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Prasad A, Choh AC, Gonzalez ND, Garcia M, Lee M, Watt G, Maria Vasquez L, Laing S, Wu S, McCormick JB, Fisher-Hoch S. A high burden of diabetes and ankle brachial index abnormalities exists in Mexican Americans in South Texas. Prev Med Rep 2024; 38:102604. [PMID: 38375159 PMCID: PMC10874877 DOI: 10.1016/j.pmedr.2024.102604] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Ethnic differences exist in the United States in the interrelated problems of diabetes (DM), peripheral arterial disease (PAD), and leg amputations. The purpose of this study was to determine the prevalence and risk factor associations for subclinical PAD in a population sample of Mexican Americans using the ankle brachial (ABI) index. The ABI-High (higher of the two ankle pressures/highest brachial pressure) and ABI-Low (lower of the two ankle pressures/highest brachial pressure) were calculated to define PAD. Toe brachial index (TBI) was also calculated. 746 participants were included with an age of 53.4 ± 0.9 years, 28.3 % had diabetes mellitus (DM), 12.6 % were smokers, and 51.2 % had hypertension (HTN). Using ABI-High ≤ 0.9, the prevalence of PAD was 2.7 %. This rose to 12.7 % when an ABI-Low ≤ 0.9 was used; 4.0 % of the population had an ABI-High > 1.4. The prevalence of TBI < 0.7 was 3.9 %. DM was a significant risk factor for ABI-High ≤ 0.9 and ABI-High > 1.4, and TBI < 0.7. Increased age, HTN, smoking was associated with ABI-High ≤ 0.9, while being male was associated with ABI-High > 1.4. Increased age, smoking, and lower education were all associated with abnormal TBI. Despite relatively younger mean age than other studied Hispanic cohorts, the present population has a high burden of ABI abnormalities. DM was a consistent risk factor for PAD. These abnormalities indicate an important underlying substrate of vascular and metabolic disease that may predispose this population to the development of symptomatic PAD and incident amputations.
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Affiliation(s)
- Anand Prasad
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Audrey C. Choh
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Nelson D. Gonzalez
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Marlene Garcia
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Miryoung Lee
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Gordon Watt
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, India
| | | | - Susan Laing
- The University of Texas Health Science Center at Houston, USA
| | - Shenghui Wu
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Joseph B. McCormick
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Susan Fisher-Hoch
- University of Texas School of Public Health Brownsville Regional Campus, USA
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Patel RN, Sharma A, Prasad A, Bansal S. Heart Failure With Preserved Ejection Fraction With CKD: A Narrative Review of a Multispecialty Disorder. Kidney Med 2023; 5:100705. [PMID: 38046909 PMCID: PMC10692714 DOI: 10.1016/j.xkme.2023.100705] [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: 12/05/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome with varying phenotypic expression. The phenotype chronic kidney disease (CKD) associated HFpEF is increasing in prevalence globally and is associated with increased morbidity and mortality compared to other HFpEF variants. These 2 conditions share common risk factors, including obesity, diabetes, and metabolic syndrome, as well as similar pathophysiology, including systemic inflammation, oxidative stress, elevated neurohormones, mineralocorticoid-receptor activation, and venous congestion. Given the coexistence of CKD and HFpEF, the diagnosis of HFpEF can be difficult. Moreover, treatment options for HFpEF have remained limited despite the success seen in its counterpart, heart failure with reduced ejection fraction. HFpEF encompasses complex multisystem pathophysiological perturbations beyond neurohormones, it is unlikely that a single agent can have significant benefit in this population. Recent data on sodium-glucose cotransporter 2 (SGLT2) inhibitors in HFpEF and CKD, and on glucagon-like peptide-1 (GLP-1) agonists and mineralocorticoid-receptor antagonists in metabolic syndrome, which target multiple pathways simultaneously, have led to promising therapeutics for HFpEF and CKD. In this perspective, our goal is to increase awareness of HFpEF as a multisystem disorder that shares the same disease processes seen in CKD and to emphasize that its management in individuals with CKD warrants a collective and multidisciplinary approach.
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Affiliation(s)
- Rahul N. Patel
- Transplant Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Akash Sharma
- The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Anand Prasad
- Division of Cardiology, The University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Shweta Bansal
- Division of Nephrology, The University of Texas Health at San Antonio, San Antonio, Texas, USA
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3
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Fath AR, Aglan A, Khurana A, Abuasbeh J, Eldaly AS, Mantha Y, Abraham B, Olagunju A, Prasad A. Transcatheter Aortic Valve Replacement: Variations in Use, Charges, and Geography in the United States. Am J Cardiol 2023; 205:363-368. [PMID: 37647820 DOI: 10.1016/j.amjcard.2023.07.151] [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: 05/05/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023]
Abstract
The use of transcatheter aortic valve replacement (TAVR) in the United States has been increasing but with variability. We used a 100% sample of Medicare beneficiaries (MBs), from the Centers for Medicare and Medicaid Services database, who underwent TAVR by cardiologists between 2015 and 2019. We stratified data by geographic region, rural/urban areas, and provider's gender. We examined the average number of TAVRs performed per 100,000 MBs, the average number of TAVRs performed per individual cardiologist, and the average submitted charge (ASC) per procedure. The number of TAVR per 100,000 MBs was significantly variable among regions in all years (all P≤0.028), except in 2015 (P=0.103), with the highest rates being in the Northeast and the lowest being in the West. The number of TAVRs per cardiologist was significantly different among regions only in 2019 (P=0.04), with the Northeast showing the highest numbers and the South showing the lowest. The ASC was also significantly variable among regions in all years (all P≤0.01). The highest ASC was in the Midwest for all years, whereas the lowest was in the West in 2015 to 2016 and in the South in 2017 to 2019. In all years, the number of TAVRs per cardiologist was higher in urban areas than in rural areas (all P<0.05); however, rural cardiologists had higher ASCs (all P<0.05). The number of TAVR procedures per cardiologist was not significantly different between male and female cardiologists (all P>0.1). Female cardiologists had a significantly higher ASC only in 2015 (P=0.034). In conclusion, there are variations in TAVR use and charges for MBs according to geographic, urban, and rural regions and the performing cardiologist's gender.
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Affiliation(s)
- Ayman R Fath
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas
| | - Amro Aglan
- Department of Internal Medicine, Beth Israel Lahey Health, Boston, Massachusetts
| | - Aditya Khurana
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jumanah Abuasbeh
- Department of Public Health, University of Arizona, Phoenix, Arizona
| | | | - Yogamaya Mantha
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | | | - Anand Prasad
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas.
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Mantha Y, Asif A, Fath A, Prasad A. Implications of Kidney Disease in Patients with Peripheral Arterial Disease and Vascular Calcification. Interv Cardiol Clin 2023; 12:531-538. [PMID: 37673497 DOI: 10.1016/j.iccl.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Persons with chronic kidney disease (CKD) are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals with normal renal function. Among patients with CKD, PAD is predominantly characterized by the calcification of the medial layer of arterial vessels in addition to intimal atherosclerosis and calcification. Vascular calcification (VC) is initiated by CKD-associated hyperphosphatemia, hypercalcemia, high concentrations of parathyroid hormone (PTH) as well as inflammation and oxidative stress. VC is widely prevalent in this cohort (>80% dialysis and 50% patients with CKD) and contributes to reduced arterial compliance and symptomatic peripheral arterial disease (PAD). The most severe form of PAD is critical limb ischemia (CLI) which has a substantial risk for increased morbidity and mortality. Percutaneous endovascular interventions with transluminal angioplasty, atherectomy, and intravascular lithotripsy are the current nonsurgical treatments for severe calcific plaque. Unfortunately, there are no randomized controlled trials that address the optimal approach to PAD and CLI revascularization in patients with CKD.
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Affiliation(s)
- Yogamaya Mantha
- Division of Cardiology, Department of Medicine, UT Health San Antonio, MC 7872, 8300 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Anum Asif
- Division of Cardiology, Department of Medicine, UT Health San Antonio, MC 7872, 8300 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Ayman Fath
- Division of Cardiology, Department of Medicine, UT Health San Antonio, MC 7872, 8300 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, UT Health San Antonio, MC 7872, 8300 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Fritz C, Barrette LX, Prasad A, Triantafillou V, Suresh N, De Ravin E, Rajasekaran K. Human papillomavirus related oropharyngeal cancer: identifying and quantifying topics of patient interest. J Laryngol Otol 2023; 137:1141-1148. [PMID: 36794539 DOI: 10.1017/s0022215123000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE As the incidence of human papillomavirus related oropharyngeal cancer continues to rise, it is increasingly important for public understanding to keep pace. This study aimed to identify areas of patient interest and concern regarding human papillomavirus and oropharyngeal cancer. METHOD This study was a retrospective survey of search queries containing the keywords 'HPV cancer' between September 2015 and March 2021. RESULTS There was 3.5-fold more interest in human papillomavirus related oropharyngeal cancer (15 800 searches per month) compared with human papillomavirus related cervical cancer (4500 searches per month). Among searches referencing cancer appearance, 96.8 per cent pertained to the head and neck region (3050 searches per month). Among vaccination searches, 16 of 47 (34.0 per cent; 600 searches per month) referenced human papillomavirus vaccines as being a cause of cancer rather than preventing cancer. CONCLUSION The vast majority of online searches into human papillomavirus cancer pertain to the oropharynx. There are relatively few search queries on the topic of vaccination preventing human papillomavirus associated oropharyngeal cancer, which highlights the continued importance of patient education and awareness campaigns.
