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Heaton J, Alshami A, Imburgio S, Mararenko A, Schoenfeld M, Sealove B, Asif A, Almendral J. Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines. J Am Heart Assoc 2024; 13:e034322. [PMID: 38563377 DOI: 10.1161/jaha.123.034322] [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: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. METHODS AND RESULTS Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. CONCLUSIONS Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guideline treatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.
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Affiliation(s)
- Joseph Heaton
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Abbas Alshami
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Steven Imburgio
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Anton Mararenko
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Matthew Schoenfeld
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Brett Sealove
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
| | - Arif Asif
- Department of Medicine Jersey Shore University Medical Center Neptune City NJ
| | - Jesus Almendral
- Division of Cardiology Jersey Shore University Medical Center Neptune City NJ
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Imburgio S, Udongwo N, Mararenko A, Johal A, Tafa M, Akhlaq H, Dandu S, Hossain M, Alshami A, Sealove B, Almendral J, Heaton J. Impact of Frailty on Left Ventricular Assist Device Clinical Outcomes. Am J Cardiol 2023; 207:69-74. [PMID: 37734302 DOI: 10.1016/j.amjcard.2023.08.171] [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: 08/13/2023] [Revised: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
Frailty is a clinical syndrome prevalent in older adults and carries poor outcomes in patients with heart failure. We investigated the impact of frailty on left ventricular assist device (LVAD) clinical outcomes. The Nationwide Readmission Database was used to retrospectively identify patients with a primary diagnosis of heart failure who underwent LVAD implantation during their hospitalization from 2014 to 2020. Patients were categorized into frail and nonfrail groups using the Hospital Frailty Risk Score. Cox and logistic regression were used to predict the impact of frailty on inpatient mortality, 30-day readmissions, length of stay, and discharge to a skilled nursing facility. LVADs were implanted in 11,465 patients who met the inclusion criteria. There was more LVAD use in patients who were identified as frail (81.6% vs 18.4%, p <0.001). The Cox regression analyses revealed that LVAD insertion was not associated with increased inpatient mortality in frail patients (hazard ratio 1.15, 95% confidence interval 0.81 to 1.65, p = 0.427). Frail patients also did not experience a higher likelihood of readmissions within 30 days (hazard ratio 1.15, 95% confidence interval 0.91 to 1.44, p = 0.239). LVAD implantation did not result in a significant increase in inpatient mortality or readmission rates in frail patients compared with nonfrail patients. These data support continued LVAD use in this high-risk patient population.
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Affiliation(s)
- Steven Imburgio
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey.
| | - Ndausung Udongwo
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Anton Mararenko
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Anmol Johal
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Medin Tafa
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Hira Akhlaq
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Sowmya Dandu
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Abbas Alshami
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Brett Sealove
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Jesus Almendral
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey
| | - Joseph Heaton
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey
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Mararenko A, Udongwo N, Pannu V, Miller B, Alshami A, Ajam F, Odak M, Tavakolian K, Douedi S, Mushtaq A, Asif A, Sealove B, Almendral J, Zacks E, Heaton J. Intracardiac leadless versus transvenous permanent pacemaker implantation: Impact on clinical outcomes and healthcare utilization. J Cardiol 2023; 82:378-387. [PMID: 37196728 DOI: 10.1016/j.jjcc.2023.05.001] [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: 01/15/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Transvenous permanent pacemakers are used frequently to treat cardiac rhythm disorders. Recently, intracardiac leadless pacemakers offer potential treatment using an alternative insertion procedure due to their novel design. Literature comparing outcomes between the two devices is scarce. We aim to assess the impact of intracardiac leadless pacemakers on readmissions and hospitalization trends. METHODS We analyzed the National Readmissions Database from 2016 to 2019, seeking patients admitted for sick sinus syndrome, second-degree-, or third-degree atrioventricular block who received either a transvenous permanent pacemaker or an intracardiac leadless pacemaker. Patients were stratified by device type and assessed for 30-day readmissions, inpatient mortality, and healthcare utilization. Descriptive statistics, Cox proportional hazards, and multivariate regressions were used to compare the groups. RESULTS Between 2016 and 2019, 21,782 patients met the inclusion criteria. The mean age was 81.07 years, and 45.52 % were female. No statistical difference was noted for 30-day readmissions (HR 1.14, 95 % CI 0.92-1.41, p = 0.225) and inpatient mortality (HR 1.36, 95 % CI 0.71-2.62, p = 0.352) between the transvenous and intracardiac groups. Multivariate linear regression revealed that length of stay was 0.54 (95 % CI 0.26-0.83, p < 0.001) days longer for the intracardiac group. CONCLUSION Hospitalization outcomes associated with intracardiac leadless pacemakers are comparable to traditional transvenous permanent pacemakers. Patients may benefit from using this new device without incurring additional resource utilization. Further studies are needed to compare long-term outcomes between transvenous and intracardiac pacemakers.
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Affiliation(s)
- Anton Mararenko
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Viraaj Pannu
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Brett Miller
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Abbas Alshami
- Division of Cardiology, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Firas Ajam
- Division of Cardiology, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Mihir Odak
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Kameron Tavakolian
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Steven Douedi
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ, USA
| | - Arman Mushtaq
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Brett Sealove
- Division of Cardiology, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Jesus Almendral
- Division of Cardiology, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Eran Zacks
- Division of Cardiology, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - Joseph Heaton
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA.
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Patel SV, Alshami A, Douedi S, Udongwo N, Hossain M, Tarina D, Walch B, Carpenter K, Kountz D, Buccellato V, Sable K, Frank E, Asif A. The Utilization of 15-Minute Multidisciplinary Rounds to Reduce Length of Stay in Patients under Observation Status. Healthcare (Basel) 2023; 11:2823. [PMID: 37957968 PMCID: PMC10648780 DOI: 10.3390/healthcare11212823] [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: 06/23/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
With the recent change to value-based care, institutions have struggled with the appropriate management of patients under observation. Observation status can have a huge impact on hospital and patient expenses. Institutions have implemented specialized observation units to provide better care for these patients. Starting in January 2020, coinciding with the initiation of daily multidisciplinary rounds, our study focused on patients aged 18 and older admitted to our hospital under observation status. Efforts were built upon prior initiatives at Jersey Shore University Medical Center (JSUMC) to optimize patient care and length of stay (LOS) reduction. The central intervention revolved around the establishment of daily "Observation Huddles"-succinct rounds led by hospital leaders to harmonize care for patients under observation. The primary aim was to assess the impact of daily multidisciplinary rounds (MDR) on LOS, while our secondary aim involved identifying specific barriers and interventions that contributed to the observed reduction. Our study revealed a 9-h reduction in observation time, resulting in approximately USD 187.50 saved per patient. When accounting for the period spanning 2020 to 2022, potential savings totaled USD 828,187.50 in 2020, USD 1,046,062.50 in 2021, and USD 1,243,562.50 in 2022. MDR for observation patients led to a reduction in LOS from 29 h to 20 h (p < 0.001).
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Affiliation(s)
| | | | | | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (S.V.P.); (A.A.); (S.D.); (M.H.); (D.T.); (B.W.); (K.C.); (D.K.); (V.B.); (K.S.); (E.F.); (A.A.)
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5
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Fatuyi M, Udongwo N, Favour M, Alshami A, Sanyi A, Amah C, Safiriyu I, Al-Amoodi M, Sealove B, Shishehbor MH, Shemisa K. Thirty-Day Readmission Rate & Healthcare Economic Effects of patients with Transcatheter Aortic Valve Replacement and Co-Existing Chronic Congestive Heart Failure. Curr Probl Cardiol 2023; 48:101695. [PMID: 36921650 DOI: 10.1016/j.cpcardiol.2023.101695] [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: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) procedures have increased since adoption in 2010. Readmission for TAVR patients with underlying chronic congestive heart failure (cCHF) remains challenging. Therefore, we sought to determine the 30-day readmission rate (30-DRr) of patients who undergo TAVR & co-existing cCHF & its impact on mortality & healthcare utilization in the United States. METHODS We performed a retrospective study using the national readmission database year 2017 and 2018. The patients studied were discharged with TAVR as a principal diagnosis & underlying cCHF as a secondary diagnosis according to ICD-10 codes. The primary outcome was a 30-day readmission rate and mortality, while secondary outcomes were the most common diagnoses for readmission, & resource utilization. RESULTS A total of 76,892 index hospitalization for TAVR with co-existing cCHF: mean age was 79.7 years [SD: ± 2], & 54.5% of patients were males. In-hospital mortality rate for index admission was 1.63%. The 30-DRr was 9.5%. Among the group of readmitted patients, in-hospital mortality rate was 3.13%. Readmission mortality showed a statistically significant increase compared to index mortality (3.13% vs. 1.63%, adjusted p=<0.001, aOR: 2.1, 95% CI: 1.6-2.9). The total healthcare in-hospital economic spending was $94.4 million, and total patient charge of $412 million. CONCLUSION Approximately 1 in 10 patients who underwent TAVR with underlying cCHF had 30-DRr, with subsequent readmissions associated with increased healthcare spending. Readmission mortality showed a statistically significant increase when compared to index mortality. TAVR patients with cCHF are a vulnerable subset requiring additional outpatient care.
