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Vongsavath T, Rahmani R, Tun KM, Manne V. The Use of Fecal Microbiota Transplant in Overcoming and Modulating Resistance to Anti-PD-1 Therapy in Patients with Skin Cancer. Cancers (Basel) 2024; 16:499. [PMID: 38339251 PMCID: PMC10854771 DOI: 10.3390/cancers16030499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
While immune checkpoint inhibitors have evolved into the standard of care for advanced melanoma, 40-50% of melanoma cases progress while on therapies. The relationship between bacterium and carcinogenesis is well founded, such as in H. pylori in gastric cancers, and Fusobacterium in colorectal cancers. This interplay between dysbiosis and carcinogenesis questions whether changes in the microbiome could affect treatment. Thus, FMT may find utility in modifying the efficacy of anti-PD-1. This review aims to examine the use of FMT in treatment-resistant melanoma. A literature search was performed using the keywords "fecal microbiota transplant" and "skin cancer". Studies were reviewed for inclusion criteria and quality and in the final stage, and three studies were included. Overall objective responses were reported in 65% of patients who were able to achieve CR, and 45% who achieved PR. Clinical benefit rate of combined CR/PR with stable disease greater or equal to 6 months was 75%. Reported objective responses found durable stable disease lasting 12 months. Overall survival was 7 months, and overall PRS was 3 months. As for the evaluation of safety, many patients reported grade 1-2 FMT related AE. Only following the administration of anti-PD-1 therapy were there a grade 3 or higher AE.
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Affiliation(s)
- Tahne Vongsavath
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA; (R.R.)
| | - Rodd Rahmani
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA; (R.R.)
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA; (R.R.)
| | - Vignan Manne
- Department of Gastroenterology and Hepatology, University of Nevada, Las Vegas, NV 89154, USA
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Laeeq T, Tun KM, Vongsavath T, Singh A, Manne V. Incidence and risk factors of Clostridioides difficile infection in liver transplant recipients: A comprehensive literature review. Clin Liver Dis (Hoboken) 2024; 23:e0131. [PMID: 38487351 PMCID: PMC10939552 DOI: 10.1097/cld.0000000000000131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/26/2023] [Indexed: 03/17/2024] Open
Affiliation(s)
- Tooba Laeeq
- Department of Internal Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Tahne Vongsavath
- Department of Internal Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Aditi Singh
- Department of Internal Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Vignan Manne
- Department of Gastroenterology, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
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Laeeq T, Vongsavath T, Tun KM, Hong AS. The Potential Role of Fecal Microbiota Transplant in the Reversal or Stabilization of Multiple Sclerosis Symptoms: A Literature Review on Efficacy and Safety. Microorganisms 2023; 11:2840. [PMID: 38137984 PMCID: PMC10745313 DOI: 10.3390/microorganisms11122840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Multiple sclerosis (MS) affects millions of people worldwide, and recent data have identified the potential role of the gut microbiome in inducing autoimmunity in MS patients. To investigate the potential of fecal microbiota transplant (FMT) as a treatment option for MS, we conducted a comprehensive literature search (PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane) and identified five studies that involved 15 adult MS patients who received FMT for gastrointestinal symptoms. The primary outcome of this review was to assess the effect of FMT in reversing and improving motor symptoms in MS patients, while the secondary outcome was to evaluate the safety of FMT in this patient population. Our findings suggest that all 15 patients who received FMT experienced improved and reversed neurological symptoms secondary to MS. This improvement was sustained even in follow-up years, with no adverse effects observed. These results indicate that FMT may hold promise as a treatment option for MS, although further research is necessary to confirm these findings.
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Affiliation(s)
- Tooba Laeeq
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA
| | - Tahne Vongsavath
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA
| | - Annie S. Hong
- Department of Gastroenterology, University of Nevada, Las Vegas, NV 89154, USA
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Dhindsa BS, Tun KM, Scholten KJ, Deliwala S, Naga Y, Dhaliwal A, Ramai D, Saghir SM, Dahiya DS, Chandan S, Singh S, Adler DG. New Alternative? Self-Assembling Peptide in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:3694-3701. [PMID: 37402986 DOI: 10.1007/s10620-023-08009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a common and potentially fatal condition with all-cause mortality ranging from 3 to 10%. Endoscopic therapy traditionally involves mechanical, thermal, and injection therapies. Recently, self-assembling peptide (SAP) has become increasingly available in the United States. When applied to an affected area, this gel forms an extracellular matrix-type structure allowing for hemostasis. This is the first systematic review and meta-analysis to assess the safety and efficacy of this modality in GIB. METHODS We performed a comprehensive literature search of major databases from inception to Nov 2022. The primary outcomes assessed were the success of hemostasis, rebleeding rates, and adverse events. The secondary outcomes assessed were successful hemostasis with monotherapy with SAP and combined therapy, which may include mechanical, injection, and thermal therapies. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI). RESULTS The analysis included 7 studies with 427 patients. 34% of the patients were on anticoagulation or antiplatelet agents. SAP application was technically successful in all patients. The calculated pooled rate of successful hemostasis was 93.1% (95% confidence interval (CI) 84.7-97.0, I2 = 73.6), and rebleeding rates were 8.9% (95% CI 5.3-14.4, I2 = 55.8). The pooled rates of hemostasis with SAP monotherapy and combined therapy were similar. No adverse events were noted related to SAP. CONCLUSION SAP appears to be a safe and effective treatment modality for patients with GIB. This modality provides an added advantage of improved visualization over the novel spray-based modalities. Further, prospective, or randomized controlled trials are needed to validate our findings.
