1
|
Isseh M, Hasan LZ, Imam Z, Armstrong J, Rana K. Migration of Gastroduodenal Artery Embolization Coil Into the Duodenal Lumen. J Can Assoc Gastroenterol 2022; 5:51. [PMID: 35368322 PMCID: PMC8972308 DOI: 10.1093/jcag/gwab010] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mahmoud Isseh
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Leen Z Hasan
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Zaid Imam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA
| | - Justin Armstrong
- Department of Internal medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA
| | - Ketan Rana
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA
| |
Collapse
|
2
|
Abstract
AIMS Cannabis use has been reported as a risk factor for stroke. We systematically review the prevalence and outcomes of stroke in people with cannabis use. METHODS We searched MEDLINE and 6 other databases from inception to January 2020 for studies on the relationship between cannabis use and stroke. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Two independent reviewers extracted the data. Study quality was assessed by the Newcastle-Ottawa Scale for cohort and case-control studies. RESULTS Seventeen studies involving 3,185,560 people with cannabis use were included. Descriptive statistics demonstrated 18,676 (median 1.1%, interquartile range [IQR] 0.3%-1.3%) experienced stroke compared with 0.8% of those without use (Odds Ratio 1.17, 95% CI 1.10-1.25). Among people with cannabis use, median age was 26.2 years (IQR 25.2-34.3 years) and mostly male (median 57.8%). Of stroke subtypes, ischemic stroke was most prevalent (median 1.2%, IQR 0.4%-1.9%), followed by undefined stroke subtype (median 1.2%, IQR 1.1%-1.2%) and hemorrhagic stroke (median 0.3%, IQR 0.1%-0.6%). The majority of people with cannabis use who experienced stroke survived (median: 85.1%, IQR 83%-87.5%) and 64.0% of people experienced a good neurologic outcome, defined as modified Rankin Scale of 0 to 3. Few studies included outcomes of vasospasm or seizure. CONCLUSIONS In people with cannabis use, the prevalence of ischemic stroke and hemorrhagic stroke was 1.2% and 0.3%, respectively, higher than the prevalence of people without use (0.8% and 0.2%). There is insufficient information on timing, exposure, duration, and dose-responsive relationship.
Collapse
Affiliation(s)
- Carol Swetlik
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (CS, IM, ABB), Department of Medicine, University of Connecticut School of Medicine, Hartford, CT (LZH), Welch Medical Library, Johns Hopkins University, Baltimore, MD (CP), Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (MC)
| | | | | | | | | | | |
Collapse
|
3
|
Hasan LZ, Vecchio E, Wu Q, Goldenberg SA, Rezaizadeh H. Eosinophilic Esophagitis With Subsequent Eosinophilic Colitis: Keeping a High Index of Suspicion. Cureus 2022; 14:e22073. [PMID: 35295355 PMCID: PMC8917324 DOI: 10.7759/cureus.22073] [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: 02/09/2022] [Indexed: 11/05/2022] Open
Abstract
The prevalence of eosinophilic esophagitis (EoE) has significantly increased, while, in comparison, eosinophilic gastroenteritis and colitis remain rare entities. The diagnosis and management of eosinophilic gastrointestinal (GI) disorders can be challenging given the non-specific manifestations and variable treatment response. Symptoms refractory to initial therapies (e.g., proton pump inhibitors, dietary modifications, topical steroids) should raise suspicion for distal involvement of the GI tract. In this case report, we describe a patient with EoE with a subsequent diagnosis of eosinophilic colitis and symptom response to systemic corticosteroids. In addition, we review recent updates regarding the management of eosinophilic gastrointestinal disorders.
Collapse
|
4
|
Abstract
Hepatic encephalopathy is an often devastating complication of chronic liver disease, associated with high mortality and increased burden on patients and healthcare systems. Current agents (such as nonabsorbable disaccharides and oral antibiotics) are often only partially effective and associated with unpleasant side effects. With our improved understanding of the pathophysiology of hepatic encephalopathy, multiple treatment modalities have emerged with promising results when used alone or as an adjunct to standard medications. The mechanisms of these agents vary greatly, and include the manipulation of gut microbial composition, reduction of oxidative stress, inhibition of inflammatory mediators, protection of endothelial integrity, modulation of neurotransmitter release and function, and other novel methods to reduce blood ammonia and neurotoxins. Despite their promising results, the studies assessing these treatment modalities are often limited by study design, sample size, outcome assessment heterogeneity, and paucity of data regarding their safety profiles. In this article, we discuss these novel agents in depth and provide the best evidence supporting their use, along with a critical look at their limitations and future directions.