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Affiliation(s)
- Michael Fatuyi
- Department of Medicine, Trihealth Good Samaritan Hospital, Cincinnati, OH.
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ
| | - Markson Favour
- Department of Medicine, Lincoln Medical Center, Bronx, NY
| | - Abbas Alshami
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ
| | - Allen Sanyi
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Chidi Amah
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Israel Safiriyu
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mohammed Al-Amoodi
- Department of Cardiology, Trihealth Good Samaritan Hospital Program, Cincinnati, OH
| | - Brett Sealove
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ
| | - Mehdi H Shishehbor
- Department of Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals of Cleveland, OH, United States
| | - Kamal Shemisa
- Department of Cardiology, Trihealth Good Samaritan Hospital Program, Cincinnati, OH
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6
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Iglesias J, Vassallo A, Ilagan J, Ang SP, Udongwo N, Mararenko A, Alshami A, Patel D, Elbaga Y, Levine JS. Acute Kidney Injury Associated with Severe SARS-CoV-2 Infection: Risk Factors for Morbidity and Mortality and a Potential Benefit of Combined Therapy with Tocilizumab and Corticosteroids. Biomedicines 2023; 11:biomedicines11030845. [PMID: 36979824 PMCID: PMC10045336 DOI: 10.3390/biomedicines11030845] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Acute kidney injury (AKI) is a common complication in patients with severe COVID-19. Methods: We retrospectively reviewed 249 patients admitted to an intensive care unit (ICU) during the first wave of the pandemic to determine risk factors for AKI. Demographics, comorbidities, and clinical and outcome variables were obtained from electronic medical records. Results: Univariate analysis revealed older age, higher admission serum creatinine, elevated Sequential Organ Failure Assessment (SOFA) score, elevated admission D-Dimer, elevated CRP on day 2, mechanical ventilation, vasopressor requirement, and azithromycin usage as significant risk factors for AKI. Multivariate analysis demonstrated that higher admission creatinine (p = 0.0001, OR = 2.41, 95% CI = 1.56–3.70), vasopressor requirement (p = 0.0001, OR = 3.20, 95% CI = 1.69–5.98), elevated admission D-Dimer (p = 0.008, OR = 1.0001, 95% CI = 1.000–1.001), and elevated C-reactive protein (CRP) on day 2 (p = 0.033, OR = 1.0001, 95% CI = 1.004–1.009) were independent risk factors. Conversely, the combined use of Tocilizumab and corticosteroids was independently associated with reduced AKI risk (p = 0.0009, OR = 0.437, 95% CI = 0.23–0.81). Conclusion: This study confirms the high rate of AKI and associated mortality among COVID-19 patients admitted to ICUs and suggests a role for inflammation and/or coagulopathy in AKI development. One should consider the possibility that early administration of anti-inflammatory agents, as is now routinely conducted in the management of COVID-19-associated acute respiratory distress syndrome, may improve clinical outcomes in patients with AKI.
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Affiliation(s)
- Jose Iglesias
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
- Department of Nephrology, Community Medical Center, RWJBarnabas Health, Toms River, NJ 08757, USA
- Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
- Correspondence:
| | - Andrew Vassallo
- Department of Pharmacy, Community Medical Center, RWJBarnabas Health, Toms River, NJ 08757, USA
| | - Justin Ilagan
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Song Peng Ang
- Department of Medicine, Community Medical Center, RWJBarnabas Health, Toms River, NJ 08757, USA
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Anton Mararenko
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Dylon Patel
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Yasmine Elbaga
- Department of Pharmacy, Monmouth Medical Center Southern Campus, RWJBarnabas Health, 600 River Ave., Lakewood, NJ 08701, USA
| | - Jerrold S. Levine
- Department of Medicine, Division of Nephrology, University of Illinois Chicago, Chicago, IL 60612, USA
- Department of Medicine, Division of Nephrology, Jesse Brown Veterans Affairs Medical Center, Chicago, IL 60612, USA
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7
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Mararenko A, Udongwo N, Alshami A, Pannu V, Ajam F, Heaton J, Mushtaq A, Selan JC, Almendral JG. RISK OF ACUTE CORONARY SYNDROME AND CORONARY ARTERY DISEASE IN PATIENTS WITH PRIMARY HYPOGONADISM ON TESTOSTERONE REPLACEMENT THERAPY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01722-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Museedi A, Alshami A, Upadhrasta S, Jassir DU, Alsaad AA, Rozenbaum Z. TRANSCATHETER TRICUSPID VEGETATION DEBULKING OUTCOME IN HIGH RISK PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02453-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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9
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Mararenko A, Alshami A, Udongwo N, Desai D, Selan JC. FEAR THE BITE - IMPELLA ASSOCIATED CHORDAE TENDINEAE RUPTURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04380-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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10
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Wiseman K, Gor D, Udongwo N, Alshami A, Upadhaya V, Daniels SJ, Chung WK, Koo CH. Ventricular arrhythmias in Kearns-Sayre syndrome: A cohort study using the National Inpatient Sample database 2016-2019. Pacing Clin Electrophysiol 2022; 45:1357-1363. [PMID: 36208035 DOI: 10.1111/pace.14607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/06/2022] [Revised: 09/05/2022] [Accepted: 10/02/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Degeneration of the cardiac conduction system resulting in complete heart block (CHB), ventricular arrhythmias (VA), and sudden cardiac death (SCD) is recognized in patients with Kearns-Sayre syndrome (KSS) and is potentially preventable with permanent pacemaker (PPM) implantation. However, other mechanisms for SCD have been proposed, and the efficacy of implanting a defibrillator instead of PPM remains to be investigated. METHODS We utilized the National Inpatient Sample (NIS) database 2016-2019 to investigate the risk of VA or dysrhythmic cardiac arrest (dCA) in KSS patients. We compared the outcomes of KSS to myotonic dystrophy (MD), a more common genetic disorder with similar clinical cardiac features and course. RESULTS We identified 640 admissions for KSS. VA or dCA were lower in admissions for KSS than MD patients (2.3% vs. 4.5%, p = .009). Device implantation differed between study groups. Approximately, 70% of cases with KSS and conduction abnormalities had pacemaker (± defibrillator) on hospital discharge, compared to 35% in MD. Conduction abnormalities were associated with higher rates of VA or dCA in both study groups. None of the admissions for KSS patients who developed VA or dCA had a pacemaker, and all of them had conduction abnormalities. One-third of admissions for MD patients who developed VA or dCA had a device already implanted prior to the event. CONCLUSION Despite its effectiveness in preventing VA, PPM remains underutilized in patients with KSS or MD who have conduction abnormalities. PPM alone do not fully prevent VA in MD patients; therefore, addition of defibrillator capacity might be necessary.
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Affiliation(s)
- Kyle Wiseman
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Dhairya Gor
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Ndausung Udongwo
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Abbas Alshami
- Division of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Vandan Upadhaya
- Division of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Steven J Daniels
- Division of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Wendy K Chung
- Department of Medicine, Columbia University Irving Medical Center, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Charles H Koo
- Division of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
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11
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Odak M, Douedi S, Mararenko A, Alshami A, Elkherpitawy I, Douedi H, Zacks E, Sealove B. Arrhythmogenic Right Ventricular Cardiomyopathy: The Role of Genetics in Diagnosis, Management, and Screening. Cardiol Res 2022; 13:177-184. [PMID: 36128418 PMCID: PMC9451588 DOI: 10.14740/cr1373] [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] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a predominantly autosomal dominant genetic condition in which fibrous and fatty tissue infiltrate and replace healthy myocardial tissue. This uncommon yet debilitating condition can cause ventricular arrhythmias, cardiac failure, and sudden cardiac death. Management focuses primarily on prevention of syndrome sequelae in order to prevent morbidity and mortality. Genetic testing and screening in affected families, although utilized clinically, has not yet been incorporated in guidelines due to lack of larger studies and data. We aim herein to identify causative gene mutations, present advancements in diagnosis and management, and describe the role of genetic screening and counseling in patients with ARVC. With the advancement of genetic testing and therapy, diseases such as ARVC may become more accurately diagnosed and more effectively managed, ultimately significantly reducing morbidity and mortality.