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Affiliation(s)
- C Fritz
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - L-X Barrette
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - A Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - V Triantafillou
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - N Suresh
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - E De Ravin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K Rajasekaran
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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6
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Barkhordarian M, Behbood A, Ranjbar M, Rahimian Z, Prasad A. Overview of the cardio-metabolic impact of the COVID-19 pandemic. Endocrine 2023; 80:477-490. [PMID: 37103684 PMCID: PMC10133915 DOI: 10.1007/s12020-023-03337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/21/2023] [Indexed: 04/28/2023]
Abstract
Evidence has shown that cardiometabolic disorders (CMDs) are amongst the top contributors to COVID-19 infection morbidity and mortality. The reciprocal impact of COVID-19 infection and the most common CMDs, the risk factors for poor composite outcome among patients with one or several underlying diseases, the effect of common medical management on CMDs and their safety in the context of acute COVID-19 infection are reviewed. Later on, the changes brought by the COVID-19 pandemic quarantine on the general population's lifestyle (diet, exercise patterns) and metabolic health, acute cardiac complications of different COVID-19 vaccines and the effect of CMDs on the vaccine efficacy are discussed. Our review identified that the incidence of COVID-19 infection is higher among patients with underlying CMDs such as hypertension, diabetes, obesity and cardiovascular disease. Also, CMDs increase the risk of COVID-19 infection progression to severe disease phenotypes (e.g. hospital and/or ICU admission, use of mechanical ventilation). Lifestyle modification during COVID-19 era had a great impact on inducing and worsening of CMDs. Finally, the lower efficacy of COVID-19 vaccines was found in patients with metabolic disease.
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Affiliation(s)
- Maryam Barkhordarian
- Department of Medicine, Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Arezoo Behbood
- MPH department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Maryam Ranjbar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Zahra Rahimian
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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7
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Sharma A, Patel R, Prasad A, Bansal S. Diuretic resistance in acute decompensated HFpEF vs. HFrEF. Clin Nephrol 2023:190208. [PMID: 36970966 DOI: 10.5414/cn111090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
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8
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Simsek B, Kostantinis S, Karacsonyi J, Hakeem A, Prasad A, Prasad A, Bortnick AE, Elbarouni B, Jneid H, Abbott JD, Azzalini L, Kohl LP, Gössl M, Patel RAG, Allana S, Nazif TM, Baber U, Mastrodemos OC, Chami T, Mahowald M, Rempakos A, Rangan BV, Sandoval Y, Brilakis ES. Educational Experience of Interventional Cardiology Fellows in the United States and Canada. JACC Cardiovasc Interv 2023; 16:247-257. [PMID: 36792250 PMCID: PMC9924361 DOI: 10.1016/j.jcin.2022.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic and iodinated contrast shortage may have affected interventional cardiology (IC) fellowship training. OBJECTIVES The aim of this study was to investigate the educational experience of first-year IC fellows in the United States and Canada. METHODS A 59-question online survey was conducted among 2021-2022 first-year IC fellows in the United States and Canada. RESULTS Of the 360 IC fellows invited to participate, 111 (31%) responded; 95% were from the United States, and 79% were men. Participants were mostly from university programs (70%), spent 61 to 70 hours/week in the hospital, and had an annual percutaneous coronary intervention case number of <200 (5%), 200 to 249 (8%), 250 to 349 (33%), 350 to 499 (39%), 500 to 699 (12%), or ≥700 (3%). For femoral access, a micropuncture needle was used regularly by 89% and ultrasound-guided puncture by 81%, and 43% used vascular closure devices in most cases (>80%). Intravascular ultrasound was performed and interpreted very comfortably by 62% and optical coherence tomography (OCT) by 32%, and 20% did not have access to OCT. Approximately one-third felt very comfortable performing various atherectomy techniques. Covered stents, fat embolization, and coil embolization were used very comfortably by 14%, 4%, and 3%, respectively. Embolic protection devices were used very comfortably by 11% to 24% of IC fellows. Almost one-quarter of fellows (24%) were warned about their high radiation exposure. Eighty-four percent considered IC fellowship somewhat or very stressful, and 16% reported inadequate psychological support. CONCLUSIONS This survey highlights opportunities for improvement with regard to the use of intravascular imaging, atherectomy techniques, complication prevention and management strategies, radiation awareness and mitigation, and psychological support.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Abdul Hakeem
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Anna E Bortnick
- Department of Medicine, Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Department of Medicine, Division of Geriatrics Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - J Dawn Abbott
- Department of Internal Medicine, Division of Cardiology, Brown University, Providence, Rhode Island, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Louis P Kohl
- Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | - Salman Allana
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Tarek Chami
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Madeline Mahowald
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
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Balasundaram A, Srinivasan S, Prasad A, Malik J, Kumar A. Hippocampus Segmentation-Based Alzheimer's Disease Diagnosis and Classification of MRI Images. Arab J Sci Eng 2023; 48:1-17. [PMID: 36619218 PMCID: PMC9810248 DOI: 10.1007/s13369-022-07538-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
Alzheimer's disease represents a neurological condition characterized by steady cognitive decline and eventual memory loss due to the death of brain cells. It is one of the most prominent dementia types observed in patients and which hence underlines the imminent need for potential methods to diagnose the disease early on. This work considers a novel approach by utilizing a reduced version of one of the datasets used in this work to achieve a considerably accurate prediction while also enabling quicker training. It leverages image segmentation to isolate the hippocampus region from brain MRI images and then strikes a comparison between models trained on the segmented portions and models trained on complete images. This research uses two datasets-4 classes of images from Kaggle and a popular OASIS 2 MRI and demographic dataset. A deep learning-based approach was adopted to train the Kaggle dataset to perform severity classification, and the hippocampus region segmented from a reduced version of the OASIS dataset was trained on supervised and ensemble learning algorithms to detect Alzheimer's disease. The metric used for the assessment of model performance is classification accuracy. A comparative analysis between the proposed approach and existing work was also performed, and it was observed that the proposed approach is effective in the early diagnosis of Alzheimer's disease.
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Affiliation(s)
- A. Balasundaram
- School of Computer Science and Engineering, Center for Cyber Physical Systems, Vellore Institute of Technology, Chennai, Tamil Nadu India
| | - Sruthi Srinivasan
- School of Computer Science and Engineering, Vellore Institute of Technology (VIT), Chennai, Tamil Nadu India
| | - A. Prasad
- School of Computer Science and Engineering, Vellore Institute of Technology (VIT), Chennai, Tamil Nadu India
| | - Jahan Malik
- School of Computer Science and Engineering, Vellore Institute of Technology (VIT), Chennai, Tamil Nadu India
| | - Ayush Kumar
- School of Computer Science and Engineering, Vellore Institute of Technology (VIT), Chennai, Tamil Nadu India
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10
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Keeton JZ, Prasad A, Bacharach T, Dayama A, Sako E, Almomani A. Innovative Approach to Manage Transcatheter Aortic Valve Embolization. JACC Case Rep 2022; 7:101598. [PMID: 36776798 PMCID: PMC9911928 DOI: 10.1016/j.jaccas.2022.08.015] [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: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
We describe the case of a patient with an ascending aortic aneurysm who underwent valve-in-valve transcatheter aortic valve implantation, which was complicated by valve embolization. After a multidisciplinary discussion and an innovative approach, the free-floating embolized valve was anchored securely in the aortic arch with an uncovered aortic endovascular stent. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- James Z. Keeton
- University of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USA,Address for correspondence: Dr James Keeton, University of Texas Health at San Antonio, Division of Cardiology, MC 7872, 8300 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA. @jzkeeton
| | - Anand Prasad
- University of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USA
| | - Thekla Bacharach
- University of Texas Health at San Antonio, Department of Surgery, Division of Vascular Surgery, San Antonio, Texas, USA
| | - Anand Dayama
- University of Texas Health at San Antonio, Department of Surgery, Division of Vascular Surgery, San Antonio, Texas, USA
| | - Edward Sako
- University of Texas Health at San Antonio, Department of Cardiothoracic Surgery, Division of Adult Cardiac Surgery, San Antonio, Texas, USA
| | - Ahmed Almomani
- University of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USA
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11
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Jain A, Shivamallu C, Prasad A, Dharmashekhar C. 314P Let’s bring back old drugs to conquer resistance to KRAS G12C inhibitors in NSCLC. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.343] [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: 12/05/2022] Open
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12
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Loftus MJ, Young-Sharma T, Lee SJ, Wati S, Badoordeen GZ, Blakeway LV, Byers S, Cheng AC, Cooper BS, Cottingham H, Jenney A, Hawkey J, Macesic N, Naidu R, Prasad A, Prasad V, Tudravu L, Vakatawa T, van Gorp E, Wisniewski JA, Rafai E, Peleg AY, Stewardson AJ. Attributable Mortality and Excess Length of Stay associated with Third-Generation Cephalosporin Resistant Enterobacterales Bloodstream Infections - a prospective cohort study in Suva, Fiji. J Glob Antimicrob Resist 2022; 30:286-293. [PMID: 35738385 PMCID: PMC9452645 DOI: 10.1016/j.jgar.2022.06.016] [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: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the impact of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji. METHODS We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and multistate modelling to estimate the excess length of hospital stay. RESULTS From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs, 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio (aHR) 1.13, 95% CI 0.51-2.53) or being discharged alive (aHR 0.99, 95% CI 0.65-1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36-1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31-9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5-2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission. CONCLUSION Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality.