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Affiliation(s)
- Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Las Vegas, NV, 89102, USA
| | - Kyle J Scholten
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Smit Deliwala
- Division of Gastroenterology and Hepatology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Yassin Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, McLeod Regional Medical Center, Florence, SC, 29506, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, Room 4R118, Salt Lake City, UT, 84132, USA
| | - Syed Mohsin Saghir
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Dushyant Singh Dahiya
- Division of Internal Medicine, Central Michigan University, 1015 S Washington Ave, Saginaw, MI, 48603, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Professor of Medicine, Centura Health, Denver, CO, USA.
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Tun KM, Noureddin N, Noureddin M. Noninvasive tests in the evaluation of nonalcoholic fatty liver disease: A review. Clin Liver Dis (Hoboken) 2023; 22:103-112. [PMID: 37799634 PMCID: PMC10550044 DOI: 10.1097/cld.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/08/2023] [Indexed: 10/07/2023] Open
Abstract
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Affiliation(s)
- Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Nevada, USA
| | - Nabil Noureddin
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, School of Medicine, California, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Liver Institute, Texas, USA
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Naga YSE, Dhindsa BS, Bapaye J, Tun KM, Dhaliwal A, Ramai D, Saghir SM, Chandan S, Adler DG. A Systematic Review and Meta-Analysis: A Prior Appendectomy Does Not Increase the Risk of Severe Clostridioides difficile Infection or Recurrence. Dig Dis Sci 2023; 68:3714-3720. [PMID: 37402978 DOI: 10.1007/s10620-023-07998-y] [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: 10/20/2022] [Accepted: 06/06/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVES There is conflicting evidence regarding the association between a prior appendectomy and severity of Clostridioides difficile infection. The aim of this study was to perform a systematic review and meta-analysis to evaluate this association. PATIENTS AND METHODS Comprehensive review of multiple databases was performed up to May 2022. The primary outcome assessed was the rate of severe Clostridioides difficile infection in patients with a prior appendectomy compared to patients with an appendix. The secondary outcomes assessed were recurrence, mortality, and colectomy rates associated with Clostridioides difficile infection in patients with a prior appendectomy compared to patients with an appendix. RESULTS Eight studies with 666 patients with a prior appendectomy and 3580 patients without an appendectomy were included. The odds ratio of severe Clostridioides difficile infection in patients who underwent prior appendectomy was 1.03 (95% CI 0.6-1.78, p = 0.92). The odds ratio of recurrence in patients who underwent prior appendectomy was 1.29 (95% CI 0.82-2.02, p = 0.28). The odds ratio of colectomy due to Clostridioides difficile infection in patients who underwent prior appendectomy was 2.16 (95% CI 1.27-3.67, p = 0.004). The odds ratio of mortality due to Clostridioides difficile infection in patients with a prior appendectomy was 0.92 (95% CI 0.62-1.37, p = 0.68). CONCLUSION Patients with appendectomy are not at increased risk for developing severe Clostridioides difficile infection or recurrence. Further prospective studies are needed to establish these associations.
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Affiliation(s)
- Yassin Shams Eldien Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Jay Bapaye
- Department of Internal Medicine, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY, 14621, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd., Las Vegas, NV, 89102, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, McLeod Regional Medical Center, Florence, SC, 29506, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, Room 4R118, Salt Lake City, UT, 84132, USA
| | - Syed Mohsin Saghir
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA.
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Varada N, Tun KM, Chang MJ, Bomberger S, Calagari R. A Rare Case of Hereditary Hemochromatosis Presenting With Porphyria Cutanea Tarda. Cureus 2023; 15:e41299. [PMID: 37539416 PMCID: PMC10394580 DOI: 10.7759/cureus.41299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/05/2023] Open
Abstract
Hereditary hemochromatosis is an autosomal recessive condition with incomplete penetrance that is most commonly caused by a mutation in the HFE gene. Hereditary hemochromatosis can remain asymptomatic in some patients until triggered by certain events. Porphyria cutanea tarda is a condition that can lead to iron overload due to defective synthesis of heme and can cause the onset of adult-onset hereditary hemochromatosis. Herein, we present a case where a 77-year-old man presented with painful blisters on the sun-exposed areas of his hands and was diagnosed with porphyria cutanea tarda. Further testing for mutations in the HFE gene given elevated ferritin was performed and returned positive, which confirmed the diagnosis of adult-onset hereditary hemochromatosis. The patient received serial therapeutic phlebotomy for iron overload and adopted lifestyle modifications such as avoiding sun exposure of upper extremities. The patient's blisters and laboratory iron panel parameters improved with continued phlebotomy. Therapeutic phlebotomy has been demonstrated to be an effective first-line therapy in patients with dual diagnosis. Our case highlights that cutaneous symptoms due to porphyria cutanea tarda may be the first presenting symptom in patients with underlying hemochromatosis.