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Affiliation(s)
- Mihir Odak
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
- Corresponding Author: Mihir Odak, Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.
| | - Steven Douedi
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ 08015, USA
| | - Anton Mararenko
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Abbas Alshami
- Division of Cardiology, Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Islam Elkherpitawy
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Hani Douedi
- Department of Cardiology, Community Medical Center, Toms River, NJ 08753, USA
| | - Eran Zacks
- Division of Cardiology, Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Brett Sealove
- Division of Cardiology, Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
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12
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Ajam F, Batchu P, Wiseman K, Gor D, Mason E, Alshami A, Douedi S, Mehra A, Bajwa R, Levitt M, Greenberg D, Raza M. Primary Cardiac Lymphoma: A Case Report. J Med Cases 2021; 12:433-437. [PMID: 34804301 PMCID: PMC8577611 DOI: 10.14740/jmc3773] [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: 08/28/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Cardiac lymphoma is a rare neoplasm involving heart, pericardium or both, usually seen in immunocompromised patients. We report a 61-year-old male presenting with worsening shortness of breath and 20-pound weight loss. Investigations showed right-sided tumor with interatrial septal wall perforation and left atrial expansion. The diagnosis was confirmed with mediastinal mass biopsy. After receiving the appropriate treatment, there was a steady improvement clinically and on the transesophageal echocardiography.
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Affiliation(s)
- Firas Ajam
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Priyanka Batchu
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Kyle Wiseman
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Dhairya Gor
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Elisabeth Mason
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Steven Douedi
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Aditya Mehra
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Ravneet Bajwa
- Hematology/Oncology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Michael Levitt
- Hematology/Oncology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - David Greenberg
- Hematology/Oncology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Muhammad Raza
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
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13
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Patel I, Odak M, Douedi S, Alshami A, Upadhyaya VD, Hossain M, Anne M, Patel SV. Eculizumab as a Treatment for Hyper-Haemolytic and Aplastic Crisis in Sickle Cell Disease. Eur J Case Rep Intern Med 2021; 8:002824. [PMID: 34790624 DOI: 10.12890/2021_002824] [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: 08/08/2021] [Accepted: 08/26/2021] [Indexed: 11/05/2022] Open
Abstract
Background Patients with sickle cell disease can experience various crises including sequestration crisis, haemolytic crisis and aplastic crisis. Due to alloantibody formation, transfusion alloantibodies can cause a haemolytic crisis. Treatment involves avoiding packed red blood cell transfusions, as well as intravenous immunoglobulin, steroids and eculizumab to decrease the chances of haemolysis. Case description We report the case of a 42-year-old man who was found to have worsening anaemia after packed red blood cell transfusion with evidence suggestive of haemolytic crisis. Due to reticulocytopenia, aplastic crisis was also suspected and later confirmed via parvovirus IgG and IgM titres. The patient did not improve with steroid and intravenous immunoglobulin therapy and was treated with eculizumab as a salvage therapy. Conclusion Concurrent hyper-haemolytic crisis and aplastic crisis should be suspected in patients with features of haemolysis and reticulocytopenia. Prompt recognition and treatment with eculizumab are paramount in those who fail steroid and intravenous immunoglobulin treatment. LEARNING POINTS Treatment of hyper-haemolytic and aplastic crisis in sickle cell disease with eculizumab offers therapeutic benefit.A high index of suspicion for hyper-haemolytic crisis and aplastic crisis should be maintained in those with haemolytic features as well as reticulocytopenia in the setting of sickle cell disease.
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Affiliation(s)
- Ishan Patel
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mihir Odak
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Vandan D Upadhyaya
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Mohammad Hossain
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Madhurima Anne
- Department of Hematology Oncology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Swapnil V Patel
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
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14
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Udongwo N, Gor D, Wiseman K, Alshami A, Daniels S. Kearns-Sayre Syndrome With Persistent Ventricular Tachycardia Refractory to Shocks and Medications. Cureus 2021; 13:e17175. [PMID: 34548978 PMCID: PMC8437014 DOI: 10.7759/cureus.17175] [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] [Accepted: 08/14/2021] [Indexed: 11/05/2022] Open
Abstract
Cardiovascular conduction delay makes up part of the triad associated with Kearns-Sayre syndrome (KSS). Although there have been a few reported cases of prolonged Qtc and polymorphic ventricular tachycardia associated with this disease, despite the use of automatic implantable cardioverter defibrillators (AICD) for secondary prevention, some cases have been reported where the use of AICD did not help. We present a case of a 62-year-old male with KSS who came to the emergency department (ED) after two episodes of syncope. He already had an automatic AICD placed at the age of 34. Our patient had Qtc prolongation which is an unusual finding in KSS. He also had recurrent ventricular tachycardia (VT) refractory to medications and multiple shocks from his AICD, which progressed to a VT storm. He eventually passed away after the withdrawal of care, as his prognosis worsened. We recommend that a more clear guideline will help manage this devastating disease, resulting in mortality reduction.
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Affiliation(s)
- Ndausung Udongwo
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Dhairya Gor
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Kyle Wiseman
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Steven Daniels
- Cardiology, Jersey Shore University Medical Center, Neptune, USA
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15
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Mararenko A, Alshami A, Ajam F, Zagha D. Coronary Sinus Thrombosis in a Patient Without History of Endothelial Cardiac Injury. J Med Cases 2021; 12:355-358. [PMID: 34527105 PMCID: PMC8425814 DOI: 10.14740/jmc3726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022] Open
Abstract
Coronary sinus thrombosis (CST) is a rare but life-threatening condition that involves clot formation within the vessel responsible for draining all of the venous blood from the myocardium itself. The coronary sinus is situated in the right atrium approximately half-way between the tricuspid value and the inferior vena cava. The coronary sinus is rarely cited in medical literature due to limited knowledge as well as rarity in clinical encounters. CST can be a rapidly progressive life-threatening emergency as the interruption of vascular drainage can result in pericardial effusions, tamponade and cardiogenic shock. A major clinical challenge in diagnosing and treating this condition is due to relative rarity as well as the non-specificity of presenting symptoms that are often associated with more commonly encountered cardiopulmonary diseases. CST is most commonly induced by endothelial damage, such as post intracardiac instrumentation with catheter guidewires, or any of the criteria outlined by Virchow’s triad. Our team described the finding of a thrombus 1.8 cm in diameter in a patient with underlying hepatobiliary cancer as well as underlying bacteremia from infected ascitic fluid. Though our patient remained hemodynamically stable without cardiopulmonary complications, we hope to spark a discussion within the medical community to increase awareness as well as to highlight the need for more research on this potentially life-threatening condition.
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Affiliation(s)
- Anton Mararenko
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Firas Ajam
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - David Zagha
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
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16
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Alameri A, Alkhero M, Alshaikhli A, Alshami A, Saca J. A Challenging Case of Refractory Biliary Leak in a Patient With Hydatid Liver Disease. J Med Cases 2021; 12:267-270. [PMID: 34434469 PMCID: PMC8383690 DOI: 10.14740/jmc3694] [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: 03/10/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Hydatid liver disease (HLD) is the most common form of hydatid disease, and it is caused by a zoonotic infection with a tape worm. It is endemic mostly in sheep-farming countries and rare in the United States. Liver involvement is usually asymptomatic, but symptoms develop upon growth of the cyst leading to many complications, most common of which is intra-biliary rupture, and less likely biliary obstruction. Diagnosis is clinical, serologic and radiologic. Therapeutic approaches to HLD include surgery, anthelminthic medications and medico-surgical procedures. Here we present a case of HLD that presented in advanced stage leading to grave consequences, complicated course and difficult therapeutic options. Given the rarity of hydatid disease in Northern America, physicians have to keep high index of suspicion especially in a patient with history of travel to endemic areas, as early diagnosis and treatment is important to avoid high morbidity and mortality.