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Affiliation(s)
- M J Loftus
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | | | - S J Lee
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - S Wati
- Colonial War Memorial Hospital, Suva, Fiji
| | - G Z Badoordeen
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - L V Blakeway
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Smh Byers
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - A C Cheng
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - B S Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, The United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - H Cottingham
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Awj Jenney
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Fiji National University, Suva, Fiji
| | - J Hawkey
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - N Macesic
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Centre to Impact AMR, Monash University, Melbourne, Australia
| | - R Naidu
- Colonial War Memorial Hospital, Suva, Fiji
| | - A Prasad
- Colonial War Memorial Hospital, Suva, Fiji
| | - V Prasad
- Colonial War Memorial Hospital, Suva, Fiji
| | - L Tudravu
- Colonial War Memorial Hospital, Suva, Fiji
| | - T Vakatawa
- Colonial War Memorial Hospital, Suva, Fiji
| | - E van Gorp
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - J A Wisniewski
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - E Rafai
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - A Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia.
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia.
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Tarantini G, Prasad A, Rathore S, Bansal S, Gottfried R, Rosenkranz AR, Briguori C, Yaghoubi M, Mashayekhi A, Javanbakht M, Moloney E. DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:841876. [PMID: 35547222 PMCID: PMC9081570 DOI: 10.3389/fmed.2022.841876] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is an important adverse effect associated with injecting iodinated intra-arterial contrast media (CM) during coronary angiography. The DyeVert™ Contrast Reduction System is a medical device intended to reduce the intra-arterial CM volume (CMV) administered. The aim of this study was to assess DyeVert System clinical effectiveness and safety by implementing a systematic review and meta-analysis of existing evidence. Methods Systematic electronic literature searches were conducted in MEDLINE, Embase, the Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the International Clinical Trials Registry Platform database. Relevant data were extracted from included studies and meta-analyses were performed to synthesize evidence across studies. Results The review included 17 eligible studies involving 1,731 DyeVert System cases and 1,387 control cases (without the use of DyeVert). Meta-analyses demonstrated use of the DyeVert System reduced CMV delivered to the patient by 39.27% (95% CI, 36.10-42.48%, P < 0.001), reduced CMV/baseline renal function ratios (Hedges's g, -0.56; 95% CI, -0.70 to -0.42, P < 0.001) and percentage of cases exceeding the maximum CMV threshold (risk difference -0.31, 95% CI, -0.48 to -0.13, P < 0.001) while maintaining adequate image quality in 98% of cases. DyeVert System cases demonstrated lower CA-AKI incidence vs. controls (absolute risk reduction 5.00% (95% CI, 0.40-9.80%; P = 0.03), relative risk 0.60 (95% CI, 0.40-0.90; P = 0.01) with a pooled estimate of the number needed to treat with the DyeVert System to avoid 1 CA-AKI event of 20. Conclusion DyeVert System use significantly reduces CMV delivered to the patient, CMV/baseline renal function ratios, and CA-AKI incidence while maintaining image quality. Accordingly, the device may serve as an adjunctive, procedure-based strategy to prevent CA-AKI. Future multi-center studies are needed to further assess effects of minimizing CMV on endpoints such as CA-AKI prevention, incidence of adverse cardiac and renal events, and health care costs.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Sudhir Rathore
- Frimley Health National Health Service (NHS) Foundation Trust, Camberley, United Kingdom
| | - Shweta Bansal
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Regine Gottfried
- Clinic for General and Interventional Cardiology and Angiology, Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW), Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Mohsen Yaghoubi
- Mercer University College of Pharmacy, Atlanta, GA, United States
| | - Atefeh Mashayekhi
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
| | - Mehdi Javanbakht
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
- Device Access UK Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
| | - Eoin Moloney
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
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Pillarisetti J, Cheema MS, Haloot J, Panday M, Badin A, Mehta A, Anderson AS, Prasad A. Cardiac Complications of COVID-19: Incidence and Outcomes. Indian Heart J 2022; 74:170-177. [PMID: 35490848 PMCID: PMC9050189 DOI: 10.1016/j.ihj.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023] Open
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15
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Sattar Y, Almas T, Arshad J, Zghouzi M, Ullah W, Mir T, Mohamed MO, Elgendy IY, Aljaroudi W, Prasad A, Shlofmitz R, Mamas MA, Kereiakes DJ, Chadi Alraies M. Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis. IJC Heart & Vasculature 2022; 39:100975. [PMID: 35242998 PMCID: PMC8881660 DOI: 10.1016/j.ijcha.2022.100975] [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] [Received: 10/16/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
Background Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC). Methods Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios. Results Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69–5.32); diameter decrease in the stenotic area after IVL session was −5.23 mm (95 CI –22.6–12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06–1.63; p < 0.00001) and 1.34 mm2 (95% CI 0.71–1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD −0.22; 95% CI −0.40–0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669). Conclusions Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions.
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Osman H, Ullah W, Suleiman ARM, ZahidUllah H, Zahid S, Zghouzi M, Sattar Y, Prasad A, Bagur R, Shafi I, Kapadia SR, Mamas M, Virani SS, Fischman DL, Alraies MC. TRENDS OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH AORTIC INSUFFICIENCY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01743-0] [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: 11/28/2022]
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17
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Mantha Y, Harfouch B, Chakravorty R, Garcia M, Shrestha R, Shankar A, Almomani AA, Agoston I, Prasad A. PREGNANCY ASSOCIATED SUDDEN CORONARY ARTERY DISSECTION COMPLICATED WITH SUBCAPSULAR HEMATOMA, LIVER FAILURE AND VENTRICULAR FIBRILLATION ARREST. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03161-8] [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: 10/18/2022]
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18
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Mantha Y, Shrestha R, Jenkins J, Agoston I, Prasad A. ATYPICAL CHEST PAIN: ANOMALOUS ORIGIN OF LEFT CIRCUMFLEX AND LEFT ANTERIOR DESCENDING ARTERIES FROM THE RIGHT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03817-7] [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: 10/18/2022]
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Ullah W, Zghouzi M, Sattar Z, Ahmad B, Zahid S, Suleiman AM, Sattar Y, Khan MZ, Paul T, Bagur R, Qureshi MI, Fischman DL, Banerjee S, Prasad A, Alraies MC. Safety and efficacy of drug‐coated balloon for peripheral artery revascularization—A systematic review and meta‐analysis. Catheter Cardiovasc Interv 2022; 99:1319-1326. [PMID: 35043555 DOI: 10.1002/ccd.30074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Waqas Ullah
- Department of Cardiology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Mohammad Zghouzi
- Department of Cardiology, Detroit Medical Center Heart Hospital Detroit Michigan USA
| | - Zeeshan Sattar
- Department of Internal Medicine SUNY Downstate Medical Center Brooklyn New York USA
| | - Bachar Ahmad
- Department of Cardiology, Detroit Medical Center Heart Hospital Detroit Michigan USA
| | - Salman Zahid
- Department of Internal Medicine Rochester General Hospital Rochester New York USA
| | | | - Yasar Sattar
- Department of Cardiology West Virginia University Morgantown West Virginia USA
| | - Muhammad Zia Khan
- Department of Cardiology West Virginia University Morgantown West Virginia USA
| | - Timir Paul
- Department of Cardiology The University of Tennessee Nashville Tennessee USA
| | - Rodrigo Bagur
- Department of Cardiology London Health Science Centre Western University London Ontario Canada
| | | | - David L. Fischman
- Department of Cardiology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Subhash Banerjee
- Department of Cardiology University of Texas Southwestern Medical Center Dallas Texas USA
| | - Anand Prasad
- Department of Cardiology UT Health San Antonio San Antonio Texas USA
| | - M. Chadi Alraies
- Department of Cardiology, Detroit Medical Center Heart Hospital Detroit Michigan USA
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Praveenkumar NB, Prasad A, Bindu L, Biju S, Gleeja VL. Amelioration of fly annoyance in dairy cattle by using illuminated fly traps. Journal of Veterinary and Animal Sciences 2022. [DOI: 10.51966/jvas.2022.53.1.13-17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Blood-sucking and biting flies are a significant source of annoyance to warm-blooded animals. Behavioural changes in animals may include attempts to pursue, remove or avoid the disturbance caused by the fly by means of body movement. In the presesnt study the behaviour during a 10 min period in each four-hour interval i.e. 1 AM, 5 AM, 9 AM, 1 PM, 5 PM and 9 PM was analysed and noted for inclusion in the ethogram. The cows with light trap (treatment) were compared with those without light traps (control) to study the effectivenss of the fly trap in reducing annoyance in cattle. All the seven avaoidance behaviours were counted such as head movement, ear shaking, tail movement, skin twitching, licking, kicking on belly and restlessness and were recorded by scan method. The results of this study indicated that the incidence of all the seven fly avoidance behaviours were significantly higher (p<0.01) in the control group. It could also be concluded that the occurance of all the behaviours in the control group at 1 PM were significantly high followed by 5 PM. The findings of the study suggest that fly activity in dairy farms was high during the afternoon hours followed by evening time and illuminated fly traps could be used effectively in controlling flies, so that the fly avoidance behavior by cattle was reduced on dairy farms.
