical College, Belle Rive, Mauritius
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Sohal A, Bains K, Dhaliwal A, Chaudhry H, Sharma R, Singla P, Gupta G, Dukovic D, Sandhu S, Roytman M, Tringali S. Seasonal Variations of Hospital Admissions for Alcohol-Related Hepatitis in the United States. Gastroenterology Res 2022; 15:75-81. [PMID: 35572478 PMCID: PMC9076155 DOI: 10.14740/gr1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clinical experience suggests an increased hospitalization rate for alcohol-related hepatitis (AH) in the winter months; however, seasonal variations in the prevalence of hospitalizations for AH have not been described previously. We hypothesized that AH hospitalizations would be higher in the winter months due to the holiday season and increased alcohol sales. Methods Patients with primary or secondary discharge diagnosis of AH were included in the study (International Classification of Diseases, Clinical Modification-10th Revision codes K70.4 and K70.1) between January 2016 and December 2019. The primary outcome measure for this study was daily hospitalizations by each month of the year. Secondary outcome measures included the rate of in-hospital mortality associated with AH, for each month. Results The highest number of AH-related admissions was reported in July (n = 56,800; 9%), followed by August (n = 55,700; 8.8%) and May (n = 54,865; 8.7%). February had the lowest number of admissions (n = 46,550; 7.37%). The adjusted mortality was highest in December (overall mortality: 9.6%; adjusted odds ratio: 1.29; 95% confidence interval: 1.142 - 1.461; P < 0.0001) and lowest in May (overall mortality rate: 7.7%). No difference was noted between length of stay and total hospitalization cost between months. Conclusion Our findings demonstrate that seasonal variations in hospitalizations related to AH do exist across the United States. Regional differences also exist and follow unique patterns. The increase in admissions for AH is in line with other studies suggesting that heavy drinking happens during the warm season. Hospital administrators and other stewards of healthcare resources can use seasonal patterns to guide allocation of resources.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Kanwal Bains
- Department of Clinical Nutrition, Brigham and Women’s Hospital, Boston, MA, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus, Tucson, AZ, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, CA, USA
- Corresponding Author: Hunza Chaudhry, Department of Internal Medicine, UCSF Fresno, Fresno, CA 93722, USA.
| | | | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India
| | - Gagan Gupta
- Dayanand Medical College and Hospital, Punjab, India
| | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados
| | - Sunny Sandhu
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, Fresno, CA, USA
| | - Steven Tringali
- Department of Internal Medicine, University of California, Fresno, CA, USA
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Sohal A, Khalid S, Green V, Gulati A, Roytman M. The Pandemic Within the Pandemic: Unprecedented Rise in Alcohol-related Hepatitis During the COVID-19 Pandemic. J Clin Gastroenterol 2022; 56:e171-e175. [PMID: 34653062 PMCID: PMC8843054 DOI: 10.1097/mcg.0000000000001627] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The third leading preventable cause of death in the United States is excessive alcohol consumption. Our study sought to assess the impact of the coronavirus disease 2019 (COVID-19) on hospitalizations for alcohol-related hepatitis at a community hospital system. We hypothesized an increase in cases of alcohol-related hepatitis requiring inpatient management, mirroring the strain on economic and societal norms imposed by the COVID-19 pandemic. APPROACH/RESULTS We performed a retrospective chart review to study the incidence of alcohol-related hepatitis in patients presenting to 3 community hospitals in Fresno, California, before and during the COVID-19. Data including patient demographics, markers of disease severity, and clinical course were extracted from electronic medical records for 329 patients included in the study. There was a 51% increase in the overall incidence of alcohol-related hepatitis requiring hospitalization between 2019 and 2020 (P=0.003) and 69% increase (P<0.001) after implementation of the stay-at-home orders. In addition, 94% (P=0.028) increase in rehospitalizations was noted in 2020 (P=0.028), a 100% increase in patients under the age of 40 (P=0.0028), as well as a trend towards a 125% increase (P=0.06) of female patients admitted with this diagnosis during the COVID-19 pandemic. CONCLUSIONS Our study revealed drastic increases in severe alcohol-related hepatitis requiring inpatient management, specifically in patients under the age of 40 and in women during the COVID-19 pandemic. Given the high morbidity and mortality associated with severe alcohol-related hepatitis, these findings have far-reaching and lasting implications for our already strained health care system extending beyond the COVID-19 pandemic timeframe. Urgent public health interventions are needed to combat the rising misuse of alcohol and its consequences.