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Affiliation(s)
- Aws Alameri
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Mohammed Alkhero
- Department of Internal Medicine, UHS Southern California Medical Education Consortium, 42211 Stonewood Rd, Temecula, CA 92591, USA
| | - Alfarooq Alshaikhli
- Department of Internal Medicine, University of Texas, Rio Grande Valley at DHR, 5423 S McColl Rd, Edinburg, TX 78539, USA
| | - Abbas Alshami
- Department of Internal Medicine, Jersey Shore University Medical Center, 1945 NJ-33, Neptune City, NJ 07753, USA
| | - James Saca
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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17
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Mararenko A, Douedi S, Alshami A, Odak M, Patel SV. Rare Case of Small Bowel Obstruction Secondary to Cryptosporidium in a Young Patient With Uncontrolled AIDS. Cureus 2021; 13:e16040. [PMID: 34336522 PMCID: PMC8321418 DOI: 10.7759/cureus.16040] [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] [Accepted: 06/29/2021] [Indexed: 11/05/2022] Open
Abstract
Small bowel obstruction is a common cause of abdominal pain and accounts for approximately 20% of surgical admissions related to abdominal pain. In the United States alone, there are over 300,000 admissions annually for small bowel obstruction and account for every 15 out of 100 admissions for abdominal pain. If treated appropriately with medical management, over 80% of cases resolve without life-threatening, long-term complications or the need for surgical intervention. The three most common causes including adhesions, tumors, and hernias account for the majority of cases. Less frequently reported causes include infections. We present the case of a 26-year-old male with a history of AIDS who was found to have a small bowel obstruction in the setting of active Cryptosporidium infection. Cryptosporidium is an opportunistic infection that more commonly affects immunocompromised hosts, especially those noncompliant with antiretroviral therapy. Our patient had an uncomplicated hospital course and made a full recovery due to early diagnosis and immediate intervention. We hope to make the medical community more aware of this rare and potentially life-threatening association given the rarity of such a presentation. Early diagnosis and intervention are critical to preventing morbidity and mortality.
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Affiliation(s)
- Anton Mararenko
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Steven Douedi
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Mihir Odak
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
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18
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Ogedegbe C, Udongwo N, Kalejaiye A, Alshami A, Alfraji N, Spariousu M. Self-Inflicted Traumatic Bilateral Upper Extremity Amputation as a Suicidal Gesture? Cureus 2021; 13:e17176. [PMID: 34532196 PMCID: PMC8437003 DOI: 10.7759/cureus.17176] [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] [Accepted: 08/14/2021] [Indexed: 11/21/2022] Open
Abstract
Traumatic amputations are partial or complete dismemberment of part of the human body (usually one limb) due to an injury that involves a component of blunt force trauma. It is usually caused by accidental events and only very rarely due to suicidal events. A 37-year-old female with major depressive disorder attempted suicide by placing her forearms on a railroad track, resulting in traumatic bilateral upper extremity amputations. Emergency Department resuscitation was initiated as the patient was taken immediately to the operating room; however, restoration of the limbs was unfeasible, and the patient had successful debriding and fashioning a flap to the distal ends of the upper extremities after hemostasis was achieved. Depression may still be an undertreated clinical entity in our society, and many preventable causes of suicide are attempted each year. Evidence exists that suggests severe suicide attempts occur generally in men and minor suicide attempts, or so-called suicidal gestures, occur generally in women. This case questions this notion.
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Affiliation(s)
- Chinwe Ogedegbe
- Emergency Medicine, Hackensack University Medical Center, Hackensack, USA
| | - Ndausung Udongwo
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ayoola Kalejaiye
- Internal Medicine, Montefiore Medical Center, Moses Campus, Bronx, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Nasam Alfraji
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
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19
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Douedi S, Mararenko A, Alshami A, Al‐Azzawi M, Ajam F, Patel S, Douedi H, Calderon D. COVID-19 induced bradyarrhythmia and relative bradycardia: An overview. J Arrhythm 2021; 37:888-892. [PMID: 34386113 PMCID: PMC8339085 DOI: 10.1002/joa3.12578] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022] Open
Abstract
Novel coronavirus 2019 (COVID-19) has been the focus of the medical community since its emergence in December 2019 and has already infected more than 100 million patients globally. Primarily described to cause a respiratory illness, COVID-19 has been found to affect almost every organ system. Bradycardia is a newly recognized ramification of COVID-19 that still has unknown prognostic value. Studies have shown an increase in the incidence of arrhythmias, cardiomyopathies, myocarditis, acute coronary syndromes, and coagulopathies in infected patients as well as an increased risk of mortality in patients with preexisting cardiovascular disease. While the pathogenesis of bradycardia in COVID-19 may be multifactorial, clinicians should be aware of the mechanism by which COVID-19 affects the cardiovascular system and the medication side effects which are used in the treatment algorithm of this deadly virus. There has yet to be a comprehensive review analyzing bradyarrhythmia and relative bradycardia in COVID-19 infected patients. We aim to provide a literature review including the epidemiology, pathogenesis, and management of COVID-19 induced bradyarrhythmia.
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Affiliation(s)
- Steven Douedi
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNJUSA
| | - Anton Mararenko
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNJUSA
| | - Abbas Alshami
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNJUSA
| | - Mohammed Al‐Azzawi
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNJUSA
| | - Firas Ajam
- Department of CardiologyJersey Shore University Medical CenterNeptuneNJUSA
| | - Swapnil Patel
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNJUSA
| | - Hani Douedi
- Department of CardiologyCommunity Medical CenterToms RiverNJUSA
| | - Dawn Calderon
- Department of CardiologyJersey Shore University Medical CenterNeptuneNJUSA
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20
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Udongwo N, Douedi S, Odak M, Alshami A, Patel SV, Farooq T. Atypical Presentation of Plasma Cell Neoplasm of the Sternum. Cureus 2021; 13:e16106. [PMID: 34350073 PMCID: PMC8325918 DOI: 10.7759/cureus.16106] [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] [Accepted: 07/02/2021] [Indexed: 01/10/2023] Open
Abstract
Multiple myeloma (MM) is a rare plasma cell neoplasm characterized by monoclonal cell infiltration in the bone marrow, which can cause anemia, bone pain, and recurrent infections. Extramedullary myeloma (EM) is a rare clinical presentation with a poor prognosis. It involves the accumulation of clonal plasma cells in soft tissues with a tumor-like appearance, either presenting as a primary (initial) or secondary (relapse) malignancy. We present a case of a 65-year-old male who experienced an abrupt onset of chest pain associated with a localized sternal mass while exercising the day prior to arrival. Chest computed tomography (CT) scan with contrast revealed an expansile lytic lesion around the sternal area. Due to high suspicion for malignancy, a CT-guided core needle biopsy was done, which showed plasma cells with rare Dutcher bodies consistent with MM. Bone marrow smear showed the presence of 70% plasma cells confirming a diagnosis of MM. Early detection of this devastating disease may help improve survival. Therefore, physicians should have a high index of suspicion for MM in older patients with similar clinical presentations.
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Affiliation(s)
- Ndausung Udongwo
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Steven Douedi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Mihir Odak
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Taliya Farooq
- Pathology, Jersey Shore University Medical Center, Neptune City, USA
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21
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Patel S, Alshami A, Douedi S, Campbell N, Hossain M, Mushtaq A, Tarina D, Sealove B, Kountz D, Carpenter K, Angelo E, Buccellato V, Sable K, Frank E, Asif A. Improving Hospital Length of Stay: Results of a Retrospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9060762. [PMID: 34205327 PMCID: PMC8234441 DOI: 10.3390/healthcare9060762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June-August 2019 to June-August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings.