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21
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Naveena T, Sarangi LN, Rana SK, Prasad A, Prabha TS, Jhansi D, Ponnanna NM, Sharma GK. Seroprevalence to common infectious abortifacient and infertility causing agents in the dairy herds of India. Iran J Vet Res 2022; 23:189-195. [PMID: 36425611 PMCID: PMC9681985 DOI: 10.22099/ijvr.2022.42574.6184] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/04/2022] [Accepted: 05/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Information on the prevalence of infectious agents in dairy farms forms the basis for formulating a suitable control strategy; especially in endemic situations. AIMS A cross-sectional study was undertaken to determine the prevalence of six economically important bovine diseases, causing reproductive disorders including bovine abortion in organized dairy herds in India. METHODS A total of 1,075 animals (cattle and buffaloes) from 09 dairy farms were screened by ELISA tests. RESULTS Bovine viral diarrhoea (BVD) was the most prevalent (56.5%) disease followed by infectious bovine rhinotracheitis (IBR) (45.4%). Prevalence of Q-fever (5.4%) and neosporosis (6.1%) were less on the farms. Although 16.3% of the samples turned positive for brucellosis, the contribution of calf-hood vaccination (B. abortus S19 vaccine) to the prevalence of antibodies cannot be ruled out. The overall prevalence of bovine anaplasmosis, known to cause sporadic abortions in dairy herds, was 34.1% in the 9 farms with a prevalence of less than 20% in 5 farms. Infection of multiple abortifacient (seroprevalence to more than two pathogens) was recorded in 56.8% of animals. A very strong association was observed between BVD and brucellosis (Odds ratio 14.2; P<0.001). Further, a positive association was also seen between seroprevalence of IBR and anaplasmosis, and neosporosis and Q fever (P<0.05). CONCLUSION Viral diseases were found to be more common in the dairy herds than bacterial and protozoan diseases. Increased susceptibility of IBR seropositive cows to other bacterial and viral infections was observed.
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Affiliation(s)
- T. Naveena
- MSc in Microbiology, Group of Animal Health, National Dairy Development Board Research and Development Laboratory, IIL Campus, Gachibowli, Hyderabad 500032, Telangana, India
| | - L. N. Sarangi
- Group of Animal Health, National Dairy Development Board Research and Development Laboratory, IIL Campus, Gachibowli, Hyderabad 500032, Telangana, India
| | - S. K. Rana
- Group of Animal Health, National Dairy Development Board, Anand 388001, Gujarat, India
| | - A. Prasad
- MVSc in Veterinary Microbiology, Group of Animal Health, National Dairy Development Board Research and Development Laboratory, IIL Campus, Gachibowli, Hyderabad 500032, Telangana, India
| | - T. S. Prabha
- MSc in Biotechnology, Group of Animal Health, National Dairy Development Board Research and Development Laboratory, IIL Campus, Gachibowli, Hyderabad 500032, Telangana, India
| | - D. Jhansi
- MTech in Biotechnology, Group of Animal Health, National Dairy Development Board Research and Development Laboratory, IIL Campus, Gachibowli, Hyderabad 500032, Telangana, India
| | - N. M. Ponnanna
- Group of Animal Health, National Dairy Development Board Research and Development Laboratory, IIL Campus, Gachibowli, Hyderabad 500032, Telangana, India
| | - G. K. Sharma
- MVSc in Veterinary Microbiology, Group of Animal Health, National Dairy Development Board, Anand 388001, Gujarat, India
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22
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Hosure S, Rajeev TS, Jiji RS, George PR, Prasad A, Gleeja VL. Effectiveness of livestock delivery services of dairy cooperatives of Kerala state. Journal of Veterinary and Animal Sciences 2022. [DOI: 10.51966/jvas.2022.53.3.340-347] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to know the effectiveness of livestock services delivered by the veterinarians working under state regional cooperative milk producers’ union (SRCMPU) and farmers views on these services. An ex-post-facto research design was adopted for the study. A total of fifteen veterinarians working under SRCMPU, Kerala, and thirty livestock farmers dependent on SRCMPU for the livestock services were selected. Data collection was done through using structured interview schedule method. The result from the study revealed that majority of the veterinarians and livestock farmers perceived curative services (60.00% and 46.66%), production services (53.33% and 63.33%), preventive services (53.34% and 56.66%), extension services (60.00% and 50.00%) and miscellaneous services (60.00% and 60.00%) as average. About satisfaction level, majority of the livestock farmers had medium level of satisfaction towards curative services (66.66%), production services (43.33%), preventive services (60.00%), extension services (50.00%) and miscellaneous services (60.00%). It is concluded from the result that there is need to improve the quality of livestock services from both veterinarians and farmers point of view. It is the need of hour to analyze and interpret the current scenario of service delivery systems of state regional cooperative milk producers’ union through assessing the constraints perceived by them in livestock service delivery.
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Ostrominski JW, Amione-Guerra J, Hernandez B, Michalek JE, Prasad A. Coding Variation and Adherence to Methodological Standards in Cardiac Research Using the National Inpatient Sample. Front Cardiovasc Med 2021; 8:713695. [PMID: 34796206 PMCID: PMC8592936 DOI: 10.3389/fcvm.2021.713695] [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: 05/23/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Code selection is crucial to the accuracy and reproducibility of studies using administrative data, however a comprehensive assessment of coding trends for major cardiac diagnoses and procedures is lacking. We aimed to evaluate trends in administrative code utilization for major cardiac diagnoses and procedures, and adherence to required methodological practices in cardiac research using the National Inpatient Sample (NIS). Methods: In this observational study of 445 articles, ICD-9-CM codes corresponding to acute myocardial infarction (AMI), heart failure, atrial fibrillation, percutaneous coronary intervention, and coronary artery bypass grafting were collected and analyzed. The NIS was used to compare the number of hospitalizations between the most frequently encountered AMI case definitions. Key elements were abstracted from each article to evaluate adherence to required methodological practices. Results: Variation in code utilization was observed for each diagnosis and procedure assessed, and the number of unique case definitions published per year increased throughout the study period (P < 0.001), driven largely by the significant increase in articles per year (P < 0.001). Off-target codes were observed in 39 (8.8%) studies. Upon reintroduction into the NIS for 2008–2012, the most commonly encountered case definitions for AMI were found to yield significantly different estimates of AMI hospitalizations and hospitalization trends over time. Three hundred and ninety-nine articles (84%) did not adhere to one or more required research practices. Overall adherence was superior for publications in higher-impact journals (P = 0.002). Conclusions: Substantial variation in code selection exists for major cardiac diagnoses and procedures, and non-adherence to methodological standards is widespread. These data have important implications for the accuracy and generalizability of analyses using the NIS.
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Affiliation(s)
- John W Ostrominski
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, TX, United States
| | - Javier Amione-Guerra
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, TX, United States
| | - Brian Hernandez
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, United States
| | - Joel E Michalek
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, United States
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, TX, United States
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Michel P, Amione-Guerra J, Sheikh O, Jameson LC, Bansal S, Prasad A. Meta-analysis of intravascular volume expansion strategies to prevent contrast-associated acute kidney injury following invasive angiography. Catheter Cardiovasc Interv 2021; 98:1120-1132. [PMID: 33185335 DOI: 10.1002/ccd.29387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To perform a detailed analysis of published data regarding intravascular volume expansion to prevent contrast-associated acute kidney injury (CA-AKI) and to determine if an ideal dose of IV fluids can be recommended. BACKGROUND Administration of contrast media during invasive angiography is associated with CA-AKI. Intravascular volume expansion is the most effective intervention to prevent CA-AKI, yet evidenced based protocols are lacking. METHODS Literature review and meta-analysis of randomized controlled trials (RCT) of patients receiving IV volume expansion as prophylaxis for CA-AKI was performed. Normal saline, Lactated Ringer's and sodium bicarbonate were included. The primary outcome was incidence of CA-AKI. RESULTS 37 RCTs studying 12,166 patients were included. Mean age was 67 ± 5 years, 70% of the patients were male. 68% had chronic kidney disease, 41% diabetes, and 30% heart failure. The incidence of CA-AKI was 9.5% (95% CI: 8-12%). IV expansion versus no volume administration was associated with a lower risk of CA-AKI (RR:0.62; 95% CI: 0.49-0.77, p < .001). Intensive IV volume expansion was associated with a reduced risk of CA-AKI(RR: 0.66; 95%CI: 0.52-0.85, p < .01). The intensive IV volume expansion arm received significantly more fluids than the standard protocols: 1,574(1,123 - 1,913) ml versus 849(558-1,067) ml (p = .03) without significant difference in the duration of infusion (median of 12 vs. 17 hr, p = .1) or pulmonary edema (1.7% vs 1.3%, p = .7). CONCLUSIONS Despite high variability in protocols used, IV volume expansion is effective in preventing CA-AKI. Intensive IVF expansion (median 1.6 L over 17 hr) was associated with decreased risk of CA-AKI.