Collapse
Affiliation(s)
- Leen Z. Hasan
- Correspondence to: Leen Z. Hasan, Department of Medicine, Internal Medicine Residency Program, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-1235, USA. ORCID: https://orcid.org/0000-0003-3852-8591. Tel: +1-617-283-6633, Fax: +1-860-679-4613, E-mail: ,
| | | |
Collapse
|
5
|
Migdady I, Shoskes A, Hasan LZ, Hassett C, George P, Newey C, Cho SM, Rae-Grant A, Uchino K. Timing of Acute Stroke in COVID-19-A Health System Registry Study. Neurohospitalist 2021; 11:285-294. [PMID: 34567388 DOI: 10.1177/1941874420985983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose The association between SARS-CoV-2 infection and stroke remains unknown. We aimed to compare the characteristics of stroke patients who were hospitalized with Coronavirus Disease 2019 (COVID-19) based on the timing of stroke diagnosis. Methods We performed a retrospective analysis of adult patients in a health system registry of COVID-19 who were hospitalized and had imaging-confirmed acute stroke during hospitalization. Baseline characteristics and hospital outcomes were collected and analyzed. Results Out of 882 COVID-19 patients who were hospitalized between March 9 to May 17, 2020, 14 patients (2% of all COVID-19 patients and 21% of those who underwent imaging) presented with stroke or developed stroke during hospitalization. Eleven had acute ischemic stroke (AIS) and 3 had acute hemorrhagic stroke. Six patients (43%) presented to the hospital with acute stroke symptoms and were found to have SARS-CoV-2. Compared to patients who presented with AIS, more patients with AIS during hospitalization were male, of older age, had pneumonia and acute respiratory distress syndrome, were severely ill, and had high inflammatory and thrombotic markers (including C reactive protein, D dimer, ferritin, and fibrinogen). Among all patients, hospital mortality was high (50%) and the majority of patients who were discharged had poor neurological outcome. Conclusions A distinction should be made between patients who present with acute stroke with concurrent SARS-CoV-2 infection and those who develop stroke as a complication of severe COVID-19. It is likely that a subset of stroke patients will incidentally test positive for the virus given the widespread pandemic.
Collapse
Affiliation(s)
- Ibrahim Migdady
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Shoskes
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Leen Z Hasan
- Department of Medicine, University of Connecticut, Farmington, CT, USA.,Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Hassett
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pravin George
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Newey
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sung-Min Cho
- Departments of Neurology, Neurological Intensive Care, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Rae-Grant
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
6
|
Hasan LZ, Shrestha NK, Dang V, Unai S, Pettersson G, El-Hayek K, Coppa C, Gordon SM. Surgical infective endocarditis and concurrent splenic abscess requiring splenectomy: a case series and review of the literature. Diagn Microbiol Infect Dis 2020; 97:115082. [PMID: 32535414 DOI: 10.1016/j.diagmicrobio.2020.115082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
Splenic abscess is an uncommon but serious complication of infective endocarditis (IE). The timing of surgical management of splenic abscess can be challenging when valve surgery is required. The American Heart Association (AHA) and the European Society of Cardiology (ESC) currently recommends splenectomy before valve replacement due to fear of reinfection of the heart valve; however, published data to support this recommendation are limited. In this series, we report outcomes for 5 patients with IE and splenic abscess who underwent valve replacement first, followed by splenectomy at a median of 19 days (range: 10-77 days) after valve surgery, with no recurrent infection of the new valve. Our experience and review of the available literature provide reassurance for splenectomy after valve surgery for IE.
Collapse
Affiliation(s)
- Leen Z Hasan
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - Vinh Dang
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Kevin El-Hayek
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA; Division of General Surgery, Division of Surgical Oncology, MetroHealth System, Cleveland, OH, USA.
| | - Christopher Coppa
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|