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Affiliation(s)
- Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Correspondence:
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Natasha Campbell
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Arman Mushtaq
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Dana Tarina
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Brett Sealove
- Department of Cardiology, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA;
| | - David Kountz
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Kim Carpenter
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Ellen Angelo
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Vito Buccellato
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Kenneth Sable
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Elliot Frank
- Department of Quality Improvement, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA;
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
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22
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Upadhyaya VD, Alshami A, Patel I, Douedi S, Quinlan A, Thomas T, Prentice J, Calderon D, Asif A, Sen S, Mehra A, Hossain MA. Outcomes of Renal Function in Cardiogenic Shock Patients With or Without Mechanical Circulatory Support. J Clin Med Res 2021; 13:283-292. [PMID: 34104280 PMCID: PMC8166292 DOI: 10.14740/jocmr4449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background The objective of the study was to compare the renal outcomes in patients presenting with all-cause cardiogenic shock who were supported by either Impella devices (Abiomed, Danvers, MA), intra-aortic balloon pump (IABP), or vasopressors alone. Outcomes of cardiogenic shock remain poor even with the advancement of early revascularization and circulatory supportive care. Percutaneous mechanical circulatory support (MCS) device has emerged as an effective strategy in protecting end organ function especially renal function during high risk percutaneous coronary intervention (PCI) and in patients with cardiogenic shock. Currently, comparative data amongst various MCS modalities and their association with improvement of renal function in cardiogenic shock patients have not been well characterized. Methods Data from New Jersey Cardiac Catheterization Data registry of cardiogenic shock patients from a single tertiary care institution that underwent cardiac catheterization and the modality used to treat were obtained, either with Impella devices, IABP, or treatment with vasopressors alone. Retrospective chart review was conducted to assess the incidence of acute kidney injury (AKI) on patients with cardiogenic shock prior to and after cardiac catheterization and renal function was evaluated over the course of 96 h after cardiac catheterization. Statistical analysis was performed to ascertain significant difference in creatinine and estimated glomerular filtration rate (eGFR) in patients who received Impella devices, IABP, or were treated with vasopressors alone. Results A total of 61 all-cause cardiogenic shock patients met the inclusion and exclusion criteria and were included in the study with 19 receiving IABPs, 15 receiving Impella devices, and 27 treated with vasopressors alone. Baseline characteristics among these three groups did not show any statistically significant difference. A total of 29 cardiogenic shock patients had experienced AKI prior to cardiac catheterization in which those receiving Impella devices showed statistically significant decrease in creatinine and increase in eGFR at 72 and 96 h (P < 0.05) compared to baseline. Within the same cohort, Impella group showed statistically significant lower creatinine at 96 h when compared to IABP. Patients that experienced AKI after cardiac catheterization did not show any statistically significant changes in renal function regardless of modality used. Conclusion The results of our study suggest that Impella devices improve renal function in all-cause cardiogenic shock patients who experience AKI prior to undergoing cardiac catheterization.
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Affiliation(s)
- Vandan D Upadhyaya
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Abbas Alshami
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Ishan Patel
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Steven Douedi
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Amy Quinlan
- Department of Cardiology, One Robert Wood Johnson Place, New Brunswick, NJ 08903, USA
| | - Tresy Thomas
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Joni Prentice
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Dawn Calderon
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Arif Asif
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Shuvendu Sen
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Aditya Mehra
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Mohammad A Hossain
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
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Bistre J, Douedi S, Alshami A, Ndove J, Varon J. COVID-19 Associated Spontaneous Pneumothorax and Pneumopericardium: A Case Report. Cureus 2021; 13:e14861. [PMID: 34113499 PMCID: PMC8178127 DOI: 10.7759/cureus.14861] [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] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemics of our time. There have been several complications of this disease that have also proven to be debilitating and deadly. While primarily affecting the respiratory system, some cases presented with uncommon complications such as pneumopericardium and spontaneous pneumothorax. We present a case of an elderly female diagnosed with COVID-19 found to have both spontaneous pneumothorax and pneumopericardium. She had a complicated hospital course and ultimately succumbed to her illness. While the pathogenesis of these conditions is not yet fully understood, further studies are needed to help clinicians develop treatment and prevention strategies to improve patient outcomes.
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Affiliation(s)
| | - Steven Douedi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Abbas Alshami
- Internal Medicine, Dorrington Medical Associates, Houston, USA
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Jeffrey Ndove
- Research, Dorrington Medical Associates, Houston, USA
| | - Joseph Varon
- Critical Care, United General Hospital, Houston, USA
- Critical Care, University of Texas Health Science Center at Houston, Houston, USA
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Douedi S, Alshami A, Altaei M, Ajam F, Kiss D. COVID-19 TRIGGERED ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2021. [PMCID: PMC8091216 DOI: 10.1016/s0735-1097(21)03353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alshami A, Alfraji N, Douedi S, Patel S, Hossain M, Alpert D, Calderon D. Correction to: Psoriasis as risk factor for non-ischemic dilated cardiomyopathy: a population-based cross-sectional study. BMC Cardiovasc Disord 2021; 21:179. [PMID: 33853543 PMCID: PMC8045285 DOI: 10.1186/s12872-021-01984-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Nasam Alfraji
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA.
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Deborah Alpert
- Department of Rheumatology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Dawn Calderon
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
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Alfraji N, Douedi S, Alshami A, Kuzyshyn H, Tang X. Nonischemic Dilated Cardiomyopathy in Untreated Long-Term Psoriatic Arthritis: A Newly Recognized Association: A Case Report with Mini Review. Am J Case Rep 2021; 22:e930041. [PMID: 33795630 PMCID: PMC8024668 DOI: 10.12659/ajcr.930041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patient: Male, 58-year-old Final Diagnosis: Cardiomyopathy Symptoms: Arthritis • dynpnea • rash Medication: — Clinical Procedure: — Specialty: Cardiology • Dermatology • Rheumatology
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Affiliation(s)
- Nasam Alfraji
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Halyna Kuzyshyn
- Department of Rheumatology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Xiaoyin Tang
- Department of Rheumatology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
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Alshami A, Alfraji N, Douedi S, Patel S, Hossain M, Alpert D, Calderon D. Psoriasis as risk factor for non-ischemic dilated cardiomyopathy: a population-based cross-sectional study. BMC Cardiovasc Disord 2021; 21:161. [PMID: 33789595 PMCID: PMC8015089 DOI: 10.1186/s12872-021-01972-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background Psoriasis is a chronic inflammatory skin condition commonly associated with psoriatic arthritis, malignancy, diabetes, inflammatory bowel disease, and cardiovascular disease. Several reports and studies have reported an association between psoriasis and non-ischemic dilated cardiomyopathy (NIDCM). We aim to study the relationship between psoriasis and non-ischemic dilated cardiomyopathy in a large population-based study. Methods We utilized the Healthcare Cost and Utilization Project National Inpatient Sample 2017 database, which represents a 20% sample of all payer hospitalizations in the United States. We investigated hospitalizations for patients aged 18 years old or older with diagnoses of any type of psoriasis and non-ischemic dilated cardiomyopathy. Psoriasis, cardiomyopathy, and other comorbidities were identified through their international classification of diseases, 10th revision codes recorded in the discharge record for each hospitalization. Results Of a total of 6,084,184 all-cause admissions, 0.5% were admissions for patients with psoriasis (n = 32,807). Of the patients with and without psoriasis who had non-ischemic dilated cardiomyopathy, after adjusting for age, sex, race, diabetes mellitus, hypertension, alcohol abuse, cocaine abuse, arrhythmias, and obesity in a multivariate analysis, the presence of psoriasis was not significantly associated with non-ischemic dilated cardiomyopathy. Conclusion Psoriasis is a chronic autoimmune disorder which carries a higher cardiovascular events and more prevalent traditional atherosclerotic risk factors in comparison to the general population. However, association with non-ischemic cardiomyopathy or NIDCM in particular has not been studied sufficiently. Our study, being one of the first larger studies to assess this correlation, indicated no relationship between psoriasis and non-ischemic dilated cardiomyopathy.
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Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Nasam Alfraji
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA.
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753, USA
| | - Deborah Alpert
- Department of Rheumatology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Dawn Calderon
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
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Abstract
BACKGROUND Naloxone remains the mainstay for the treatment of opioids overdose both in the clinical and public settings. Naloxone has been showing relative safety, leading to trivial adverdse effects which are mostly due to acute withdrawal effects, but when used in patients with known long-term addiction, it usually requires additional dosing or rapid infusion to achieve detoxification effects in a timely manner or to sustain the effects after they fade away. In some patients this has resulted in fatal adverse effects, including non-cardiogenic pulmonary edema (NCPE), which may require intensive care for those patients. Whether the higher dose is the cause has been debatable and not enough studies have looked into this subject. CASE REPORT Here, we report a series of 2 cases where 2 young patients were given naloxone following opioid overdose. Both our patients required frequent dosing due to insufficient response or owing to the washout of the naloxone effect shortly after, given its short half-life. Although the administered doses were different, both patients developed the adverse effect of NCPE and required ventilator support. CONCLUSIONS Evidence suggests that such a catastrophic adverse effect following the administration of such a critical medication, which is known to be relatively safe and is being publicized for saving lives, might limit its use and would require more attention and further studies to standardize a safe dose, limiting these life-threatening events and decreasing the need for unnecessary invasive respiratory support as well as admissions to intensive care units, which might create an additional burden on the health care system.