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Affiliation(s)
- Neilmegh Varada
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Kyaw Min Tun
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Mark J Chang
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Shana Bomberger
- Primary Care, VA Southern Nevada Healthcare System, Las Vegas, USA
| | - Randy Calagari
- Hematology and Oncology, VA Southern Nevada Healthcare System, Las Vegas, USA
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Hsu M, Tun KM, Batra K, Haque L, Vongsavath T, Hong AS. Safety and Efficacy of Fecal Microbiota Transplantation in Treatment of Inflammatory Bowel Disease in the Pediatric Population: A Systematic Review and Meta-Analysis. Microorganisms 2023; 11:1272. [PMID: 37317246 DOI: 10.3390/microorganisms11051272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/16/2023] Open
Abstract
Background and Aims: Fecal microbiota transplantation (FMT) has been increasingly studied in the inflammatory bowel disease (IBD) population. However, most studies have focused on the adult population, and the safety and efficacy of FMT in a pediatric population is less well understood. This systematic review and meta-analysis investigates the safety and efficacy of FMT in a pediatric IBD population. Methods: A comprehensive literature search of publications published prior to 30 June 2022 was undertaken. Safety data, IBD-related outcomes, and microbiome analysis were obtained from these studies when accessible. Individual estimates of each study were pooled, and sensitivity analysis was conducted. Results: Eleven studies satisfied our eligibility criteria. The calculated pooled rate of adverse events was 29% (95% confidence interval [CI]: 15.0%, 44.0%; p < 0.001; I2 = 89.0%, Q = 94.53), and the calculated pooled rate of serious adverse events was 10% (95% confidence interval [CI]: 6.0%, 14.0%; p = 0.28; I2 = 18.0%, Q = 9.79). One month after FMT, clinical response was achieved in 20/34 (58.8%) pediatric IBD patients, clinical remission was achieved in 22/34 (64.7%), and both clinical response and remission were achieved in 15/34 (44.1%) pediatric IBD patients. Conclusions: FMT can be a safe and effective treatment in the pediatric IBD population and may demonstrate improved safety and efficacy in the pediatric population compared to the adult population. However, our results are limited by a lack of established protocol as well as long-term follow-up for FMT in a pediatric IBD population.
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Affiliation(s)
- Mark Hsu
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Lubaba Haque
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Tahne Vongsavath
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Annie S Hong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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Naga YSE, Dhindsa BS, Deliwala S, Tun KM, Dhaliwal A, Ramai D, Bhat I, Singh S, Chandan S, Adler DG. Single-incision needle-knife biopsy for the diagnosis of GI subepithelial tumors: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:640-645.e2. [PMID: 36460089 DOI: 10.1016/j.gie.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS A histologic diagnosis of GI subepithelial tumors (SETs) is important because of the malignant potential of these lesions. The current modalities of choice, including EUS-guided FNA and biopsy (EUS-FNA/FNB) have demonstrated suboptimal diagnostic success. Single-incision with needle-knife (SINK) biopsy has emerged as an alternative diagnostic approach to increase tissue acquisition and diagnostic success. The aim of this study was to perform a systematic review and meta-analysis to evaluate the technical success, diagnostic success, and adverse events of SINK biopsy. METHODS We searched multiple databases including PubMed, EMBASE, CINAHL, Cochrane, Web of Science, and Google Scholar from inception to July 2022. The primary outcomes assessed were the technical success and diagnostic success of SINK in GI SETs. The secondary outcomes assessed were adverse events and whether immunohistochemical analysis could be successfully performed on tissue samples obtained via SINK. RESULTS Seven studies with a total of 219 SINK biopsy procedures were included in this meta-analysis. The technical success rate was 98.1% (95% CI, 94.9%-99.3%; P = .000; I2 = .0%), and the diagnostic success rate was 87.9% (95% CI, 82.6%-91.7%; P = .000; I2 = .0%). The immunohistochemical success rate was 88.3% (95% CI, 78.7%-93.9%; P = .000; I2 = 3.5%). The rate of adverse events was 7.5% (95% CI, 4.3%-12.7%; P = .00; I2 = 7.2%), and bleeding was the most common adverse event. CONCLUSION SINK biopsy is a safe diagnostic procedure with a high technical and diagnostic success in patients with GI SET. Further randomized controlled trials and direct comparison studies are needed to validate these findings.
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Affiliation(s)
- Yassin Shams Eldien Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Smit Deliwala
- Division of Gastroenterology and Hepatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, University of South Carolina School of Medicine, Florence, South Carolina, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, Colorado, USA.