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Affiliation(s)
- Pablo Michel
- Department of Medicine, Division of Cardiology, Rutgers New Jersey Medical School, Newark
| | - Javier Amione-Guerra
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas
| | - Omar Sheikh
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas
| | - Lauren C Jameson
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas
| | - Shweta Bansal
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center, San Antonio, Texas
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas
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Prasad A, Amin AP, Ryan MP, Gunnarsson C, Brilakis ES. Use of iso-osmolar contrast media during endovascular revascularization is associated with a lower incidence of major adverse renal, cardiac, or limb events. Catheter Cardiovasc Interv 2021; 99:1335-1342. [PMID: 34766727 DOI: 10.1002/ccd.30006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/31/2021] [Accepted: 10/26/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We examined the association of iso-osmolar contrast media (IOCM) versus low-osmolar contrast media (LOCM) with major adverse renal, cardiovascular, or limb events in patients at high-risk of acute kidney injury (AKI) undergoing peripheral endovascular procedures. BACKGROUND Procedural characteristics including iodinated contrast type and volume have been associated with adverse renal and cardiovascular outcomes in patients undergoing angiographic interventions. METHODS Patients at high-risk of AKI, undergoing peripheral endovascular procedures were identified using the Premier Healthcare Database and separated into claudication and critical limb ischemia (CLI) cohorts. For each cohort, we compared IOCM versus LOCM for the primary endpoint of MARCE (major adverse renal or cardiovascular events) and secondary endpoints of major adverse renal events (MARE) and major adverse renal and limb events (MARLE). These outcomes were captured within the indexed hospitalization via adjusted multivariable regression analyses. RESULTS Two procedure-based cohorts of high-risk patients were formed: claudication (N = 11,976) and CLI (N = 8713). Use of IOCM was associated with a significant absolute risk reduction (ARR) of 2.2% (p < 0.0001) for MARCE overall and in each cohort (claudication, 1.8%, p = 0.0070; CLI, 2.7%, p = 0.0054). The incidence of MARE and MARLE in the overall cohort was also lower with the use of IOCM: MARE (ARR = 1.4%, p = 0.0072) and MARLE (ARR = 2.0%, p = 0.0043). CONCLUSIONS Using IOCM versus LOCM in patients at high-risk of adverse renal events undergoing peripheral endovascular procedures was independently associated with lower risk of MARCE, MARE, and MARLE.
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Affiliation(s)
- Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Amit P Amin
- Division of Cardiology, Geisel School of Medicine, Dartmouth, USA
| | - Michael P Ryan
- Biostatistics, CTI Clinical Trial & Consulting Services, Covington, Kentucky, USA
| | - Candace Gunnarsson
- Real World Evidence, CTI Clinical Trial & Consulting Services, Covington, Kentucky, USA
| | - Emmanouil S Brilakis
- Center for Complex Coronary Interventions, Minneapolis Heart Institute, Minneapolis, Minnesota, USA.,Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Eng M, Al-Darzi W, Villablanca P, Frisoli T, Gonzalez PE, Chiang M, Basir M, Cowger J, Alaswad K, Prasad A, O'Neill W. TCT-308 Cardiogenic Shock–Associated Cardiorenal Syndrome Improves With the Use of Left Atrial Venous Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO). J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safley DM, Salisbury AC, Tsai TT, Secemsky EA, Kennedy KF, Rogers RK, Latif F, Shammas NW, Garcia L, Cavender MA, Rosenfield K, Prasad A, Spertus JA. Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention: From the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2021; 14:333-341. [PMID: 33541543 DOI: 10.1016/j.jcin.2020.10.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. BACKGROUND AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. METHODS A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. RESULTS Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of -0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. CONCLUSIONS AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI.
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Affiliation(s)
- David M Safley
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - Adam C Salisbury
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Thomas T Tsai
- Interventional Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Eric A Secemsky
- Vascular Intervention, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - R Kevin Rogers
- Vascular Medicine & Intervention, University of Colorado, Aurora, Colorado, USA
| | - Faisal Latif
- Interventional Cardiology, University of Oklahoma & VA Medical Center, Oklahoma City, Oklahoma, USA
| | | | - Lawrence Garcia
- Section of Interventional Cardiology, Tufts University School of Med, Boston, Massachusetts, USA
| | - Matthew A Cavender
- Interventional Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth Rosenfield
- Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anand Prasad
- Cardiovascular Disease, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John A Spertus
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
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28
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Amin AP, Prasad A, Ryan MP, Gunnarsson C, Brilakis ES. Association of Iso-Osmolar vs Low-Osmolar Contrast Media With Major Adverse Renal or Cardiovascular Events in Patients at High Risk for Acute Kidney Injury Undergoing Endovascular Abdominal Aortic Aneurysm Repair. J Invasive Cardiol 2021; 33:E640-E646. [PMID: 34280892] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The purpose of this analysis was to examine the association of iso-osmolar contrast media (IOCM) vs low-osmolar contrast media (LOCM) with major adverse renal or cardiovascular events (MARCE) in patients at high risk of acute kidney injury (AKI), undergoing endovascular abdominal aortic aneurysm repair (EVAR). METHODS Patients at high risk of AKI (defined as age ≥75 years, or one or more of the following comorbidities: diabetes, anemia, chronic kidney disease (CKD stages 1-4) or congestive heart failure), undergoing EVAR from September 2012 to June 2018 were identified using the Premier Hospital Database. We compared the primary endpoint of MARCE (composite of AKI, AKI requiring dialysis, acute myocardial infarction [AMI], stroke/transient ischemic attack [TIA], and death) with IOCM vs LOCM via adjusted multivariable regression analyses. RESULTS Among 15,777 high-risk patients undergoing EVAR, the occurrence of in-hospital MARCE was 6.8%, including renal events (4.5%), AMI (0.8%), stroke/TIA (0.4%), and death (1.9%), IOCM was used in 7360 patients (47%). Multivariable modeling found IOCM was associated with 1.8% (95% confidence interval [CI], 0.4-3.3; P=.01) lower absolute risk for MARCE (23.9% relative risk reduction; 95% CI, 5.2%-44.2%). CONCLUSIONS Use of IOCM vs LOCM in patients at high risk of AKI undergoing EVAR procedures was associated with a lower risk of MARCE. As prevention of AKI or cardiovascular events after EVAR procedures may lead to reduced morbidity and mortality, this finding may have important clinical implications and should be confirmed through randomized controlled clinical studies.
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Affiliation(s)
- Amit P Amin
- Interventional Cardiology, Dartmouth-Hitchcock Medical Center, Associate Professor of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756 USA.
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Sheikh O, Nguyen T, Bansal S, Prasad A. Acute kidney injury in cardiogenic shock: A comprehensive review. Catheter Cardiovasc Interv 2021; 98:E91-E105. [PMID: 32725874 DOI: 10.1002/ccd.29141] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/14/2020] [Accepted: 06/27/2020] [Indexed: 11/09/2022]
Abstract
Acute kidney injury (AKI) is an ominous predictor of mortality in cardiogenic shock. The present review examines the pathophysiology of AKI in cardiogenic shock (CS), summarizes the pertinent literature including the diagnostic criteria/definitions for AKI and possible role of biomarkers, and identifies risk factors and possible therapeutic interventions for AKI in CS. Our review finds that AKI is common in patients with CS and is associated with increased morbidity and mortality. Urinary biomarkers of renal tubular injury appear more sensitive for detection of AKI but have yet to be incorporated into daily practice. Emerging data would suggest vasopressor choices, mechanical circulatory support, and renal replacement therapy may have important therapeutic roles in the management of CS.
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Affiliation(s)
- Omar Sheikh
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tung Nguyen
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Zghouzi M, Moussa Pacha H, Ullah W, Sattar Y, Ahmad B, Osman H, Mohamed MO, Mir T, Banerjee S, Shishehbor MH, Prasad A, Rits Y, Mamas MA, Alraies MC. In-hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease. Catheter Cardiovasc Interv 2021; 98:E586-E593. [PMID: 34160890 DOI: 10.1002/ccd.29827] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/12/2021] [Accepted: 06/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The outcome of endovascular intervention (EVI) compared vs. surgical revascularization in patients with peripheral artery disease (PAD) due to chronic total occlusion (CTO) is unknown. METHODS Using the National Inpatient Sample database between 2007 and 2014, we identified all PAD patients with CTO who had limb revascularization. Multivariate analysis was performed to estimate the odds of in-hospital mortality and adverse outcomes between both groups. RESULTS A total of 168,420 patients who had peripheral CTO and underwent limb revascularization were identified. 99,279 underwent EVI, and 69,141 underwent surgical revascularization. The patients who underwent EVI were younger, more likely to be women and African American, and less likely to be white (p < 0.001 for all). EVI was associated with lower in-hospital mortality (1.2% vs 1.7%, adjusted odds ratio [aOR]: 0.54; 95% confidence interval [CI] 0.50-0.59). The EVI group had higher vascular complications, major bleeding, acute kidney injury (AKI), and major amputation compared with surgical revascularization. A subgroup analysis on patients with critical limb ischemia showed lower mortality in the EVI group (1.4% vs. 1.9, aOR 0.56; 95% CI 0.50-0.63). Although there was no difference in the incidence of AKI or major amputation between the two groups, the EVI group had higher vascular complication rates and major bleeding events. CONCLUSION EVI in PAD with CTO is associated with lower in-hospital mortality, likely due to the procedure's less-invasive nature; however, it is associated with higher postprocedural complications likely due to the CTO's complexity.