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Affiliation(s)
- Mohammed Al-Azzawi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Mustafa Al-Taei
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Ghadier Alsaoudi
- Department of Pulmonary and Critical Care, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Eric Costanzo
- Pulmonary and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA
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Alshami A, Al-Bayati A, Douedi S, Hossain MA, Patel S, Asif A. Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study. BMC Neurol 2021; 21:107. [PMID: 33750332 PMCID: PMC7941613 DOI: 10.1186/s12883-021-02143-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus. Methods We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition. Results A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality. Conclusion PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.
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Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Asseel Al-Bayati
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA.
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
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Odak M, AlAzzawi M, Alshami A, Alsaoudi G, Cosentino J. Endobronchial Hamartoma Presenting as Recurrent Pneumonia and Chronic Cough. Cureus 2021; 13:e13717. [PMID: 33833928 PMCID: PMC8019537 DOI: 10.7759/cureus.13717] [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] [Indexed: 11/29/2022] Open
Abstract
Pneumonia is an infection of the lungs that can result from various etiologies, including bronchial obstruction. It is estimated that 5.4% of community-acquired pneumonia occurs as a result of an endobronchial obstruction, classifying them as post-obstructive pneumonia. Pulmonary hamartomas are benign and exceedingly rare tumors. These hamartomas are usually asymptomatic and found incidentally on imaging, however, they can cause patients to develop post-obstructive pneumonia. We present a 40-year-old female with cough, fatigue, and recurrent right lower lobe pneumonia. Upon workup with bronchoscopy and biopsy, she was subsequently found to have an endobronchial hamartoma resulting in recurrent pneumonia in the same location. We are happy to report that the patient had a resection of the mass, as well as of the affected lung lobe, and has been pneumonia-free for five months. We hope to encourage a greater index of suspicion for endobronchial masses, including rare tumors, when a patient presents with recurrent pneumonia in the same location.
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Affiliation(s)
- Mihir Odak
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Mohammed AlAzzawi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ghadier Alsaoudi
- Pulmonary and Critical Care Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - James Cosentino
- Pulmonary and Critical Care, Jersey Shore University Medical Center, Neptune, USA
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Mararenko A, Alshami A, AlAzzawi M, Patel SV. Anticoagulants Used in Cardiac Catheterization of Patients With Chronic Lymphocytic Leukemia: A Case Report and Overview. Cureus 2021; 13:e13633. [PMID: 33816032 PMCID: PMC8011627 DOI: 10.7759/cureus.13633] [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: 11/13/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is one of the most frequently performed invasive therapeutic procedures and plays a key role in the long-term survival of patients with ischemic heart disease. Over 965,000 angioplasties are performed annually in the United States alone. While the technique and equipment have undergone significant revisions and improvement, the medical community will still benefit from more data and guidance on the optimal selection of mandatory peri-operation anticoagulation in specific, high-risk populations. Many of these procedures are performed on high-risk individuals who have an inherently higher risk of hemorrhage or thrombosis. Unfractionated heparin is the most popular choice in the general population, however, its use carries certain limitations. Here we will describe the use of an uncommonly used anticoagulant in a patient being actively treated for leukemia. We will also discuss the unique properties and benefits of the four most frequently used anticoagulants during a cardiac angioplasty. Our team describes the successful use of bivalirudin during an urgent PCI in a 71-year-old female with eight previous stents that was followed by an uncomplicated recovery period. Our experience contributes to a small, but growing, body of evidence that bivalirudin may be a safe choice to use in lieu of unfractionated heparin in patients with underlying oncological disease. Our patient had several comorbidities that significantly increased their risk of bleeding. We will also review the clinical trials that compared the four most commonly used anticoagulants during cardiac catheterization.
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Affiliation(s)
- Anton Mararenko
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Mohammed AlAzzawi
- Internal Medicine, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, USA
| | - Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
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Albayati A, Douedi S, Alshami A, Hossain MA, Sen S, Buccellato V, Cutroneo A, Beelitz J, Asif A. Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions. Healthcare (Basel) 2021; 9:healthcare9020111. [PMID: 33494294 PMCID: PMC7909809 DOI: 10.3390/healthcare9020111] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/16/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.
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Alshami A, Museedi AS, Varon J. Point of Care Ultrasound in Coronavirus 2019: Helpful or Not? CRMR 2021. [DOI: 10.2174/1573398x1602201207094738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center Neptune, Neptune City, NJ, United States
| | - Abdulrahman S. Museedi
- Department of Medicine The University of Texas Health Science Center at San Antonio San Antonio, TX, United States
| | - Joseph Varon
- The University of Texas Health Science Center at Houston Chief of Staff and Chief of Critical Care Services United Memorial Medical Center Houston, Texas, TX, United States
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Museedi AS, Alshami A, Douedi S, Ajam F, Varon J. Predictability of Inpatient Mortality of Different Comorbidities in Both Types of Acute Decompensated Heart Failure: Analysis of National Inpatient Sample. Cardiol Res 2020; 12:29-36. [PMID: 33447323 PMCID: PMC7781262 DOI: 10.14740/cr1186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 02/05/2023] Open
Abstract
Background Several prediction models have been proposed to assess the short outcomes and in-hospital mortality among patients with heart failure (HF). Several variables were used in common among those models. We sought to focus on other, yet important risk factors that can predict outcomes. We also sought to stratify patients based on ejection fraction, matching both groups with different risk factors. Methods We conducted a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016 database. Results There were totally 116,189 admissions for acute decompensated heart failure (ADHF). Of these, 50.9% were for heart failure with reduced ejection fraction (HFrEF) group (n = 59,195), and 49.1% were for heart failure with preserved ejection faction (HFpEF) group (n = 56,994). Overall, in-hospital mortality was 2.5% of admissions for ADHF (n = 2,869). When stratified by HF types, admissions for HFrEF had higher mortality rate (2.7%, n = 1,594) in comparison to admissions for HFpEF (2.2%, n = 1,275) (P < 0.001). Significantly associated variables in univariate analyses were age, race, hypertension, diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation/flutter, obesity, and chronic ischemic heart disease (IHD), while gender and chronic obstructive pulmonary disease (COPD) did not achieve statistical significance (P > 0.1). Conclusions To our knowledge, this is the first study to stratify HF patients based on ejection fraction and utilizing different predictors and in-hospital mortality. These and other data support the need for future research to utilize these predictors to create more accurate models in the future.
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Affiliation(s)
- Abdulrahman S Museedi
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Firas Ajam
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Joseph Varon
- Department of Acute and Continuing Care, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.,Critical Care Services, United Memorial Medical Center/United General Hospital, Houston, TX, USA
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Alshami A, Douedi S, Guida M, Ajam F, Desai D, Zales V, Calderon DM. Unusual Longevity of Edwards Syndrome: A Case Report. Genes (Basel) 2020; 11:genes11121466. [PMID: 33297534 PMCID: PMC7762407 DOI: 10.3390/genes11121466] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trisomy 18, also known as Edwards syndrome, was first described in the 1960s and is now defined as the second most common trisomy. While this genetic disease has been attributed to nondisjunction during meiosis, the exact mechanism remains unknown. Trisomy 18 is associated with a significantly increased mortality rate of about 5-10% of patients surviving until 1 year of age. We present a case of a 26-year-old female diagnosed with trisomy 18, well outliving her life expectancy, maintaining a stable state of health. CASE PRESENTATION A 26-year-old female with non-mosaic Edwards syndrome presented to the clinic for follow up after recent hospitalization for aspiration pneumonia. The definitive diagnosis of trisomy 18 was made prenatally utilizing chromosomal analysis and G-banding and fluorescence in situ hybridization (FISH) on cells obtained via amniocentesis. Her past medical history is characterized by severe growth and intellectual limitations; recurrent history of infections, especially respiratory system infections; and a ventricular septal defect (VSD) that was never surgically repaired. She remains in good, stable health and is under close follow-up and monitoring. CONCLUSIONS Despite the fact that Edwards syndrome carries a significantly high mortality rate due to several comorbidities, recent literature including this case report has identified patients surviving into adulthood. Advancements in early detection and parent education have likely allowed for these findings. We aim to present a case of an adult with trisomy 18, living in stable condition, with an importance on medical follow-up.
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Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA;
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA;
- Correspondence:
| | - Melissa Guida
- Department of Biology, Ramapo College of New Jersey, Mahwah, NJ 07430, USA;
| | - Firas Ajam
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (F.A.); (D.D.); (D.MC.)
| | - Dhaval Desai
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (F.A.); (D.D.); (D.MC.)
| | - Vincent Zales
- Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ 07753, USA;
| | - Dawn M Calderon
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (F.A.); (D.D.); (D.MC.)