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Tun KM, Dossaji Z, Massey BL, Batra K, Lo CH, Naga Y, Mohammed S, Muraga A, Gill A, Mukhopadhyay D, Singh A, Lankarani D, Aponte-Pieras J, Ohning G. A Comparative Study of Acute Alcoholic Hepatitis vs. Non-Alcoholic Hepatitis Patients from a Cohort with Chronic Alcohol Dependence. Genes (Basel) 2023; 14:genes14040780. [PMID: 37107538 PMCID: PMC10138017 DOI: 10.3390/genes14040780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
The rate of alcoholic hepatitis (AH) has risen in recent years. AH can cause as much as 40-50% mortality in severe cases. Successful abstinence has been the only therapy associated with long-term survival in patients with AH. Thus, it is crucial to be able to identify at-risk individuals in order to implement preventative measures. From the patient database, adult patients (age 18 and above) with AH were identified using the ICD-10 classification from November 2017 to October 2019. Liver biopsies are not routinely performed at our institution. Therefore, patients were diagnosed with AH based on clinical parameters and were divided into "probable" and "possible" AH. Logistic regression analysis was performed to determine risk factors associated with AH. A sub-analysis was performed to determine variables associated with mortality in AH patients. Among the 192 patients with alcohol dependence, there were 100 patients with AH and 92 patients without AH. The mean age was 49.3 years in the AH cohort, compared to 54.5 years in the non-AH cohort. Binge drinking (OR 2.698; 95% CI 1.079, 6.745; p = 0.03), heavy drinking (OR 3.169; 95% CI 1.348, 7.452; p = 0.01), and the presence of cirrhosis (OR 3.392; 95% CI 1.306, 8.811; p = 0.01) were identified as characteristics more commonly found in the AH cohort. Further, a higher inpatient mortality was seen in those with a probable AH diagnosis (OR 6.79; 95% CI 1.38, 44.9; p = 0.03) and hypertension (OR 6.51; 95% CI 9.49, 35.7; p = 0.02). A higher incidence of mortality was also noted among the non-Caucasian race (OR 2.72; 95% CI 4.92; 22.3; p = 0.29). A higher mortality rate despite a lower incidence of alcohol use among non-Caucasian patients may indicate healthcare disparities.
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Affiliation(s)
- Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Zahra Dossaji
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Blaine L Massey
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Yassin Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Salman Mohammed
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Abebe Muraga
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Ahmad Gill
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | | | - Ashok Singh
- Department of Resorts, Gaming & Golf Management, University of Nevada, Las Vegas, NV 89154, USA
| | | | - Jose Aponte-Pieras
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Gordon Ohning
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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Dossaji Z, Khattak A, Tun KM, Hsu M, Batra K, Hong AS. Efficacy of Fecal Microbiota Transplant on Behavioral and Gastrointestinal Symptoms in Pediatric Autism: A Systematic Review. Microorganisms 2023; 11:microorganisms11030806. [PMID: 36985379 PMCID: PMC10056604 DOI: 10.3390/microorganisms11030806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Background and Aims: There is a high prevalence of gastrointestinal-related (GI) symptoms among children with autism spectrum disorder (ASD), which is associated with the severity of behavioral symptoms. Fecal microbiota transplantation (FMT) is a proposed therapeutic strategy that aims to address the dysregulation of the gut microbiome among children with ASD. Our study performed the first systematic review aimed to evaluate the benefits of FMT on the behavioral and gastrointestinal symptoms of pediatric patients with autism. Methods: A literature search was performed using variations of the keywords "pediatrics" and "fecal microbiota transplantation" in PubMed, EMBASE, CINAHL, Cochrane, and Web of Science from inception to 30 June 2022. Four studies that met the eligibility criteria were included in the systematic review. The efficacy of FMT on behavioral symptoms was measured by the difference in Aberrant Behavior Checklist (ABC) and Child Autism Rating Scale (CARS) scores before and after FMT. Results: We found a statistically significant improvement (p < 0.05) in ABC and CARS scores following FMT, with a statistically significant decrease in scores observed across all studies. In addition, substantial improvements in gastrointestinal symptoms were observed across all studies. Conclusion: Our findings suggest that FMT may offer a promising intervention for treating both behavioral and gastrointestinal symptoms in pediatric patients with autism.
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Affiliation(s)
- Zahra Dossaji
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Adam Khattak
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kyaw Min Tun
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Mark Hsu
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Annie S Hong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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Tun KM, Laeeq T, Mohammed S, Naik K, Ohning G. A Rare Case of Methotrexate-Induced Gastric Ulcer. Cureus 2023; 15:e36321. [PMID: 37077596 PMCID: PMC10108895 DOI: 10.7759/cureus.36321] [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] [Accepted: 03/17/2023] [Indexed: 03/20/2023] Open
Abstract
Methotrexate is commonly used to treat autoimmune conditions and malignancy. Peptic ulcer disease is a sparsely documented side effect of methotrexate. A 70-year-old female patient with rheumatoid arthritis on methotrexate presented with generalized fatigue and was found to be anemic. Endoscopy revealed gastric ulcers, the etiology of which was attributed to methotrexate use after careful exclusion of other possible causes. Cessation of methotrexate has been reported in the literature as vital to the healing of ulcers. Proton pump inhibitors or histamine 2 receptor (H2R) blockers may also be used as treatment; however, methotrexate should be discontinued before initiation of proton pump inhibitors, which can hinder the metabolism of methotrexate and can, in turn, lead to a worsening of the peptic ulcer disease.