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Affiliation(s)
- Mohamed Zghouzi
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Homam Moussa Pacha
- Cardiology, University of Texas Health Science Center, Houston, Texas, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Bachar Ahmad
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Heba Osman
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Mohamed O Mohamed
- Keele Cardiovascular Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Tanveer Mir
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Subhash Banerjee
- Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Anand Prasad
- Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Yevgeniy Rits
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Mamas A Mamas
- Keele Cardiovascular Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - M Chadi Alraies
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Bansal S, Kanakia R, Sharma K, Tsai S, Prasad A. Nephrology Training: Time to Revisit Integrative Physiology. Am J Nephrol 2021; 51:244-248. [PMID: 32062651 DOI: 10.1159/000505994] [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] [Received: 11/11/2019] [Accepted: 01/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Shweta Bansal
- Division of Nephrology, University of Texas Health at San Antonio, San Antonio, Texas, USA, .,South Texas Veterans Healthcare System, San Antonio, Texas, USA,
| | - Rushit Kanakia
- Division of Cardiology, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Kumar Sharma
- Division of Nephrology, University of Texas Health at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - Steve Tsai
- Division of Cardiology, University of Texas Health at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - Anand Prasad
- Division of Cardiology, University of Texas Health at San Antonio, San Antonio, Texas, USA
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32
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Haloot J, Sheikh O, Dollar F, Javeri H, Fichardt HJ, Fernandes G, Garcia M, Prasad A. Personal Protective Equipment and Donning and Doffing Techniques in the Cardiac Catheterization Laboratory During the COVID-19 Pandemic: Insights From an Internet Search for Protocols. Front Cardiovasc Med 2021; 8:652298. [PMID: 34055934 PMCID: PMC8155273 DOI: 10.3389/fcvm.2021.652298] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, a need for precise donning and doffing protocols for personal protective equipment (PPE) among healthcare infrastructures is paramount. Procedures involving the cardiac catheterization laboratory (CCL) are routinely non-aerosolizing but have the potential for rapid patient deterioration, creating the need for aerosolizing generating procedures. Multiple societal and governmental guidelines on the use of PPE during medical procedures are available on Internet websites; however, there is limited literature available in peer-reviewed formats in this context. This study aims to provide an overview of current PPE donning and doffing protocols specific to the catheterization laboratory. Methods: A series of internet searches regarding donning and doffing of PPE in the CCL including published articles and internet protocols were compiled and compared using Pubmed.gov, Google.com, www.twitter.com, and www.youtube.com. Results: Most institutions used N95 masks, shoe covers, at least one head covering, face shield or goggles, two pairs of gloves, and inner and outer gowns. Doffing variation was greater than donning. Doffing has the potential to contaminate the healthcare worker (HCW), and therefore, this step of PPE management requires further study. Common steps in temporal priority included cleaning of gloved hands, removal of outer (or only) gown, removal of outer gloves, repeat gloved hand cleaning, removal of facial PPE last, and a final non-gloved hand cleaning. Conclusions: This analysis provides a summary of commonly used practices that may be considered when designing CCL-specific PPE protocols. Analysis of consistent steps from the literature led the authors to formulate a suggested protocol for CCL HCWs when performing procedures on patients with confirmed or suspected/unknown COVID-19.
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Affiliation(s)
- Justin Haloot
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Omar Sheikh
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Fatima Dollar
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Heta Javeri
- Division of Infectious Disease, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Hendre Jeannetta Fichardt
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Gail Fernandes
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Marlene Garcia
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Erotocritou M, Prasad A, Burns S, Haddo O, Bartlett W, Mavroveli S, Hanna S, Berber O. 458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak. Br J Surg 2021. [PMCID: PMC8135673 DOI: 10.1093/bjs/znab135.036] [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: 11/16/2022]
Abstract
Objective To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic. Method 4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence. Results Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant. Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4.62) compared to the willing group (2.89 and 2.71 respectively). Patients’ main concern was contracting COVID (35.2%). Conclusions Our study demonstrated that the majority of patients were willing to undergo surgery. This can be used to inform strategies for resuming elective surgeries. It has also highlighted several areas in patient perception that warrant further investigation and the importance of enhanced consent on the specific risks.
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Affiliation(s)
- M Erotocritou
- Whittington Health NHS Trust, London, United Kingdom
| | - A Prasad
- Whittington Health NHS Trust, London, United Kingdom
| | - S Burns
- Whittington Health NHS Trust, London, United Kingdom
| | - O Haddo
- Whittington Health NHS Trust, London, United Kingdom
| | - W Bartlett
- Whittington Health NHS Trust, London, United Kingdom
| | - S Mavroveli
- Imperial College London, London, United Kingdom
| | - S Hanna
- Royal London NHS Trust, London, United Kingdom
| | - O Berber
- Whittington Health NHS Trust, London, United Kingdom
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Ullah W, Zghouzi M, Ahmad B, Biswas S, Zaher N, Sattar Y, Pacha HM, Goldsweig A, Velagapudi P, Fischman D, Prasad A, Alraies MC. SAFETY AND EFFICACY OF SINGLE VS. DUAL ANTIPLATELET THERAPY IN POST-TAVR PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02302-0] [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: 10/21/2022]
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Acharya P, Sethi P, Ranka S, Alli A, Hance K, Prasad A, Shah Z, Gupta K. Nationwide study of six-month readmissions in critical limb ischemia: Predictors and impact of revascularization strategies. Vascular 2021; 30:255-266. [PMID: 33906558 DOI: 10.1177/17085381211011357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a paucity of data regarding six-month readmissions in critical limb ischemia patients and the influence of management strategy during index-admission [endovascular, surgical, hybrid procedure, medical therapy, and amputation]. We aimed to investigate the incidence, predictors, and impact of management strategies on six-month readmission in patients with critical limb ischemia. METHODS A secondary analysis of the Nationwide Readmissions Database (2016-2017) was conducted. Propensity score matching was performed for subgroup analysis. RESULTS We identified 50,058 patients with primary diagnosis of critical limb ischemia. Six-month all-cause and critical limb ischemia-related readmission rate was 52.36% and 10.86%, respectively. The risk of all-cause readmission was lower with amputation but was similar among other subgroups. Patients receiving surgical [HR 0.62, CI(0.48-0.79), p < 0.001] and hybrid procedure [HR 0.65 (0.46-0.93), p = 0.02] had lower risk of unplanned critical limb ischemia-related readmission compared to endovascular, though the risk of unplanned revascularization/amputation during readmission was similar between the three strategies. The risk of non-critical limb ischemia-related readmission was higher with surgical [HR 1.13, CI(1.04-1.23), p = 0.003] and hybrid procedure [HR 1.17, CI(1.08-1.28), p < 0.001], driven by increased procedure-related/wound complications. Eventhough endovascular patients were older with more severe critical limb ischemia presentation, a lower proportion received home-health or placement upon discharge from index-admission. This could account for higher readmission without higher repeat revascularization in endovascular group. CONCLUSION The risk of critical limb ischemia and non-critical limb ischemia-related readmission differ according to the management strategy. Significant differences in discharge disposition exist depending on revascularization strategy. Study findings identify opportunities for reducing readmissions by focusing on nonprocedural aspects like wound-care, discharge planning and placement.
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Affiliation(s)
- Prakash Acharya
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Prince Sethi
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Sagar Ranka
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Adam Alli
- Department of Radiology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Kirk Hance
- Division of Vascular Surgery, Department of Surgery, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Anand Prasad
- Department of Cardiology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Zubair Shah
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Kamal Gupta
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
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Ullah W, Zghouzi M, Ahmad B, Biswas S, Zaher N, Sattar Y, Pacha HM, Goldsweig AM, Velagapudi P, Fichman DL, Prasad A, Alraies MC. Meta-Analysis Comparing the Safety and Efficacy of Single vs Dual Antiplatelet Therapy in Post Transcatheter Aortic Valve Implantation Patients. Am J Cardiol 2021; 145:111-118. [PMID: 33454348 DOI: 10.1016/j.amjcard.2020.12.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
The relative safety and efficacy of aspirin versus dual antiplatelet therapy (DAPT; aspirin+clopidogrel) in patients who underwent transcatheter aortic valve implantation (TAVI) and did not have a long-term indication for oral anticoagulation remains controversial. Digital databases were searched to identify relevant articles. The major safety end point was bleeding, while the efficacy end points included after-TAVI ischemic and thrombotic events. Data were analyzed using a random effect model to calculate the pooled unadjusted odds ratio (OR) for dichotomous outcomes. Eleven studies comprising 4805 patients (aspirin 2258, DAPT 2547) were included in the quantitative analysis. Patients receiving aspirin-alone had significantly lower odds of all cause bleeding (OR 0.41, 95% CI 0.29 to .057, p <0.00001), major vascular bleeding (OR 0.51, 95% CI 0.34 to 0.77, p = 0.001), Valve Academic Research Consortium 2 (VARC-2) major bleeding (OR 0.50, 95% CI 0.30 to 0.83 p = 0.008), VARC-2 minor bleeding (OR 0.55, 95% CI 0.31 to 0.97, p = 0.04), transfusion requirement (OR 0.39, 95%CI 0.15 to 0.0.98, p = 0.05) and major vascular complications (OR0.41, 95% CI 0.26 to 0.66, p = 0.0002) compared with after-TAVI patients receiving both aspirin and clopidogrel. These was no significant difference in the odds of VARC-2 life threatening bleeding (OR 0.52, 95% CI 0.25 to 1.07, p = 0.08), prosthetic valve thrombosis (OR 1.17, 95% CI 0.22 to 6.30, p = 0.85), cardiac tamponade (OR 0.77, 95% CI 0.20 to 2.98, p = 0.70), conversion to open procedure (OR 1.99, 95 % CI 0.42 to 9.44, p = 0.39), MI (OR 0.79 95% CI 0.38 to 1.64, p = 0.52), transient ischemic attack (TIA) (OR 0.89, 95% CI 0.12 to 6.44, p = 0.91), major stroke (OR 0.68 95 % CI 0.43 to 1.08, p = 0.10), disabling stroke (0R 1.01, 95% CI 0.41 to 2.48, p = 0.99), cardiovascular mortality (OR 0.81 95% CI 0.38 to 1.74, p = 0.59) and all-cause mortality (OR 0.86, 95% CI 0.63 to 1.16, p = 0.31) between the 2 groups. In conclusion, after-TAVI patients who received aspirin alone had lower bleeding events with no significant differences in mortality and stroke rate compared with those who received DAPT.