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Alshami A, Einav S, Skrifvars MB, Varon J. Administration of inhaled noble and other gases after cardiopulmonary resuscitation: A systematic review. Am J Emerg Med 2020; 38:2179-2184. [PMID: 33071073 DOI: 10.1016/j.ajem.2020.06.066] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Inhalation of noble and other gases after cardiac arrest (CA) might improve neurological and cardiac outcomes. This article discusses up-to-date information on this novel therapeutic intervention. DATA SOURCES CENTRAL, MEDLINE, online published abstracts from conference proceedings, clinical trial registry clinicaltrials.gov, and reference lists of relevant papers were systematically searched from January 1960 till March 2019. STUDY SELECTION Preclinical and clinical studies, irrespective of their types or described outcomes, were included. DATA EXTRACTION Abstract screening, study selection, and data extraction were performed by two independent authors. Due to the paucity of human trials, risk of bias assessment was not performed DATA SYNTHESIS: After screening 281 interventional studies, we included an overall of 27. Only, xenon, helium, hydrogen, and nitric oxide have been or are being studied on humans. Xenon, nitric oxide, and hydrogen show both neuroprotective and cardiotonic features, while argon and hydrogen sulfide seem neuroprotective, but not cardiotonic. Most gases have elicited neurohistological protection in preclinical studies; however, only hydrogen and hydrogen sulfide appeared to preserve CA1 sector of hippocampus, the most vulnerable area in the brain for hypoxia. CONCLUSION Inhalation of certain gases after CPR appears promising in mitigating neurological and cardiac damage and may become the next successful neuroprotective and cardiotonic interventions.
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Affiliation(s)
- Abbas Alshami
- Jersey Shore University Medical Center, Neptune, NJ, USA; Dorrington Medical Associates, PA, Houston, TX, USA
| | - Sharon Einav
- Intensive Care Unit of the Share Zedek Medical Center and Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph Varon
- The University of Texas Health Science Center at Houston, USA; University of Texas Medical Branch at Galveston, USA; United Memorial Medical Center/United General Hospital, Houston, TX, USA.
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Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center Neptune, NJ, United States
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center Neptune, NJ, United States
| | - Joseph Varon
- The University of Texas Health Science Center at Houston Chief of Staff and Chief of Critical Care Services United Memorial Medical Center Houston, Texas, United States
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Al-Azzawi M, Douedi S, Alshami A, Al-Saoudi G, Mikhail J. Spontaneous Subcutaneous Emphysema and Pneumomediastinum in COVID-19 Patients: An Indicator of Poor Prognosis? Am J Case Rep 2020; 21:e925557. [PMID: 32703927 PMCID: PMC7405921 DOI: 10.12659/ajcr.925557] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Case series Patients: Male, 36-year-old • Male, 47-year-old • Male, 78-year-old Final Diagnosis: COVID-19 • pneumomediastinum • subcutaneous emphysema Symptoms: Respiratory distress • shortness of breath Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Pulmonology
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Affiliation(s)
- Mohammed Al-Azzawi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Ghadier Al-Saoudi
- Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - John Mikhail
- Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA
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Braganza J, Aljwaid A, Alazzawi M, Alshami A, Patel NS. Bilateral facial cutaneous angiomyolipomas: First case in the literature and a possible correlation with human immunodeficiency virus. IDCases 2020; 21:e00909. [PMID: 32685377 PMCID: PMC7355718 DOI: 10.1016/j.idcr.2020.e00909] [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: 05/30/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Angiomyolipomas (AMLs) are benign tumors consisting of smooth muscle-like cells, adipocyte-like cells, and epithelioid cells. They are usually renal in origin, and extrarenal AMLs are rare. Cutaneous AMLs are even more rare. We present a case of 65 year old female, with no underlying genetic condition, who developed bilateral facial cutaneous AMLs. To the best of our knowledge, this is the first case in the literature. In addition, we investigate and suggest a correlation between human immunodeficiency virus and AMLs.
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Affiliation(s)
| | | | - Mohammed Alazzawi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
- Corresponding author.
| | - Nitin S. Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
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40
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Museedi AS, Nashawi M, Ghali A, Alshami A, Chakravorty R. Prosthetic mitral valve Aspergillus fumigatus endocarditis. IDCases 2020; 21:e00891. [PMID: 32642437 PMCID: PMC7332524 DOI: 10.1016/j.idcr.2020.e00891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
Aspergillus endocarditis is a fatal source of valvular infection with a near 100 % mortality rate if pharmacotherapy and valve-replacement surgery are not initiated swiftly after diagnosis. Complicating its diagnosis is the low yield for growth on standard blood culture and time requirements for molecular diagnostic tools to return a result. Aspergillus endocarditis of the mitral valve presents as valvular vegetations that reduce the caliber of the mitral valve and can cause syncope as in the case of mitral stenosis with subsequent valve failure, left atrial enlargement, and prospective cardiovascular failure. Reports of the management of Aspergillus endocarditis after serial mitral valve replacement are not prominent in the literature. We report the case of a 41-year-old female with previous mitral valve prosthesis who received a second prosthetic mitral valve after a syncopal episode. Vegetations resembling thrombi were noted on transesophageal echocardiogram, diagnosed as Aspergillus fumigatus endocarditis, and successfully treated with antifungal therapy in conjunction with removal of her dysfunctional prosthesis.
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Affiliation(s)
- Abdulrahman S Museedi
- Department of Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mouhamed Nashawi
- Department of Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abdullah Ghali
- Department of Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Ripa Chakravorty
- Department of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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41
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Al-bayati A, Alshami A, AlAzzawi M, Al Hillan A, Hossain M. Metastatic Osteoarticular Infective Endocarditis by Methicillin-sensitive Staphylococcus Aureus. Cureus 2020; 12:e8124. [PMID: 32542174 PMCID: PMC7292723 DOI: 10.7759/cureus.8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infective endocarditis (IE) is a well-known complication of bacteremia with high-risk microorganisms such as Staphylococcus and Streptococcus. Skin and soft tissue infections with Staphylococcus remain a significant cause of bacteremia and IE, even with proper prompt management of the source of infection and the absence of risk factors. Although methicillin-resistant Staphylococcus aureus is a well-known etiology for osteoarticular septic emboli in IE, healthcare providers should be aware of the hidden virulence of methicillin-sensitive Staphylococcus aureus for metastatic osteoarticular infection. We report a case of IE with septic vertebral embolic lesion complicating a properly managed acute paronychia.
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Al hillan A, Mohamed M, Chien D, Alshami A, Arif F. Postcolonoscopy Appendicitis: A Delayed Complication. Cureus 2020; 12:e7716. [PMID: 32431994 PMCID: PMC7234083 DOI: 10.7759/cureus.7716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Colonoscopy is a procedure that enables a physician (usually a gastroenterologist) to directly image and examine the entire colon. It has both diagnostic and therapeutic benefits with a relatively low morbidity rate. Complications have been well described in the literature. Nevertheless, it is necessary for operators to be aware of the rare complications of colonoscopy. Acute appendicitis is an unusually rare occurrence following a colonoscopy, and it can be easily confused with other complications of the procedure. Prompt recognition of this complication can lead to early, effective treatment, and delayed diagnosis can lead to serious results. We present a case of a 33-year-old man who underwent a routine colonoscopy with no intraoperative complication who presented with appendicitis two weeks later as a rare delayed side effect; such a delayed presentation has not been described in the literature previously. This case highlights that appendicitis should be considered in the differential diagnosis of right-sided lower abdominal pain following a colonoscopy.
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Abstract
Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome (ARDS) accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation (VV-ECMO) may be used. We present a case of a 41-year-old female, with no significant medical history and no recent history of exposure to sick contacts, presented to the emergency department (ED) with fever, severe shortness of breath, and flu-like symptoms with a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.
