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Guddeti RR, Gill GS, Parekh JD, Jhand AS, Walters RW, Panaich SS, Goldsweig AM, Alla VM. Transcatheter Aortic Valve Implantation in Mixed Aortic Valve Disease: A Multicenter Study. Am J Cardiol 2023; 203:394-402. [PMID: 37517135 DOI: 10.1016/j.amjcard.2023.07.064] [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: 03/04/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Mixed aortic valve disease (MAVD), defined by the concurrent presence of aortic stenosis (AS) and insufficiency is frequently seen in patients who have undergone transcatheter aortic valve implantation (TAVI). However, studies comparing the outcomes of TAVI in MAVD versus isolated AS have demonstrated conflicting results. Therefore, we aim to assess the outcomes of TAVI in patients with MAVD in comparison with those with isolated severe AS. Patients who underwent native valve TAVI for severe AS at 3 tertiary care academic centers between January 2012 and December 2020 were included and categorized into 3 groups based on concomitant aortic insufficiency (AI) as follows: group 1, no AI; group 2, mild AI; and group 3, moderate to severe AI. Outcomes of interest included all-cause mortality and all-cause readmission rates at 30 days and 1 year. Other outcomes include bleeding, stroke, vascular complications, and the incidence of paravalvular leak at 30 days after the procedure. Of the 1,588 patients who underwent TAVI during the study period, 775 patients (49%) had isolated AS, 606 (38%) had mild AI, and 207 (13%) had moderate to severe AI. Society of Thoracic Surgeons risk scores were significantly different among the 3 groups (5% in group 1, 5.5% in group 2, and 6% in group 3, p = 0.003). Balloon-expandable valves were used in about 2/3 of the population. No statistically significant differences in 30-day or 1-year all-cause mortality and all-cause readmission rates were noted among the 3 groups. Post-TAVI paravalvular leak at follow-up was significantly lower in group 1 (2.3%) and group 2 (2%) compared with group 3 (5.6%) (p = 0.01). In summary, TAVI in MAVD is associated with comparable outcomes at 1 year compared with patients with isolated severe AS.
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Affiliation(s)
- Raviteja R Guddeti
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
| | - Gauravpal S Gill
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
| | - Jai D Parekh
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Aravdeep S Jhand
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan W Walters
- Department of Clinical Research, Creighton University School of Medicine, Omaha, Nebraska
| | - Sidakpal S Panaich
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Andrew M Goldsweig
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Venkata Mahesh Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska.
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Gupta AK, Jneid H, Addison D, Ardehali H, Boehme AK, Borgaonkar S, Boulestreau R, Clerkin K, Delarche N, DeVon HA, Grumbach IM, Gutierrez J, Jones DA, Kapil V, Maniero C, Mentias A, Miller PS, Ng SM, Parekh JD, Sanchez RH, Sawicki KT, te Riele ASJM, Remme CA, London B. Current Perspectives on Coronavirus Disease 2019 and Cardiovascular Disease: A White Paper by the JAHA Editors. J Am Heart Assoc 2020; 9:e017013. [PMID: 32347144 PMCID: PMC7429024 DOI: 10.1161/jaha.120.017013] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020. In this White Paper, we address the cardiovascular co-morbidities of COVID-19 infection; the diagnosis and treatment of standard cardiovascular conditions during the pandemic; and the diagnosis and treatment of the cardiovascular consequences of COVID-19 infection. In addition, we will also address various issues related to the safety of healthcare workers and the ethical issues related to patient care in this pandemic.