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Kawana E, Vachirakorntong B, Zhitny VP, Wajda MC, Alexander L, Young JP, Tun KM, Al-Taweel O, Ahsan C, Varsanyi G, Singh A. Cardiac Anesthesia Intraoperative Interpretation Accuracy of Transesophageal Echocardiograms: A Review of the Current Literature and Meta-Analysis. Vasc Health Risk Manag 2023; 19:223-230. [PMID: 37056574 PMCID: PMC10086216 DOI: 10.2147/vhrm.s400117] [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: 12/03/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
Background In the United States, echocardiography is an essential component of the care of many cardiac patients. Recently, increased attention has been given to the accuracy of interpretation of cardiac-based procedures in different specialties, amongst them the field of cardiac anesthesiology and primary echocardiographers for transesophageal echocardiogram (TEE). The purpose of this study was to assess the TEE skills of cardiac anesthesiologists in comparison to primary echocardiographers, either radiologists or cardiologists. In this systematic review, we evaluated available current literature to identify if cardiac anesthesiologists interpret TEE procedures at an identical level to that of primary echocardiographers. Methods A PRISMA systematic review was utilized from PubMed from the years 1952-2022. A broad keyword search of "Cardiology Anesthesiology Echocardiogram" and "Echocardiography Anesthesiology" to identify the literature was used. From reviewing 1798 articles, there were a total of 9 studies included in our systematic review, 3 of which yielded quantitative data and 6 of which yielded qualitative data. The mean accuracy from each of these three qualitative studies was calculated and used to represent the overall accuracy of cardiac anesthesiologists. Results Through identified studies, a total of 8197 TEEs were interpreted by cardiac anesthesiologists with a concordance rate of 84% to the interpretations of primary echocardiographers. Cardiac anesthesiologists had a concordance rate of 83% when compared to radiologists. On the other hand, cardiac anesthesiologists and cardiologists had a concordance rate of 87% in one study and 79% in another study. Conclusion Based on these studies, cardiac anesthesiologists are shown to interpret TEEs similarly to that of primary echocardiographers. At this time, there is no gold standard to evaluate the accuracy of TEE readings. One way to address this is to individually assess the TEE interpretation of anesthesiologists and primary echocardiographers with a double-blind study.
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Affiliation(s)
- Eric Kawana
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | | | - Vladislav Pavlovich Zhitny
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University, New York City, NY, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
- Correspondence: Vladislav Pavlovich Zhitny, New York University, Department of Anesthesiology, Perioperative Care and Pain Medicine, 5578 Victoria Regina Avenue, Las Vegas, Nevada, 89139, USA, Email
| | - Michael C Wajda
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University, New York City, NY, USA
| | - Luzviminda Alexander
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
- Department of Cardiology, University Medical Center of Southern Nevada, Las Vegas, NV, USA
| | | | - Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
| | - Omar Al-Taweel
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
- Department of Cardiology, University Medical Center of Southern Nevada, Las Vegas, NV, USA
| | - Chowdhury Ahsan
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
- Department of Cardiology, University Medical Center of Southern Nevada, Las Vegas, NV, USA
| | - Gyorgy Varsanyi
- Department of Anesthesiology and Perioperative Medicine, OptumCare, Las Vegas, NV, USA
| | - Aditi Singh
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
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Manfra A, Chen C, Batra K, Min Tun K, Kioka MJ. Factors associated with improved outcome of inhaled corticosteroid use in COVID-19: A single institutional study. Medicine (Baltimore) 2022; 101:e32420. [PMID: 36595838 PMCID: PMC9794212 DOI: 10.1097/md.0000000000032420] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Asthmatics seem less prone to adverse outcomes in coronavirus disease 2019 (COVID-19) and some data shows that inhaled corticosteroids (ICS) are protective. We gathered data on anecdotal ICS and outcomes of patients hospitalized with COVID-19, given there is literature supporting ICS may reduce risk of severe infection. In addition, we fill gaps in current literature evaluating Charlson Comorbidity Index (CCI) as a risk assessment tool for COVID-19. This was a single-center, retrospective study designed and conducted to identify factors associated intubation and inpatient mortality. A multivariate logistic regression model was fit to generate adjusted odds ratios (OR). Intubation was associated with male gender (OR, 2.815; 95% confidence interval [CI], 1.348-5.881; P = .006) and increasing body mass index (BMI) (OR, 1.053; 95% CI, 1.009-1.099; P = .019). Asthma was associated with lower odds for intubation (OR, 0.283; 95% CI, 0.108-0.74; P = .01). 80% of patients taking pre-hospital ICS were not intubated (n = 8). In-patient mortality was associated with male gender (OR, 2.44; 95% CI, 1.167-5.1; P = .018), older age (OR, 1.096; 95% CI, 1.052-1.142; P = <.001), and increasing BMI (OR, 1.079; 95% CI, 1.033-1.127; P = .001). Asthma was associated with lower in-patient mortality (OR, 0.221; 95% CI, 0.057-0.854; P = .029). CCI did not correlate with intubation (OR, 1.262; 95% CI, 0.923-1.724; P = .145) or inpatient mortality (OR, 0.896; 95% CI, 0.665-1.206; P = .468). Asthmatics hospitalized for COVID-19 had less adverse outcomes, and most patients taking pre-hospital ICS were not intubated. CCI score was not associated with intubation or inpatient mortality.