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Affiliation(s)
| | | | | | - Alakh Gulati
- Gastroenterology and Hepatology, UCSF Fresno, Fresno, CA
| | - Marina Roytman
- Gastroenterology and Hepatology, UCSF Fresno, Fresno, CA
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Sohal A, Chaudhry H, Bains K, Dhaliwal A, Sharma R, Gupta G, Singla P, Dukovic D, Sandhu S, Roytman M. Predictors of leaving against medical advice in patients with alcohol-related hepatitis. Ann Gastroenterol 2022; 35:541-546. [PMID: 36061158 PMCID: PMC9399570 DOI: 10.20524/aog.2022.0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine, University of California, Fresno, California, USA (Aalam Sohal, Hunza Chaudhry, Sunny Sandhu)
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, California, USA (Aalam Sohal, Hunza Chaudhry, Sunny Sandhu)
- Correspondence to: Hunza Chaudhry, Department of Internal Medicine, UCSF Fresno, 155 N Fresno St, Fresno, CA, 93722, USA, e-mail:
| | - Kanwal Bains
- Department of Clinical Nutrition, Brigham and Women’s Hospital, Massachusetts (Kanwal Bains)
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus, Arizona (Armaan Dhaliwal)
| | - Raghav Sharma
- Punjab Institute of Medical Sciences, India (Raghav Sharma)
| | - Gagan Gupta
- Dayanand Medical College and Hospital, India (Gagan Gupta, Piyush Singla)
| | - Piyush Singla
- Dayanand Medical College and Hospital, India (Gagan Gupta, Piyush Singla)
| | - Dino Dukovic
- Ross University School of Medicine, Barbados, (Dino Dukovic)
| | - Sunny Sandhu
- Department of Internal Medicine, University of California, Fresno, California, USA (Aalam Sohal, Hunza Chaudhry, Sunny Sandhu)
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, Fresno, California, USA (Marina Roytman)
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Sohal A, Alhankawi D, Sandhu S, Chintanaboina J. Turmeric-Induced Hepatotoxicity: Report of 2 Cases. Int Med Case Rep J 2021; 14:849-852. [PMID: 34992472 PMCID: PMC8711139 DOI: 10.2147/imcrj.s333342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
The use of herbal and dietary supplements is rising in the United States. Turmeric has been one of the most popular supplements recently, used widely for various conditions such as arthritis, digestive disorder, and liver conditions. Although rarely reported, hepatotoxicity can happen with turmeric use. Here, we present 2 cases of drug-induced liver injury due to turmeric use with the complete resolution after cessation.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine, UCSF Fresno, Fresno, CA, USA
| | - Dhuha Alhankawi
- Department of Gastroenterology and Hepatology, UCSF Fresno, Fresno, CA, USA
| | - Sunny Sandhu
- Department of Internal Medicine, UCSF Fresno, Fresno, CA, USA
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Abstract
Cefepime is a common antibiotic used to treat various infections such as pneumonia, skin infections, and intra-abdominal infections due to its broad gram-positive and gram-negative spectrum. However, patients with acute kidney injury, end-stage renal disease, and renal transplantation are disproportionately at higher risk of developing complications from administration of cefepime, secondary to its predominant renal excretion. Current guidelines prescribe cefepime renal-dosing, dependent on the glomerular filtration rate, to prevent toxicity. This study presents a rare case where an acutely hospitalized patient undergoing chronic renal transplant rejection was administered renal-dose cefepime. Despite renal dosing, the patient developed neurotoxicity that manifested as delirium, inability to tolerate oral intake, and non-convulsive status epilepticus. Solely adjusting for renal dysfunction may be inadequate to prevent the accumulation of cefepime metabolites, which may present in an atypical manner in the patient. Such possibilities emphasize the need for continued evaluation of a patient’s mentation in case of cefepime administration. Cefepime-induced neurotoxicity incidences need to be evaluated and researched thoroughly.
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Affiliation(s)
- Tanjot Saini
- Internal Medicine, University of California, San Francisco, Fresno, USA
| | - Monica N Gaines
- Internal Medicine, University of California, San Francisco, Fresno, USA
| | - Aalam Sohal
- Internal Medicine, University of California, San Francisco, Fresno, USA
| | - Lin Li
- Internal Medicine, University of California, San Francisco, Fresno, USA
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Sohal A, Green V, Sandhu S, Roytman M. Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management. J Community Hosp Intern Med Perspect 2021; 11:722-726. [PMID: 34567473 PMCID: PMC8462881 DOI: 10.1080/20009666.2021.1954784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Hepatic encephalopathy (HE) is a reversible brain dysfunction caused by liver insufficiency and portosystemic shunting. Hepatic encephalopathy is a common complication of advanced liver disease and is on a rise with the increasing incidence of non-alcoholic steatohepatitis (NASH). Since partnership with nursing staff is a critical part of successful management of these complex patients, we conducted a survey assessing their knowledge regarding HE.169 nurses participated in the survey. We found that more than 30% of the nurses did not know that ammonia is one of the toxins responsible for causing hepatic encephalopathy. We also found that 20% of the nurses had difficulty answering questions regarding titration of lactulose to bowel movements. Dietary education is a significant area for improvement as 80% of the nurses wanted to restrict fat and carbohydrate intake in these patients. With this simple survey, we identified important knowledge gaps among experienced nurses at our institution. We believe that by improving knowledge through focused lectures, we can improve patient care and reduce the length of hospitalizations in patients with HE.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine , UCSF Fresno, Fresno, USA
| | - Victoria Green
- Department of Internal Medicine , UCSF Fresno, Fresno, USA
| | - Sunny Sandhu
- Department of Internal Medicine , UCSF Fresno, Fresno, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, UCSF Fresno, Fresno, USA
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