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Jisha N, Girish Varma G, Gleeja V, Prasad A, Beena V, Karthiayini K, Sejian V. Annual temperature profile of Thrissur: a climate change perspective. J Vet Anim Sci 2021. [DOI: 10.51966/jvas.2021.52.1.26-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Prasad A, Panhwar S, Hendel RC, Sheikh O, Mushtaq Z, Dollar F, Vinas A, Alraies C, Almonani A, Nguyen TH, Amione-Guerra J, Foster MT, Sisson C, Anderson A, George JC, Kutkut I, Guareña Casillas JA, Badin A. COVID-19 and the cardiovascular system: A review of current data, summary of best practices, outline of controversies, and illustrative case reports. Am Heart J 2020; 226:174-187. [PMID: 32599258 PMCID: PMC7834076 DOI: 10.1016/j.ahj.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022]
Abstract
As the severe acute respiratory syndrome coronavirus 2 virus pandemic continues to grow globally, an association is apparent between patients with underlying cardiovascular disease comorbidities and the risk of developing severe COVID-19. Furthermore, there are potential cardiac manifestations of severe acute respiratory syndrome coronavirus 2 including myocyte injury, ventricular dysfunction, coagulopathy, and electrophysiologic abnormalities. Balancing management of the infection and treatment of underlying cardiovascular disease requires further study. Addressing the increasing reports of health care worker exposure and deaths remains paramount. This review summarizes the most contemporary literature on the relationship of the cardiovascular system and COVID-19 and society statements with relevance to protection of health care workers, and provides illustrative case reports in this context.
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Affiliation(s)
- Anand Prasad
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX.
| | - Siyab Panhwar
- Tulane University School of Medicine, Department of Medicine, Division of Cardiology, New Orleans, LA
| | - Robert C Hendel
- Tulane University School of Medicine, Department of Medicine, Division of Cardiology, New Orleans, LA
| | - Omar Sheikh
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Zunair Mushtaq
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Fatima Dollar
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Ariel Vinas
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Chadi Alraies
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI
| | - Ahmed Almonani
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Tung Huy Nguyen
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Javier Amione-Guerra
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Mark T Foster
- The Department of Emergency Medicine, UT Health San Antonio, San Antonio, TX
| | - Craig Sisson
- The Department of Emergency Medicine, UT Health San Antonio, San Antonio, TX
| | - Allen Anderson
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
| | - Jon C George
- Einstein Medical Center, Division of Cardiology, Philadelphia, PA
| | - Issa Kutkut
- New York-Presbyterian Brooklyn Methodist Hospital, New York, NY
| | | | - Auroa Badin
- The Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, TX
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Bhardwaj B, Spertus JA, Kennedy KF, Jones WS, Safley D, Tsai TT, Aronow HD, Vora AN, Pokharel Y, Kumar A, Attaran RR, Feldman DN, Armstrong E, Prasad A, Gray B, Salisbury AC. Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry. JACC Cardiovasc Interv 2020; 12:1140-1149. [PMID: 31221303 DOI: 10.1016/j.jcin.2019.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 01/15/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to assess periprocedural bleeding complications in lower-extremity peripheral vascular interventions (PVIs). BACKGROUND Few studies have examined the incidence, predictors, or outcomes of periprocedural bleeding after lower-extremity PVI. METHODS The study examined patients undergoing PVI at 76 hospitals in the National Cardiovascular Data Registry PVI registry from 2014 to 2016. Post-PVI major bleeding was defined as any overt bleeding with a hemoglobin (Hb) drop of ≥3 g/dl, any Hb decline of ≥4 g/dl, or blood transfusion in patients with pre-procedure Hb >8 g/dl within 72 h of their procedure. Hierarchical multivariable logistic regression was used to identify factors independently associated with post-PVI bleeding. The study also examined adjusted in-hospital mortality among patients with or without major bleeding complications. RESULTS Among 18,289 PVI procedures, major bleeding occurred in 744 (4.10%). Patient characteristics independently associated with bleeding included age, female sex, heart failure, pre-procedural hemoglobin <12 g/dl, nonelective PVI, and critical limb ischemia on presentation. Procedural characteristics associated with bleeding included nonfemoral vascular access, use of thrombolytic therapy, PVI of the aortoiliac segment, and multilesion interventions, whereas use of closure devices was associated with less bleeding. All-cause in-hospital mortality was higher in patients who experienced bleeding than in those who did not (6.60% vs. 0.30%; p < 0.001; adjusted hazard ratio: 10.9; 95% confidence interval: 6.9 to 17.0). CONCLUSIONS Major bleeding occurred in 4.10% of lower-extremity PVI procedures and was associated with several patient and procedural characteristics, as well as in-hospital mortality. These insights can be incorporated into strategies to reduce periprocedural bleeding after PVI.
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Affiliation(s)
- Bhaskar Bhardwaj
- Division of Cardiovascular Diseases, University of Missouri, Columbia, Missouri; Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - John A Spertus
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
| | - Kevin F Kennedy
- Division of Cardiovascular Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
| | - W Schuyler Jones
- Division of Cardiology, Duke University Health System, Duke Heart Center, Durham, North Carolina
| | - David Safley
- Division of Cardiovascular Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
| | - Thomas T Tsai
- Division of Cardiovascular Medicine, University of Colorado and Institute for Health Research, Kaiser Permanente, Denver, Colorado
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Amit N Vora
- Division of Cardiology, Duke University Health System, Duke Heart Center, Durham, North Carolina
| | - Yashashwi Pokharel
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
| | - Arun Kumar
- Division of Cardiovascular Diseases, University of Missouri, Columbia, Missouri
| | - Robert R Attaran
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Ehrin Armstrong
- Division of Cardiovascular Medicine, University of Colorado, Denver, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Bruce Gray
- Department of Surgery at Greenville Health System, Greenville, South Carolina
| | - Adam C Salisbury
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri.
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Nguyen TH, Sheikh O, Sha'ar M, Bansal S, Prasad A. An Overview of Contrast-Associated Acute Kidney Injury Following Lower-Extremity Percutaneous Peripheral Interventions. J Invasive Cardiol 2020; 32:276-282. [PMID: 32610269] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Contrast-associated acute kidney injury, resulting from the use of iodinated contrast media, is a well-known adverse event following endovascular procedures and is associated with poor prognosis when it happens. There is an abundance of literature studying acute kidney injury following percutaneous coronary interventions, with very few studies done in the setting of percutaneous peripheral intervention. Although both percutaneous coronary intervention and percutaneous peripheral intervention utilize iodinated contrast media, several differences exist that can affect the incidence and management of contrast-associated acute kidney injury. This article aims to review what we currently know about contrast-associated acute kidney injury and available prevention strategies, specifically following percutaneous peripheral interventions.
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Affiliation(s)
| | | | | | | | - Anand Prasad
- Interventional Cardiology and Vascular Medicine, Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7872, San Antonio, TX 78229-3900 USA.
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Bihaqi SJ, Allaie IM, Banday MAA, Sankar M, Wani ZA, Prasad A. Multiple anthelmintic resistance in gastrointestinal nematodes of Caprines on Mountain Research Centre for Sheep and Goat at Kashmir Valley, India. Parasite Epidemiol Control 2020; 11:e00163. [PMID: 32984565 PMCID: PMC7494505 DOI: 10.1016/j.parepi.2020.e00163] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 05/03/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
The study was conducted to evaluate the status of anthelmintic resistance in Gastro-Intestinal Nematodes (GINs) of goats at an organized farm located in Kashmir, as there is no report of resistance against these parasites of goats from this temperate region, although it has been reported worldwide including India. Caprines reared at this farm exhibited reduced efficacy to multiple anthelmintics following treatments with Fenbendazole (FBZ), Closantel and Ivermectin (IVM) in Faecal Egg Count Reduction Test (FECRT). The results suggested that the overall efficacy was highest for IVM at 83.5% and 90.0% on 7th and 14th day post-treatment, respectively and least for FBZ at 44.3% and 62.5%, respectively, whereas the corresponding figures for closantel were 68.3% and 86.2%, respectively. The pre-treatment faecal culture revealed Haemonchus contortus, Teladorsagia circumcincta and Trichostrongylus colubriformis as predominant strongyles, however, in post-treatment samples, only H. contortus was observed. Further, the infective larvae were subjected to Allele specific PCR (AS-PCR) for accurate diagnosis of BZ resistance. The AS-PCR revealed 52% of H. contortus were homozygous resistant (rr) and 17% were heterozygous (rS) on day “0” before treatment and 100% homozygous resistant (rr) on 7th day post treatment. In both T. colubriformis and T. circumcincta, 100% population was homozygous susceptible (SS) at day “0” before treatment. The overall frequency of resistant (r) allele for H. contortus was 60.5% and for susceptible allele (s) was 39.5%. For T. colubriformis and T. circumcincta the frequency of susceptible allele (s) was 100%. The survey indicated that the GINs of goats on the farm have developed multiple anthelmintic resistance to FBZ, closantel and IVM and the condition is alarming in the farm. Moreover surveillance studies about status of anthelmintic resistance in other farms (Govternment as well as Private) of Kashmir valley should be carried out at large scale to develop effective and sustainable control strategies against GI Nematodes.