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Affiliation(s)
- Andrew Manfra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Claire Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Kavita Batra
- Department of Medical Education and Office of Research, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Kyaw Min Tun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
| | - Mutsumi John Kioka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada Las Vegas, Nevada, Las Vegas, USA
- * Correspondence: Mutsumi John Kioka, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, 1701 W. Charleston Blvd., Suite 230, Las Vegas, NV 89102, USA (e-mail: )
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15
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Tun KM, Hsu M, Batra K, Lo CH, Laeeq T, Vongsavath T, Mohammed S, Hong AS. Efficacy and Safety of Fecal Microbiota Transplantation in Treatment of Clostridioides difficile Infection among Pediatric Patients: A Systematic Review and Meta-Analysis. Microorganisms 2022; 10:microorganisms10122450. [PMID: 36557703 PMCID: PMC9781859 DOI: 10.3390/microorganisms10122450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Aims: Cases of Clostridioides difficile infection have been rising among the pediatric and adolescent population. Fecal microbiota transplantation (FMT) has emerged as an alternative therapy for recurrent C. difficile infection. We aim to perform the first systematic review and meta-analysis investigating the safety and efficacy of fecal microbiota transplantation for C. difficile infection in children and adolescents. Methods: A literature search was performed using variations of the keywords “pediatrics”, “C. difficile infection”, and “fecal microbiota transplantation” in PubMed, EMBASE, CINAHL, Cochrane, and Google Scholar from inception to 30 June 2022. The resulting 575 articles were independently screened by three authors. Fourteen studies that satisfied the eligibility criteria were included in the meta-analysis. Results: The pooled success rate of FMT in the overall cohort was 86% (95% confidence interval: 77−95%; p < 0.001; I2 = 70%). There were 38 serious adverse events in 36 patients with a pooled rate of 2.0% (95% confidence interval: 0.0−3.0%; p = 0.1; I2 = 0.0%) and 47 adverse events in 45 patients with a pooled rate of 15% (95% confidence interval: 5.0−25.0%; p = 0.02; I2 = 54.0%). There was no death associated with FMT. Conclusions: FMT was concluded to be an effective and safe therapy in pediatric and adolescent patients with C. difficile infection. Underlying comorbidities may impede the efficacy. A rigorous screening process of the donors is recommended prior to embarking on FMT. There is no universal and cost-effective way to monitor the long-term outcomes of FMT. While promising, metagenomic sequencing may not be available in settings with limited resources. Robust data from randomized clinical trials is warranted.
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Affiliation(s)
- Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Correspondence:
| | - Mark Hsu
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Tooba Laeeq
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Tahne Vongsavath
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Salman Mohammed
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Annie S. Hong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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Gill A, Al-Taweel O, Fakhra S, Tun KM, Hawwass D, Ahsan C. Short-term outcomes of patients transferred from non-acute care centers with sick sinus syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-acute care centers, such as nursing homes and urgent care clinics, are a staple of healthcare systems worldwide. The short-term prognostic outcomes of patients transferred from a non-acute care center to an acute healthcare facility for further management have been less studied.
Purpose
In this study, we examine the in-hospital outcomes of patients with sick sinus syndrome who are transferred to an acute care hospital from a non-acute care center.
Methods
This was a retrospective cohort study comparing adult patients who were transferred to a hospital from a non-acute center with regular, non-transferred hospital admissions between 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted with a principal diagnosis of sick sinus syndrome. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, atrial flutter, first and third-degree atrioventricular block, heart failure, hypertension, obstructive sleep apnea and type 2 diabetes mellitus.
Results
120,300 patients met our inclusion criteria. Patients transferred from non-acute care centers had 2.63 times higher odds of suffering in-hospital mortality compared to regular hospital admissions (aOR 2.63, 95% CI: 1.54–4.49; p<0.001). When separated by race, non-acute care transfers had higher mortality rates amongst Asian (6.9% vs 0.7%, p<0.001), Hispanic (4.8% vs 0.8%, p<0.001) and White (1.8% vs 0.6%, p<0.001, Figure 1) patients as well as longer hospital stays (4.7 vs 4.0 days, p<0.001, Table 1). Furthermore, these patients had higher rates of comorbidities such as atrial fibrillation, atrial flutter, heart failure and chronic kidney disease, but decreased rates of hypertension, type 2 diabetes mellitus and first and third-degree atrioventricular block (Table 1). Non-acute care transfers were also more likely to have a pacemaker placed (1.5% vs 0.9%, p<0.001). In terms of operative complications, non-acute transfers were more likely to have intraoperative cardiac arrest (0.1% vs 0.03%, p<0.005, Table 1). There was no significant difference between our two cohorts in postoperative complications such as cardiac arrest and intracerebral infarction.