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Affiliation(s)
- Ajay K. Gupta
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Hani Jneid
- Division of CardiologyBaylor College of MedicineHoustonTX
| | - Daniel Addison
- Division of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Hossein Ardehali
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern UniversityChicagoIL
| | - Amelia K. Boehme
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNY
| | | | | | - Kevin Clerkin
- Division of CardiologyDepartment of MedicineVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | | | - Holli A. DeVon
- University of California, Los Angeles, School of NursingLos AngelesCA
| | - Isabella M. Grumbach
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
| | - Jose Gutierrez
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | - Daniel A. Jones
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Vikas Kapil
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
| | - Carmela Maniero
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
| | - Amgad Mentias
- Division of CardiologyDepartment of Internal MedicineUniversity of IowaIowa CityIA
| | | | - Sher May Ng
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Jai D. Parekh
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
| | - Reynaldo H. Sanchez
- Division of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Konrad Teodor Sawicki
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern UniversityChicagoIL
| | - Anneline S. J. M. te Riele
- Division of Heart and LungsDepartment of CardiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental CardiologyHeart CentreAmsterdam UMCLocation Academic Medical CenterAmsterdamthe Netherlands
| | - Barry London
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
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Kunwar S, Parekh JD, Chilukuri RS, Andukuri VA. Necrotizing Autoimmune myopathy: A case report on statin induced rhabdomyolysis requiring immunosuppressive therapy. Drug Discov Ther 2019; 12:315-317. [PMID: 30464165 DOI: 10.5582/ddt.2018.01049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Statins can cause a wide spectrum of muscular adverse effects ranging from asymptomatic elevation of Creatine Kinase (CK), myalgia and exercise intolerance to rhabdomyolysis. Most of these effects generally resolve on stopping the medication. However, statins can be associated with a unique autoimmune myopathy wherein symptoms persist or even progress after statin discontinuation and require immunosuppressive therapy. The case presented is a 60-year-old woman who was on statin treatment for a period of 2 years. She developed muscle weakness with a limb girdle distribution. She had persistent elevation of CK even after discontinuation of statin therapy. EMG done revealed irritable myopathy and muscle biopsy showed necrosis without inflammation. She subsequently tested positive for anti-3-hydroxy-3-methylglutaryl-coenzyme A (anti-HMG CoA) antibody which is found to be present in patients with statin-associated necrotizing autoimmune myopathy. Patient was started on steroid without much improvement in her symptoms. After a month of follow up, her upper extremity strength was back but lower extremity continued to be weak which prompted us to start her on Methotrexate and Azathioprine. Like our patient, there are rare subgroup of patients with an immune-mediated necrotizing myopathy that does not improve after discontinuation of the drug and requires aggressive treatment with immunosuppressive agents. Awareness and early recognition of this disease is very important in patients who continue to have CK elevation and weakness after discontinuation of statin therapy.
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Affiliation(s)
- Sandeep Kunwar
- Department of Internal Medicine, Creighton University School of Medicine
| | - Jai D Parekh
- Department of Internal Medicine, Creighton University School of Medicine
| | | | - Venkata A Andukuri
- Department of Internal Medicine, Creighton University School of Medicine
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Parekh JD, Iguidbashian J, Kukrety S, Guerins K, Millner PG, Andukuri V. A Rare Case of Isolated Left Ventricular Non-compaction in an Elderly Patient. Cureus 2018; 10:e2886. [PMID: 30155388 PMCID: PMC6110421 DOI: 10.7759/cureus.2886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 61-year-old male, with a history of emphysema, obstructive sleep apnea, and hypertension, presented to the emergency room with worsening shortness of breath over a three-month period. The patient also complained of orthopnea, paroxysmal nocturnal dyspnea, and progressively worsening lower limb swelling. On examination, the patient had jugular venous distension, bilateral lower extremity edema, and bibasilar crackles. The laboratory evaluation showed an elevated B-natriuretic peptide level and a normal troponin level. A transthoracic echocardiogram (TTE) showed a reduced left ventricular ejection fraction (LVEF) of 20%-25% with prominent hyper-trabeculations noted in the left ventricle, most prominent in the lateral and apical walls. These findings were concerning for left ventricular non-compaction (LVNC). The patient underwent left heart catheterization, which did not show obstructive coronary disease as a cause of his cardiomyopathy. The patient was managed with guideline-directed therapy for heart failure and was started on warfarin due to the increased risk of thromboembolism associated with LVNC. During his admission, he exhibited multiple episodes of nonsustained ventricular tachycardia and was subsequently evaluated by electrophysiology (EP). He was discharged home with a wearable cardioverter defibrillator with instructions to follow up with EP in three months for an evaluation of implantable cardioverter-defibrillator (ICD) placement for primary prevention.
