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Sandhu A, Kalamkar P, Miller K, Bigbee M, Finley GG, Parda DS, Mayernik DG. Practice variance as determinant of cost in the oncology care model (OCM). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ariel Sandhu
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, US
| | | | - Katherine Miller
- Allegheny General Hosital, Department of Hematology & Oncology, Pittsburgh, PA
| | - Matthew Bigbee
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | | | - David S. Parda
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
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Kalamkar P, Sandhu A, Lee DJ, Bigbee M, Finley G, Parda DS, Mayernik DG. Cost variance analysis in treatment of advanced non-small cell lung cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ariel Sandhu
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, US
| | - Daniel Jung Lee
- Division of Hematology and Cellular Therapy, Allegheny Health Network, Pittsburgh, PA
| | - Matthew Bigbee
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Gene Finley
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - David S. Parda
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
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Thiagaraj A, Kalamkar P, Rahman R, Farah V, Poornima I. An unprecedented case report of primary cardiac lymphoma exclusive to left ventricle: a diagnostic and therapeutic challenge. Eur Heart J Case Rep 2018; 2:yty029. [PMID: 31020112 PMCID: PMC6177073 DOI: 10.1093/ehjcr/yty029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/14/2018] [Indexed: 12/04/2022]
Abstract
Introduction Primary cardiac lymphoma accounts for <2% of all primary cardiac tumours. It is uncommon in immunocompetent patients, often fatal and diagnosed at autopsy. Tumour usually involves the right heart chambers and pericardium. With advances in imaging, early diagnosis is possible and treatment including chemotherapy and surgery affords good prognosis. Case presentation We present a 50-year-old woman with abdominal pain and fevers for 5 days. Computed tomography of the abdomen showed splenic and renal infarcts but no mass or vegetation was noted on echocardiography. Thoracic computed tomography divulged a large left ventricular filling defect. Cardiac magnetic resonance imaging delineated a 3.5 × 4.5 cm anterobasal mass with frond-like projections and endocardial invasion without extracardiac involvement suggestive of a low-vascularity tumour. Echo-guided endomyocardial biopsy and minithoracotomy with needle biopsy were inconclusive. A sarcoid-protocol cardiac positron emission tomography-fluorodeoxyglucose scan showed focally elevated uptake in the basal anteroseptum without extracardiac uptake, supporting a malignant entity. This prompted open heart mass resection. Pathology revealed diffuse large B-cell lymphoma. Discussion Our case is a unique report of cardiac lymphoma isolated to the left ventricle. Location of the tumour and lack of specific imaging characteristics made it a diagnostic challenge. It underscores the importance of including lymphoma in the differential for intracardiac masses as it is responsive to chemotherapy. Additionally, it emphasizes the complementary role of imaging modalities and multidisciplinary team approach in diagnosis. Early diagnosis and therapy is the key to establishing successful outcomes.
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Affiliation(s)
- Ashwin Thiagaraj
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Prachi Kalamkar
- Department of Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Riaz Rahman
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Victor Farah
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Indu Poornima
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
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Wani AS, Kalamkar P, Alhassan S, Farrell MJ. Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma. Oxf Med Case Reports 2015; 2015:378-81. [PMID: 26719812 PMCID: PMC4689984 DOI: 10.1093/omcr/omv069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/02/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022] Open
Abstract
Lung herniation has been defined as a protrusion of lung tissue through its bounding structure. We present a case of spontaneous intercostal lung herniation following bouts of cough, which was complicated by multiple rib fractures, in which we had to adopt a non-surgical approach due to the clinical circumstance. Its understanding in the field of internal medicine is important as appropriate therapeutic judgment, and long-term follow-up is essential for full recovery.