Conclusion
Patients who were transferred to an acute care hospital from a non-acute care center with sick sinus syndrome had higher odds of suffering in-hospital mortality compared to regular hospital admissions. These patients were also at increased risk of intraoperative cardiac arrest. Our findings illustrate that non-acute care transfers require additional support in the acute care setting. This study highlights the need for further health policy discussion and an increased emphasis on medical resource reallocation to support this vulnerable population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Gill
- University of Nevada, Las Vegas School of Medicine, Internal Medicine , Las Vegas , United States of America
| | - O Al-Taweel
- University of Nevada, Las Vegas School of Medicine, Cardiology , Las Vegas , United States of America
| | - S Fakhra
- University of Nevada, Las Vegas School of Medicine, Internal Medicine , Las Vegas , United States of America
| | - K M Tun
- University of Nevada, Las Vegas School of Medicine, Internal Medicine , Las Vegas , United States of America
| | - D Hawwass
- University of Nevada, Las Vegas School of Medicine, Cardiology , Las Vegas , United States of America
| | - C Ahsan
- University of Nevada, Las Vegas School of Medicine, Cardiology , Las Vegas , United States of America
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Tun KM, Naga Y, Aponte-pieras J, Bhaya B. Intrapulmonary Gallstones and Pleuro-Biliary Fistula Formation Due to Complication From Prior Cholecystectomy: A Case Report and Literature Review. Cureus 2022; 14:e25836. [PMID: 35836468 PMCID: PMC9273197 DOI: 10.7759/cureus.25836] [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] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
Intrapulmonary gallstones and the formation of pleuro-biliary fistula is a rare complication of laparoscopic cholecystectomy. The stones are most commonly found in the right lower lobe of the lungs. The symptoms tend to be insidious in nature and can manifest as hemoptysis, irritating cough, and cholelithoptysis years after the procedure. The stones can be removed through lobectomy or may also be treated non-invasively with antibiotics only. Here, we describe a case of a patient who developed hemoptysis and was found to have intrapulmonary gallstones from laparoscopic cholecystectomy and subsequent fistula formation.
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Tun KM, Hong AS, Batra K, Naga Y, Ohning G. A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients With Cirrhosis. Cureus 2022; 14:e25537. [PMID: 35800791 PMCID: PMC9246246 DOI: 10.7759/cureus.25537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/17/2022] Open
Abstract
The microbiome of the human gut and liver coexists by influencing the health and disease state of each system. Fecal microbiota transplantation (FMT) has recently emerged as a potential treatment for conditions associated with cirrhosis, such as hepatic encephalopathy and recurrent/refractory Clostridioides difficile infection (rCDI). We have conducted a systematic review of the safety and efficacy of FMT in treating hepatic encephalopathy and rCDI. A literature search was performed using variations of the keywords "fecal microbiota transplant" and "cirrhosis" on PubMed/MEDLINE from inception to October 3, 2021. The resulting 116 articles were independently reviewed by two authors. Eight qualifying studies were included in the systematic review. A total of 127 cirrhotic patients received FMT. Hepatic encephalopathy was evaluated by cognitive tests, such as the Psychometric Hepatic Encephalopathy Score (PHES) and EncephalApp Stroop test. Not only was there an improvement in the cognitive performance in the FMT cohort, but the improvement was also maintained throughout long-term follow-up. In the treatment of rCDI, the FMT success rate is similar between cirrhotic patients and the general population, although more than one dose may be needed in the former. The rate of serious adverse events and adverse events in the cirrhotic cohort was slightly higher than that in the general population but was low overall. We found evidence that supports the therapeutic potential and safety profile of FMT to treat hepatic encephalopathy and rCDI in cirrhotic patients. Further research will be beneficial to better understand the role of FMT in cirrhosis.
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Affiliation(s)
- Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Annie S Hong
- Department of Gastroenterology and Hepatology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Kavita Batra
- Department of Research, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Yassin Naga
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Gordon Ohning
- Department of Gastroenterology and Hepatology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
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Abd Rahman R, Min Tun K, Kamisan Atan I, Mohamed Said MS, Mustafar R, Zainuddin AA. New Benefits of Hydroxychloroquine in Pregnant Women with Systemic Lupus Erythematosus: A Retrospective Study in a Tertiary Centre. Rev Bras Ginecol Obstet 2020; 42:705-711. [PMID: 33254264 PMCID: PMC10309213 DOI: 10.1055/s-0040-1715140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine pregnancy outcomes in women with systemic lupus erythematosus (SLE) who were treated with hydroxychloroquine in a tertiary center. METHODS A retrospective study involving pregnant women with SLE who had antenatal follow-up and delivery in between 1 January 2007 and 1 January 2017. All participants were retrospectively enrolled and categorized into two groups based on hydroxychloroquine treatment during pregnancy. RESULTS There were 82 pregnancies included with 47 (57.3%) in the hydroxychloroquine group and 35 (42.7%) in the non-hydroxychloroquine group. Amongst hydroxychloroquine users, there were significantly more pregnancies with musculoskeletal involvement (p = 0.03), heavier mean neonatal birthweight (p = 0.02), and prolonged duration of pregnancy (p = 0.001). In non-hydroxychloroquine patients, there were significantly more recurrent miscarriages (p = 0.003), incidence of hypertension (p = 0.01) and gestational diabetes mellitus (p = 0.01) and concurrent medical illness (p = 0.005). Hydroxychloroquine use during pregnancy was protective against hypertension (p = 0.001), and the gestational age at delivery had significant effect on the neonatal birthweight (p = 0.001). However, duration of the disease had a significant negative effect on the neonatal birthweight (p = 0.016). CONCLUSION Hydroxychloroquine enhanced better neonatal outcomes and reduced adverse pregnancy outcomes and antenatal complications such as hypertension and diabetes.