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Iguidbashian JP, Parekh JD, Kukrety S, Andukuri VG. Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis. BMJ Case Rep 2018; 2018:bcr-2018-224941. [PMID: 29880626 DOI: 10.1136/bcr-2018-224941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.
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Affiliation(s)
| | - Jai D Parekh
- Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA
| | - Shweta Kukrety
- Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA
| | - Venkata Giri Andukuri
- Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA
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Abstract
A 23-year-old, previously healthy female presented with lower abdominal pain and mildly elevated creatinine one month following a right ureter stent for non-specific ureteral thickening causing obstruction. On admission, computed tomography (CT) revealed moderate hydronephrosis of the left kidney that would require stent placement as well. During stent placement, it was noted that the gross appearance of the ureters resembled ureteritis cystica. Biopsies were taken and showed signs of chronic inflammatory changes consistent with this diagnosis. Interestingly, this patient had no obvious medical history suggesting a cause for this process. She had been otherwise healthy with no recurrent episodes of urinary tract infection, nephrolithiasis, or sexually transmitted infection. The patient was discharged symptom-free following stent placement and will follow with urology for future stent replacements and clinical monitoring.
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Affiliation(s)
- Jai D Parekh
- Internal Medicine, Creighton University Medical Center, Omaha, USA
| | | | - Venkata Andukuri
- Internal Medicine, Creighton University Medical Center, Omaha, USA
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Abstract
Only a few case reports to date have described patients with three or more cancers. However, the incidence of multiple primary malignancies is increasing due to the improved survival of cancer patients, the prolonged lifespan of the general population, and better diagnostic techniques. This report describes a 73-year-old woman with primary breast, rectal squamous cell, and renal cell carcinomas. This case is unique because, in addition to having three primary malignancies, this patient had rectal squamous cell carcinoma—one of the rarest types of rectal cancer. We discuss screening and prevention of multiple malignancies and rectal squamous cell carcinoma, as well as methods for managing these patients.
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Affiliation(s)
- Jai D Parekh
- Internal Medicine, Creighton University Medical Center, Omaha, USA
| | - Shweta Kukrety
- Internal Medicine, Creighton University Medical Center, Omaha, USA
| | - Abhishek Thandra
- Internal Medicine, Creighton University Medical Center, Omaha, USA
| | - Carrie Valenta
- Internal Medicine, Creighton University Medical Center, Omaha, USA
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Parekh JD, Thandra A, Aggarwal G, White M, Arora R. CRT-100.54 Culpritvessel-only Versus Multi-vessel Percutaneous Coronary Intervention In Patients With Cardiogenic shock complicating ST-segment-elevation Myocardial Infarction outcomes In Short Term Mortality: An Updated Meta-analysis. JACC Cardiovasc Interv 2018. [DOI: 10.1016/j.jcin.2018.01.055] [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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Parekh JD, Jani V, Patel U, Aggarwal G, Thandra A, Arora R. CRT-200.08 Methamphetamine Use Is Associated With Increased Risk of Stroke and Sudden Cardiac Death: Analysis of the Nationwide Inpatient Sample Database. JACC Cardiovasc Interv 2018. [DOI: 10.1016/j.jcin.2018.01.093] [Citation(s) in RCA: 3] [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] [Indexed: 10/18/2022]
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Abstract
Aging is characterized by progressive deterioration of physiological integrity, decline in homeostasis, and degeneration of the tissues that occurs after the reproductive phase of life is complete, leading to impaired function. This deterioration is an important risk factor for chronic lung pathologies such as chronic obstructive pulmonary disease (COPD). COPD is a disease that develops gradually. Emphysematous changes in the lung take years to develop after exposure to cigarette smoke; hence, the vast majority of patients are elderly. There has been a dramatic increase in the life expectancy of the general population, resulting in an increased burden of chronic lung diseases. There is growing evidence that molecular mechanisms involved in aging may also play a role in COPD pathogenesis. Recently, the nine hallmarks of aging were identified. In this article, we will review the nine hallmarks of aging and how each hallmark contributes to the pathogenesis of COPD.
