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Patel AA, Mahajan A, Benjo A, Pathak A, Kar J, Jani VB, Annapureddy N, Agarwal SK, Sabharwal MS, Simoes PK, Konstantinidis I, Yacoub R, Javed F, El Hayek G, Menon MC, Nadkarni GN. A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status. Neurohospitalist 2015; 6:51-8. [PMID: 27053981 DOI: 10.1177/1941874415601164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE With the "weekend effect" being well described, the Brain Attack Coalition released a set of "best practice" guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a "weekend effect" in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. MATERIALS AND METHODS We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. RESULTS Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. CONCLUSION Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care.
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Affiliation(s)
- Achint A Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alexandre Benjo
- Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Ambarish Pathak
- Department of Public Health, New York Medical College, Valhalla, NY
| | - Jitesh Kar
- Neurology Consultants of Huntsville, Huntsville, AL, USA
| | - Vishal B Jani
- Department of Neurology, Michigan State University, East Lansing, MI, USA
| | - Narender Annapureddy
- Division of Rheumatology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shiv Kumar Agarwal
- Division of Cardiology, Department of Internal Medicine, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Manpreet S Sabharwal
- Department of Internal Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA
| | - Priya K Simoes
- Department of Internal Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fahad Javed
- Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Georges El Hayek
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhav C Menon
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Lithium is used as a mood stabilizer in patients with manic-depressive disorder. It is a drug that requires close monitoring due to its narrow therapeutic window and many side effects. There are several case reports of lithium side effects and toxicity occurring even at the therapeutic levels. Cardiac toxicity is observed in approximately 5% of patients; however, severe bradycardia caused by a single dose of lithium is exceedingly rare. We herein report a case of severe symptomatic bradycardia in a young man that occurred after a single dose of lithium. This case emphasizes the need to closely monitor patients when initiating therapy, even before the lithium levels are high enough to be detected.
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Affiliation(s)
- Manpreet S Sabharwal
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, USA
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Kanakadandi V, Annapureddy N, Agarwal SK, Sabharwal MS, Ammakkanavar N, Simoes P, Sanjani HP, Nadkarni GN. The Austrian syndrome: a case report and review of the literature. Infection 2012; 41:695-700. [PMID: 23124908 DOI: 10.1007/s15010-012-0361-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/20/2012] [Indexed: 11/27/2022]
Abstract
A 61-year-old man presented with fever and altered mental status. He was intubated for respiratory distress and was found to have multilobar pneumonia for which antibiotic therapy was instituted. However, his mental status continued to deteriorate despite appropriate antibiotic therapy for his pneumonia. The results from lumar puncture revealed meningitis and endocarditis was evident on a trans-esophageal echocardiogram. His blood and respiratory cultures grew Streptococcus pneumoniae. The patient was diagnosed with Austrian syndrome. After appropriate changes to his antibiotic regimen and an aortic valve replacement, he recovered and was discharged.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Aortic Valve/surgery
- Bacteremia/complications
- Bacteremia/diagnosis
- Bacteremia/microbiology
- Bacteremia/pathology
- Blood/microbiology
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/pathology
- Humans
- Male
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Meningitis, Pneumococcal/pathology
- Middle Aged
- Pneumonia, Pneumococcal/complications
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/pathology
- Respiratory System/microbiology
- Streptococcus pneumoniae/isolation & purification
- Treatment Outcome
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Affiliation(s)
- V Kanakadandi
- Kansas City Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
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Javed F, Aziz EF, Sabharwal MS, Nadkarni GN, Khan SA, Cordova JP, Benjo AM, Gallagher D, Herzog E, Messerli FH, Pi-Sunyer FX. Association of BMI and cardiovascular risk stratification in the elderly African-American females. Obesity (Silver Spring) 2011; 19:1182-6. [PMID: 21183933 PMCID: PMC3319033 DOI: 10.1038/oby.2010.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We aimed to estimate the association of BMI and risk of systemic hypertension in African-American females aged 65 years and older. In this retrospective, cross-sectional study, medical charts were randomly reviewed after obtaining institutional review board approval and data collection was conducted for height, weight, BMI, age, ethnicity, gender, and hypertension. A multivariable logistic regression analysis was performed. The mean BMI was significantly higher in hypertensive subjects than normotensives (30.3 vs. 29 kg/m2; P = 0.003). A higher proportion of hypertensive subjects had a BMI >23 kg/m2 as compared to normotensives (88.9% vs. 83.5%; P = 0.023). When the log odds of having a history of hypertension was plotted against BMI as a continuous variable, we found that the odds showed an increasing trend with increasing BMI and a steep increase after a BMI of 23 kg/m2. When BMI was analyzed as a categorical variable, a BMI of 23-30 kg/m2 was found to have an odds ratio of 1.43 (95% confidence interval 1.01-2.13; P = 0.05) and a BMI of >30 kg/m2 had an odds ratio of 1.76 (95% confidence interval 1.17-2.65; P = 0.007) when compared to a BMI of <23 kg/m2. This association remained significant in both univariate and multivariate analysis. We conclude that BMI is an independent predictor of hypertension in elderly African-American females. Our results indicate that the risk of hypertension increased significantly at BMI of >23 kg/m2 in this ethnic group. Weight reduction to a greater extent than previously indicated could play an integral role in prevention and control of high blood pressure in this particular population.
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Affiliation(s)
- Fahad Javed
- New York Obesity Research Center, Division of Endocrinology, Diabetes, and Nutrition, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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