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Affiliation(s)
- Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Kyaw Min Tun
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ixora Kamisan Atan
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Ruslinda Mustafar
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ani Amelia Zainuddin
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Awale S, Tezuka Y, Banskota AH, Kouda K, Tun KM, Kadota S. Five novel highly oxygenated diterpenes of Orthosiphon stamineus from Myanmar. J Nat Prod 2001; 64:592-596. [PMID: 11374950 DOI: 10.1021/np000607t] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Five novel highly oxygenated diterpenes, orthosiphols K (1), L (2), M (3), and N (4) and norstaminone A (5), were isolated from the aerial part of Orthosiphon stamineus, together with three known diterpenes, orthosiphols A (6) and B (7) and neoorthosiphol A (8). Orthosiphol L (2) is an isopimarane-type diterpene with a hydroxyl group at C-12, which supports the biogenesis of staminane-type diterpenes, i.e., migration of a vinylic group from C-13 of isopimarane to C-12. Norstaminone A (5) has a staminane carbon framework and supports the biosynthetic pathway from staminols to norstaminols via staminolactones. All the isolated compounds showed mild to weak antiproliferative activities toward highly liver metastatic colon 26-L5 carcinoma and human HT-1080 fibrosarcoma cell lines.
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Affiliation(s)
- S Awale
- Institute of Natural Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan
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Motomura K, Kusagawa S, Kato K, Nohtomi K, Lwin HH, Tun KM, Thwe M, Oo KY, Lwin S, Kyaw O, Zaw M, Nagai Y, Takebe Y. Emergence of new forms of human immunodeficiency virus type 1 intersubtype recombinants in central Myanmar. AIDS Res Hum Retroviruses 2000; 16:1831-43. [PMID: 11118069 DOI: 10.1089/08892220050195793] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have previously shown that HIV-1 env subtypes B' (a Thai-B cluster within subtype B) and E (CRF01_AE) are distributed in Yangon, the capital city of Myanmar. However, HIV strains from the rest of country have not yet been genetically characterized. In the present study, we determined env (C2/V3) and gag (p17) subtypes of 25 specimens from central Myanmar (Mandalay). Phylogenetic analyses identified 5 subtype C (20%), in addition to 10 CRF01_AE (40%) and 4 subtype B' (16%). Interestingly, the remaining six specimens (24%) showed discordance between gag and env subtypes; three gag subtype B'/env subtype C, one gag subtype B'/env subtype E, one gag subtype C/env subtype B', and one gag subtype C/env subtype E. These discordant specimens were found frequently among injecting drug users (4 of 12, 33%) and female commercial sex workers (2 of 8, 25%) engaging in high-risk behaviors. The recombinant nature of these HIV-1 strains was verified in three specimens, indicating the presence of new forms of HIV-1 intersubtype C/B' and C/B'/E recombinants with different recombination breakpoints. The data suggest that multiple subtypes of B', C, and CRF01_AE are cocirculating in central Myanmar, leading to the evolution of new forms of intersubtype recombinants among the risk populations exhibiting one of the highest HIV infection rates in the region.
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Affiliation(s)
- K Motomura
- Laboratory of Molecular Virology and Epidemiology, National Institute of Infectious Diseases, Tokyo, Japan
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22
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Tun KM, Win H, Oo AK, Myint SS, Hla SK, Naing H. Tuberculin conversion after BCG vaccination: comparison by gestation and by age at immunization in Myanmar. Trans R Soc Trop Med Hyg 2000; 94:219-20. [PMID: 10897373 DOI: 10.1016/s0035-9203(00)90282-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- K M Tun
- Department of Health, Yangon, Myanmar
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23
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Aung T, Tun KM, Thinn K, Thein AA. Knowledge, attitudes and practices of mothers on childhood acute respiratory infections (ARI). Southeast Asian J Trop Med Public Health 1994; 25:590-3. [PMID: 7777932] [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: 01/27/2023]
Abstract
A total of three hundred mothers in both rural and urban areas were interviewed and their knowledge, attitude and practice (KAP) on acute respiratory infections (ARI) were compared. It was observed that KAP on ARI of mothers in both categories was almost the same with the exception of their health care seeking practice. Most had traditional beliefs as to the cause of ARI with only a minority knowing the causes. Only one third of mothers knew signs and symptoms of pneumonia; the majority had not experienced the fatal danger sign, chest indrawing and could not recognize it. As regards health care seeking practices, private general practitioners were identified as favorite health providers in urban areas. Utilization of government health facilities was higher among rural mothers. Self medication was found to be common in both categories of mothers, with western medicine being the top of the list.
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Affiliation(s)
- T Aung
- Department of Health Man Power, Ministry of Health, Yangon, Myanmar
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