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Affiliation(s)
- Steven Douedi
- Internal Medicine, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, USA
| | - Abbas Alshami
- Internal Medicine, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, USA.,Internal Medicine, Dorrington Medical Associates, Houston, USA
| | - Eric Costanzo
- Pulmonology and Critical Care, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, USA
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Museedi AS, Nashawi M, Ghali A, Alameri A, Alshami A, Nathanson R. Influenza: National Trends Using the National Inpatient Sample Database from 1993 to 2015. Cureus 2020; 12:e7684. [PMID: 32431964 PMCID: PMC7233507 DOI: 10.7759/cureus.7684] [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: 11/05/2022] Open
Abstract
Background There is a significant impact of influenza on individuals, families, and societies both economically and clinically. This significant impact is a result of hospital admissions, medication expenses, side effects, secondary bacterial infections, and more days off from work or other forms of reduced productivity for the patients or their caretakers. Our objective is to present the trends in the rate of hospital discharges per 100,000 population from the years 1993 through 2015, the mean age, and the inpatient mortality rate. Methods This is a retrospective study utilizing the National Inpatient Sample (NIS) from 1993 through 2015. Discharges due to influenza from 1993 to 2015 were identified, and the rate of discharges per 100,000 population, inpatient mortality, and mean age of discharged patients were trended. Linear regression was used to assess if the deviation from horizontal was statistically significant for the trends of the rate of discharges per 100,000 population, mean age, and percentage of the inpatient mortality. Result The mean age and inpatient mortality vary from year to year. The linear regression analysis for the trends was not statistically significant, and for the percentage of the inpatient mortality, the deviation from horizontal was not significant, P-value 0.75 and F-value: 0.09. Similarly, for the mean age, the deviation from horizontal was not significant with a P-value of 0.97 and an F-value of 0.001. However, the linear regression analysis for the rate of discharges per 100,000 population was remarkable for a statistically significant deviation from the horizontal with a P-value of 0.0002 and an F value of 19.5. Conclusion Recent advancements in influenza detection have made the detection feasible, quick, and cost-effective. However, the role of these advanced modalities on the outcome is still controversial. Our analysis revealed a significant increase in the rate of discharges due to influenza, but there was no significant change in the parentage of the inpatient mortality over the years between 1993 - 2015. Advanced influenza virus detection tests are now recommended in both outpatient (including emergency department) and inpatient admissions. The recent increase in inpatient admissions could be due to better detection modalities. However, no change in the percentage of inpatient mortality makes the impact of these detection tests on the outcome questionable. A further prospective study is warranted to assess the impact of these tests on the outcome.
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Affiliation(s)
- Abdulrahman S Museedi
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Mouhamed Nashawi
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Abdullah Ghali
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Aws Alameri
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Abbas Alshami
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Robert Nathanson
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
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Agarwal KK, Douedi S, Alshami A, DeJene B, Kayser RG. Peripheral Embolization of Left Ventricular Thrombus Leading to Acute Bilateral Critical Limb Ischemia: A Rare Phenomenon. Cardiol Res 2020; 11:134-137. [PMID: 32256921 PMCID: PMC7092770 DOI: 10.14740/cr1030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 11/29/2022] Open
Abstract
Left ventricular thrombus (LVT) is a well-known complication of myocardial infarction (MI) leading to significant morbidity and mortality. LVT can also lead to systemic thromboembolic events causing threatening limb ischemia. We report a rare case of critical bilateral limb ischemia that resulted from peripheral embolization of LVT post MI, which was managed successfully by emergent surgical intervention and anticoagulation. A 74-year-old male with a medical history of hypertension, diabetes, hyperlipidemia and coronary artery disease status post stenting of the left anterior descending and left circumflex arteries presented to the emergency department with typical chest pain and progressive shortness of breath. Cardiac troponin levels on admission were 35 ng/mL of blood. The patient subsequently underwent emergent cardiac catheterization which revealed significant triple vessel disease, and was referred for coronary artery bypass grafting (CABG) surgery. Transthoracic and transesophageal echocardiograms revealed the presence of an apical aneurysm with chronic organized mobile thrombus at the apex. Post CABG, the patient complained of excruciating right leg pain. Computed tomography (CT) angiogram of the abdominal aorta and lower extremities revealed a large embolus at the aortic bifurcation occluding the right and nearly occluding the left common iliac arteries and thrombus in the right popliteal artery. He underwent emergent vascular surgery with resolution of his symptoms and remained without further complications. The incidence of LVT remains high in post-MI patients, and complications of LVT are known to include thromboembolic events. Peripheral embolization of acute or chronic LVT leading to bilateral distal embolization and critical limb ischemia remains a rare occurrence. This case report aims to aid clinicians to recognize and promptly manage LVT and related arterial thromboembolic events with anticoagulation and emergent surgical intervention if limb ischemia develops.
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Affiliation(s)
- Khushboo K Agarwal
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Brook DeJene
- Department of Cardiothoracic Surgery, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Robert G Kayser
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
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Ramirez L, Diaz J, Alshami A, Varon DS, Einav S, Surani S, Varon J. Cardiopulmonary resuscitation in television medical dramas: Results of the TVMD2 study. Am J Emerg Med 2020; 43:238-242. [PMID: 32192897 DOI: 10.1016/j.ajem.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Television medical dramas (TVMDs) use cardiopulmonary resuscitation (CPR) as a mean of achieving higher viewing rates. TVMDs portrayal of CPR can be used to teach laypersons attempting to perform CPR and to form a shared professional and layperson mental model for CPR decisions. We studied the portrayal of CPR across a wide range of TVMDs to see whether newer series fulfill this promise. MATERIALS AND METHODS Advanced cardiac life support (ACLS) certified healthcare providers underwent training in the use of a unique instrument based on the AHA (American Heart Association) guidelines to assess TVMD CPR scenarios. Components of the assessment included the adequacy of CPR techniques, gender distribution in CPR scenes, performance quality by different healthcare providers, and CPR outcomes. Thirty-one TVMDs created between 2010 and 2018 underwent review. RESULTS Among 836 TVMD episodes reviewed, we identified 216 CPR attempts. CPR techniques were mostly portrayed inaccurately. The recommended compressions depth was shown in only 32.0% of the attempts (n = 62). The recommended rate was shown in only 44.3% of the attempts (n = 86). Survival to hospital discharge was portrayed as twice higher in male patients (67.6%, n = 71) than in female patients (32.4%, n = 29) (p < 0.05). Paramedics were portrayed as having better performance than physicians or nurses; compression rates were shown to be within the recommendations in only 42% (n = 73) of the CPR attempts performed by physicians, 44% (n = 8) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Complete chest recoil after compression was shown in only 34% (n = 58) of the CPR attempts performed by physicians, 38% (n = 7) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Outcomes were better on the screen than in real life; among the episodes showing outcome (n = 202), the overall rate of survival from CPR was 61.9% (n = 125). CONCLUSION Portrayal of CPR in TVMDs remains a missed opportunity for improving performance and communication on CPR.
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Affiliation(s)
- Luz Ramirez
- Dorrington Medical Associates, PA, Houston, TX, USA; Benemerita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Jose Diaz
- Dorrington Medical Associates, PA, Houston, TX, USA; Benemerita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Abbas Alshami
- Dorrington Medical Associates, PA, Houston, TX, USA; Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | | | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Hebrew University, Jerusalem, Israel
| | | | - Joseph Varon
- United General Hospital, Department of Acute and Continuing Care, The University of Texas Health Science Center at Houston, USA.
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Alshami A, Alhillan A, Varon J. Computed Tomographic Angiography in Pulmonary Embolism: Diagnostic or a Screening Tool. CRMR 2020. [DOI: 10.2174/1573398x1503191125144633] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Abbas Alshami
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center Neptune, NJ, United States
| | - Alsadiq Alhillan
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center Neptune, NJ, United States
| | - Joseph Varon
- The University of Texas Health Science Center at Houston Chief of Staff and Chief of Critical Care Services United Memorial Medical Center Houston, Texas, United States
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Varon J, Alshami A, Ramirez L, Varon D, Einav S. OUTCOMES OF CARDIAC ARREST BETWEEN REALITY AND TELEVISION MEDICAL DRAMAS: RESULTS OF THE TVMD2 STUDY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.899] [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: 10/25/2022] Open
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49
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Alshami A, Alazzawi M, Varon J. The Use of Statins in Respiratory Diseases. CRMR 2019. [DOI: 10.2174/1573398x1501190709103017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Abbas Alshami
- Dorrington Medical Associates, PA Houston, Texas, United States
| | | | - Joseph Varon
- The University of Texas Health Science Center at Houston Clinical Professor of Medicine The University of Texas Medical Branch at Galveston, Chief of Critical Care Services, United Memorial Medical Center, Houston, Texas 77030, United States
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Ramirez L, Diaz L, Alshami A, Einav S, Varon J. WHO CAN PERFORM BETTER CPR? CARDIOPULMONARY RESUSCITATION ON TELEVISION MEDICAL DRAMAS: RESULTS OF THE TVMD2 STUDY. Chest 2019. [DOI: 10.1016/j.chest.2019.02.151] [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: 10/27/2022] Open
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