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Affiliation(s)
- S J Bihaqi
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences & Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shuhama Campus, Alusteng, Srinagar, Kashmir-190006, J&K, India
| | - I M Allaie
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences & Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shuhama Campus, Alusteng, Srinagar, Kashmir-190006, J&K, India
| | - M A A Banday
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences & Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shuhama Campus, Alusteng, Srinagar, Kashmir-190006, J&K, India
| | - M Sankar
- Division of Parasitology, Indian Veterinary Research Institute, Izzatnagar, Bareilly-243122, UP, India
| | - Z A Wani
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences & Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shuhama Campus, Alusteng, Srinagar, Kashmir-190006, J&K, India
| | - A Prasad
- Division of Temperate Animal Husbandry, Regional Research Station of Indian Veterinary Research Institute, Mukteswar, Nainital-263138, Uttarakhand, India
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Abstract
Since the first peripheral endovascular intervention (PVI) in 1964, the procedure's technical aspects and indications have advanced significantly. Today, endovascular procedures span the spectrum of presentations from acute limb ischemia to critical limb ischemia and symptomatic limiting claudication. Goals of PVI remain restoring limb perfusion, minimizing rates of amputation and mortality, and sparing the need for the high-risk bypass surgery. Unfortunately, there are no large randomized controlled trials that address the optimal approach to peripheral arterial disease revascularization in chronic kidney disease (CKD) patients.
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Affiliation(s)
- Badr Harfouch
- Division of Cardiology, Department of Medicine, UT Health San Antonio, MC 7872, 8300 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, UT Health San Antonio, MC 7872, 8300 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Rodriguez R, Hasoon M, Eng M, Michalek J, Liu Q, Hernandez B, Bansal S, Bailey SR, Prasad A. Incidence and Predictors of Acute Kidney Injury Following Transcatheter Aortic Valve Replacement: Role of Changing Definitions of Renal Function and Injury. J Invasive Cardiol 2020; 32:138-141. [PMID: 31941833] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is a known complication. The prospective validation of various AKI definitions and estimated baseline renal function equations in the context of TAVR remains an ongoing area of research. This study examined the Valve Academic Research Consortium (VARC) 1 and 2 criteria for AKI, and impact of three estimated glomerular filtration rate (eGFR) equations (CKD-EPI, MDRD, and Cockcroft-Gault) on AKI incidence in TAVR patients. METHODS Retrospective review of 120 consecutive TAVR procedures over a 4-year period was performed. AKI, including stage, was defined using the VARC 1 and VARC 2 criteria. Univariate and multivariate analyses were performed for association between AKI and known patient, hemodynamic, and procedural variables. Further logistic regression, stepwise logistic regression, and association plots were performed for the three different eGFR calculations. RESULTS AKI occurred in 22% of VARC 1 patients and 23% of VARC 2 patients. On multivariate analysis, baseline eGFR was predictive of stage 1 AKI by CKD-EPI classification (VARC 1: odds ratio [OR], 0.93; 95% confidence interval [CI], 0.88-0.99; P=.02; VARC 2: OR, 0.93; 95% CI, 0.87-0.99; P=.03) and MDRD (OR, 0.93; 95% CI, 0.88-0.99; P=.03). Non-transfemoral approach was predictive of stage 1 AKI by VARC 2 (OR, 33.33; 95% CI, 1.6-696.41; P=.02). CONCLUSIONS The risk factor associations for AKI post TAVR vary by definitions used. Decreased GFR at baseline by both MDRD and CKD-EPI and non-transfemoral approach were associated with an increased risk of AKI post TAVR.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anand Prasad
- Interventional Cardiology and Vascular Medicine, Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7872, San Antonio, TX 78229-3900 USA.
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Shaffer A, Sheikh O, Prasad A. Cardiogenic Shock: A Systematic Review of Clinical Trials Registered With ClinicalTrials.gov. J Invasive Cardiol 2020; 32:E86-E96. [PMID: 32240097] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite a range of devices, medical interventions, and revascularization techniques utilized in cardiogenic shock (CS), there is a lack of evidence guiding management. We sought to characterize the contemporary trials through utilization of the ClinicalTrials.gov database. METHODS We investigated all phase II-IV interventional trials in the ClinicalTrials.gov database through June 29, 2019 that enrolled patients with CS. Published trials investigating medical interventions were evaluated for methodological quality using the Jadad scoring system. RESULTS The initial query yielded 28 registered studies, of which 28 directly studied CS through whole or subgroup analyses. Of these, five were withdrawn or terminated, while 13 were recruiting, not yet recruiting, or were of unknown recruitment status. The remaining 10 were published and had a median patient size of 69 patients and a median site size of 6. Of the published studies, all-cause mortality was the most common primary endpoint (60%), including composite endpoints that included mortality. The remaining endpoints examined surrogate hemodynamic parameters of cardiac function through echocardiography. The mean Jadad score of the published trials investigating pharmacological therapies was 2.42. Of the trials investigating device therapies or revascularization methods, all were randomized, parallel-arm studies that were open label. CONCLUSIONS Modern trials vary from single center to multicenter and are small in size. The primary endpoints were clinical, focusing on mortality and restoration of cardiac output or cardiac index. Methodological quality varies in the trials focused on pharmacologic therapy. Trials with devices or revascularization do not employ blinding, but do employ randomization.
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Affiliation(s)
| | - Omar Sheikh
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA.
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Prasad A, Rosenthal NA, Kartashov A, Knish K, Dreyfus J. Contemporary trend of acute kidney injury incidence and incremental costs among US patients undergoing percutaneous coronary procedures. Catheter Cardiovasc Interv 2020; 96:1184-1197. [DOI: 10.1002/ccd.28824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Anand Prasad
- Department of Medicine, Division of Cardiology, Medical Arts & Research Center UT Health San Antonio Texas USA
| | - Ning A. Rosenthal
- Premier Applied Sciences Premier Healthcare Solutions Inc. Charlotte North Carolina USA
| | - Alex Kartashov
- Premier Applied Sciences Premier Healthcare Solutions Inc. Charlotte North Carolina USA
| | | | - Jill Dreyfus
- Premier Applied Sciences Premier Healthcare Solutions Inc. Charlotte North Carolina USA
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Rymer JA, Kennedy KF, Lowenstern AM, Secemsky EA, Tsai TT, Aronow HD, Prasad A, Gray B, Armstrong EJ, Rosenfield K, Shishehbor MH, Jones WS. In-Hospital Outcomes and Discharge Medication Use Among Patients With Critical Limb Ischemia Versus Claudication. J Am Coll Cardiol 2020; 75:704-706. [DOI: 10.1016/j.jacc.2019.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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Jones WS, Kennedy KF, Hawkins BM, Attaran RR, Secemsky EA, Latif F, Shammas NW, Feldman DN, Aronow HD, Gray B, Armstrong EJ, Grossman PM, Ho KK, Prasad A, Jaff MR, Rosenfield K, Tsai TT. Expanding opportunities to understand quality and outcomes of peripheral vascular interventions: The ACC NCDR PVI Registry. Am Heart J 2019; 216:74-81. [PMID: 31419621 DOI: 10.1016/j.ahj.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/15/2019] [Indexed: 01/14/2023]
Abstract
Lower extremity peripheral artery disease (PAD) and cerebrovascular disease (CeVD) are prevalent conditions in the United States, and both are associated with significant morbidity (eg, stroke, myocardial infarction, and limb loss) and increased mortality. With a growth in invasive procedures for PAD and CeVD, this demands a more clear responsibility and introduces an opportunity to study how patients are treated and evaluate associated outcomes. The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) Peripheral Vascular Intervention (PVI) Registry is a prospective, independent collection of data elements from individual patients at participating centers, and it is a natural extension of the already robust NCDR infrastructure. As of September 20, 2018, data have been collected on 45,316 lower extremity PVIs, 12,417 carotid artery stenting procedures, and 11,027 carotid endarterectomy procedures at 208 centers in the United States. The purpose of the present report is to describe the patient and procedural characteristics of the overall cohort and the methods used to design and implement the registry. In collecting these data, ACC and ACC PVI Registry have the opportunity to play a pivotal role in scientific evidence generation, medical device surveillance, and creation of best practices for PVI and carotid artery revascularization.
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Michel P, Sheikh O, Guerra JA, Bansal S, Prasad A. TCT-613 Preventive Intravascular Volume Expansion Strategies for Contrast-Induced Acute Kidney Injury in Patients Receiving Intra-Arterial Contrast Media. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.727] [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: 10/25/2022]
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Amin A, Prasad A, Ryan M, Gunnarsson C, Brilakis E. TCT-609 Use of Iso-Osmolar Contrast Media in High AKI Risk Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Is Associated With Lower Incidence of Major Adverse Renal or Cardiac Events (MARCE). J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.723] [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: 10/25/2022]
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50
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Prasad A, Amin A, Ryan M, Gunnarsson C, Brilakis E. TCT-31 Use of Iso-Osmolar Contrast Media in High-AKI-Risk Patients Undergoing Peripheral Revascularization Procedures Is Associated With Lower Incidence of Major Adverse Renal or Cardiac Events (MARCE). J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.058] [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: 11/29/2022]
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