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Affiliation(s)
- Adil S Wani
- Division of Internal Medicine , Allegheny General Hospital, Allegheny Health Network , Pittsburgh, PA , USA
| | - Prachi Kalamkar
- Division of Internal Medicine , Conemaugh Memorial Medical Centre , Johnstown, PA , USA
| | - Sulaiman Alhassan
- Division of Pulmonary Critical Care , Allegheny General Hospital, Allegheny Health Network , Pittsburgh, PA , USA
| | - Michael J Farrell
- Division of Internal Medicine , Allegheny General Hospital, Allegheny Health Network , Pittsburgh, PA , USA
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Pratap B, Bastawrose J, Pamidimukala CK, Patel D, Kalamkar P, Lingannan A, Panneerselvam N, Gurram A, Patel S, Pierce M, Ghosh H, Herzog E, Aziz E. Abstract 223: Patients With Cardiac Comorbidities Carry Worse Outcome as Identified by Our SELF Risk Stratification Pathway: An ACAP-SELF Syncope Dataset Analysis. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.223] [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: 11/16/2022]
Abstract
Background:
According to the design of published and validated SELF pathway, patients with syncope are stratified according to the SELF-1 criteria (Short period, Early-rapid onset, Loss of consciousness, Full recovery) and SELF-2 Criteria (Structural heart disease, abnormal electrocardiogram, and arrhythmia/AFib/AFl).
Methods:
3044 patients were prospectively followed after presenting to our emergency department for the evaluation of syncope. Patients were divided into four groups: Group A (SELF +/+) who met both SELF-1 and 2 criteria, Group B (SELF +/-) who met SELF-1 criteria but not SELF-2, Group C (SELF -/+) who met SELF-2 criteria but not SELF-1 and Group D (SELF -/-) who met neither SELF criteria. The primary endpoint was a composite of readmission for syncope, myocardial infarction (MI), stroke or death. Follow-up was 5 years.
Results:
Group A included 1001 patients (33%), Group B included 359 patients (12%), Group C had 880 patients (29%) and Group D had 804 patients (26%). Patients who met SELF-2 criteria, i.e., patients in Groups A and C, had significantly worse outcome (Group A: HR 1.85; 95% CI: 1.47-2.36; p<0.0001; Group C: HR 2.0; 95% CI: 1.54-2.52; p<0.0001). Presence of Diabetes (HR: 1.3; 95% CI: 1.1-1.5; p=0.003), Coronary Artery Disease (HR: 1.44; 95%CI: 1.2-1.7; p=0.0001) and Congestive Heart Failure (HR 2.0; 95% CI: 1.6-2.4; p<0.0001) were also important predictors of poor outcome.
Conclusions:
Using the SELF-pathway for patients presenting with syncope effectively identifies high risk patients who merit hospitalization and close follow-up post-discharge. These include patients with structural heart disease, abnormal EKG and abnormal telemetry, as well as patients with diabetes, CAD and CHF. This has important implications for the evaluation of a common disease that poses a significant economic burden on healthcare systems.
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Affiliation(s)
| | | | | | - Dipen Patel
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | | | | | | | | | | | | | | | - Eyal Herzog
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | - Emad Aziz
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
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Pratap B, Bastawrose J, Pamidimukala C, Patel D, Kalamkar P, Lingannan A, Panneerselvam N, Gurram A, Umali T, Shahanoor Z, Verzosa J, Herzog E, Aziz EF. Abstract 376: African-American Patients Presenting with Unexplained Syncope Have Significantly Worse Outcome Compared to Other Races: An ACAP-SELF Dataset Analysis. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.376] [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: 11/16/2022]
Abstract
Background:
In the US, 2 million people are evaluated for syncope annually. Published literature shows that of all ethnicities, African Americans (AA) are more likely to have comorbidities like hypertension, diabetes & lifestyle risk factors that translate to poorer outcome. Having published short-term outcomes showing worse outcome for AA with syncope, we followed up these patients over 5 years to evaluate long-term outcomes.
Methods:
3044 patients were prospectively followed after presenting with syncope. Patients were separated into five ethnic groups: Caucasians(30%), AA(30%), Hispanics(20%), Asians(3%) and others(17%). Patients or relatives were interviewed at least yearly during the follow-up period of 5 years. The primary endpoint was a composite of readmission for syncope, myocardial infarction, stroke or death.