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Affiliation(s)
- Shweta P Kukrety
- Department of Internal Medicine, Creighton University, Omaha, NE, USA
| | - Jai D Parekh
- Department of Internal Medicine, Creighton University, Omaha, NE, USA
| | - Kristina L Bailey
- Department of Internal Medicine, University of Nebraska Medical Center; Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
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Dargad RR, Parekh JD, Dargad RR. Acromegaly with Dilated Cardiomyopathy. J Assoc Physicians India 2016; 64:96-97. [PMID: 27739285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acromegaly is a rare condition with an approximate incidence of 3-4 new cases per million per year and occurs as a result of excess secretion of growth hormone (GH). It is associated with several cardiovascular manifestations of which dilated cardiomyopathy with systolic and diastolic dysfunction is relatively rare but associated with increased mortality. There are very few documented cases of acromegaly with dilated cardiomyopathy in Indian female patients in literature, thus justifying the uniqueness of our case. We report a case of acromegaly in a 41 year old female patient who remained undiagnosed for 6 years and presented to us for the first time with symptoms of heart failure. The symptoms were attributed to dilated cardiomyopathy resulting from a prolonged and excessive exposure of the myocardium to a GH secreting pituitary tumor. Subsequently she underwent trans-sphenoidal resection of the pituitary macroadenoma.
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Affiliation(s)
- Ramesh R Dargad
- Consulting Physician and Cardiologist, Stress Test Clinic, Mumbai, Maharashtra
| | - Jai D Parekh
- Medical Graduate, BJ Medical College, Pune, Maharashtra
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Dargad RR, Parekh JD, Dargad RR, Kukrety S. Azilsartan: Novel Angiotensin Receptor Blocker. J Assoc Physicians India 2016; 64:96-98. [PMID: 27731574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the efficacy and safety profile of the new angiotensin receptor blocker (ARB), "Azilsartan Medoxomil", reviewing data available from both clinical and pre-clinical studies. MATERIAL We completed a review of the English literature from PubMed using the keywords- azilsartan medoxomil, angiotensin receptor blockers (ARB), angiotensin converting enzyme inhibitors (ACEi) and hypertension. DATA EVALUATION Many clinical trials have been conducted comparing the efficacy of azilsartan with other ARB's and also with the ACEi ramipril. The trials have shown azilsartan to be more effective in reducing the mean 24-hour systolic blood pressure compared to its counterparts. CONCLUSIONS Azilsartan is a recently approved ARB and appears to be more efficacious in reducing blood pressure (BP) than the other ARBs with a similar safety and tolerability profile. Azilsartan's very high affinity to and slow dissociation from the angiotensin 1 receptor (AT1R) along with its inverse agonistic properties make it a very good candidate for clinical effects beyond simple BP control, potentially counteracting cardiac hypertrophy, cardiac fibrosis and insulin resistance, together with improved reno-protection and atherosclerotic plaque stabilization.
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Affiliation(s)
- Ramesh R Dargad
- Consulting Physician and Cardiologist, Lilavati, Seven Hills and L.H. Hiranandani Hospital
| | - Jai D Parekh
- Medical Graduate, B.J. Medical College, Pune, Maharashtra
| | - Rohit R Dargad
- Senior Registrar, ICU-Fortis Hospital, Mumbai, Maharashtra
| | - Shweta Kukrety
- Internal Medicine Resident, Creighton University, Nebraska, USA
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Abstract
The antiemetic properties of marijuana are well known, but there is increasing evidence of its paradoxical hyperemetic effects on the gastrointestinal tract and central nervous system, known as 'cannabinoid hyperemesis syndrome' (CHS). We report a case of CHS encountered in our outpatient clinic. We also completed a review of the literature using PubMed in patients over 18 years of age with CHS. Understanding the diagnostic criteria and risk factors associated with CHS may reduce the ordering of unnecessary and expensive investigations, and pursuing inappropriate medical and surgical treatments. Ultimately, abstaining from cannabis use leads to resolution of symptoms in the majority of patients.
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Affiliation(s)
- Jai D Parekh
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Susan E Wozniak
- Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Kamran Khan
- Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Sudhir K Dutta
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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