Results:
AA were older with mean age of 68±20 years, had hypertension (72% vs. 60%, p<0.001), higher creatinine levels (1.5mg/dl vs. 1.2mg/dl, p< 0.001), diabetes (28% vs. 23%, p<0.001), heart failure (12% vs. 9%, p=0.04), and smoking (26% vs. 10%; p=0.003). Compared to all other races, AA had significantly worse outcome as seen by the KM curve in the primary endpoint (33% vs. 25%; HR 1.5; 95% CI: 1.25-1.75; p<0.0001).
Conclusions:
AA who are admitted with unexplained syncope are identified according to the SELF pathway as high risk group that can likely be attributed to the presence of comorbidities and warrants hospitalization for further work-up and optimizing medical management.
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Affiliation(s)
| | | | | | - Dipen Patel
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | | | | | | | | | - Tad Umali
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | | | | | - Eyal Herzog
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | - Emad F Aziz
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
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Pratap B, Bastawrose J, Gurram A, Panneerselvam N, Lingannan A, Kalamkar P, Patel D, Verzosa J, Shahanoor Z, Umali T, Pamidimukala C, Pierce M, Aziz EF, Herzog E. Abstract 178: Females with Cardiac Comorbidities Have Worse Outcome Compared to Males Presenting with Unexplained Syncope: An ACAP-SELF Dataset Analysis. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.178] [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: 11/16/2022]
Abstract
Background:
The ACAP program consists of strategies for implementing ACC/AHA guidelines for various cardiac disorders, one of which is the SELF pathway, which covers the spectrum of care from presentation to discharge in patients with syncope. Patients are stratified according to SELF-1 (Short period, Early onset, Loss of consciousness, Full recovery) and SELF-2 criteria (Structural heart disease, abnormal ECG, arrhythmia).
Methods:
3044 patients were prospectively followed for syncope. They were divided into 4 groups: Group A (SELF +/+) who met both SELF 1 and 2 criteria, Group B (SELF +/-) who met SELF-1 criteria but not SELF-2, Group C (SELF -/+) who met SELF-2 criteria alone and Group D (SELF -/-) who met neither criteria. These groups were further separated into males and females. The primary endpoint was composite of readmission for syncope, myocardial infarction, stroke or death. Follow-up was 5 years.
Results:
Females were older than males (69+/-21 years), had more hypertension (65% vs. 63%) and syncopal episodes (18% vs. 16%). Males were more likely to be diabetic (25% vs. 24%), have coronary artery disease (21% vs. 16%; p=0.001), heart failure (11% vs. 9%) and smoking (65% vs. 42%; p<0.001). Regardless of sex, Group A patients had worse outcomes (p=0.25) while Group D patients had better outcome with far fewer events (p=0.06). In Group B patients, males were noted to have worse outcome while in Group C, females were noted to have significantly worse long-term outcome.
Conclusions:
The SELF-pathway for patients with syncope helps identify at-risk subgroups in our patient population. Females with SELF-2 criteria (Structural heart disease, abnormal ECG, arrhythmia) had significantly worse long-term outcome compared to males regardless of manner of syncopal presentation.
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Affiliation(s)
| | | | | | | | | | | | - Dipen Patel
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | | | | | - Tad Umali
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | | | | | - Emad F Aziz
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
| | - Eyal Herzog
- St. Luke's - Roosevelt Hosp Cntr, New York, NY
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Pierce M, Pratap B, Pamidimukala C, Bastawrose J, Lingannan A, Panneerselvam N, Gurram A, Patel D, Kalamkar P, Usmani R, Umali T, Herzog E, Aziz E. FEMALE GENDER, LASER SHEATH USE AND OPERATOR SKILL DRIVE THE SUCCESS AND COMPLICATION RATES OF CARDIAC DEVICE LEAD EXTRACTION: AN ACAP REGISTRY ANALYSIS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60381-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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