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Nain P, Seth L, Bell AS, Raval P, Sharma G, Bethel M, Sharma G, Guha A. Chemotherapy in Pregnancy: Assessing the Safety of Adriamycin Administration in Pregnancy Complicated by Breast Cancer. JACC Case Rep 2023; 28:102141. [PMID: 38204522 PMCID: PMC10774876 DOI: 10.1016/j.jaccas.2023.102141] [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: 08/29/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 01/12/2024]
Abstract
Pregnancy-associated breast cancer is challenging to treat. Treatment with chemotherapeutic agents such as anthracyclines poses a risk of cardiotoxicity, despite being considered safe after the second trimester of pregnancy. Management requires multidisciplinary comanagement with cardio-obstetrics, cardiology-oncology, maternal-fetal medicine, and oncology.
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Affiliation(s)
- Priyanshu Nain
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Lakshya Seth
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Ashley Shawn Bell
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Priyanka Raval
- Division of Hematology and Oncology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Gyanendra Sharma
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Monique Bethel
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Garima Sharma
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Gajurel BP, Nepal G, Jaiswal V, Ang SP, Nain P, Shama N, Ruchika F, Bohara S, Kharel S, Yadav JK, Medina JRT, Shrestha AB. Utilization rates of intravenous thrombolysis for acute ischemic stroke in Asian countries:: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35560. [PMID: 37861564 PMCID: PMC10589571 DOI: 10.1097/md.0000000000035560] [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: 04/03/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Despite intravenous thrombolysis (IVT) being used for the treatment of acute ischemic stroke (AIS) for over two decades, its accessibility remains limited in various regions of the world. The Asian region, which experiences the highest age-standardized incidence of AIS, currently lacks comprehensive data on the utilization of IVT. AIMS This study aimed to provide precise estimates of IVT usage for AIS in Asian countries. METHODS A literature search was conducted on PubMed and Google using appropriate search terms. English language, peer reviewed articles published after 2010 were included in the analysis. The pooled proportion was calculated utilizing the DerSimonian and Laird random-effects model. Additionally, a subgroup analysis was conducted, taking into account factors such as the study's country, the economic status of the country, specific Asian regions, publication year (before 2015 and from 2015 onwards), study location, study setting, hospital stroke protocol, and national stroke guidelines. RESULTS 67 observational studies with 778,046 patients with AIS were included in the meta-analysis. The overall utilization rate of IVT was found to be 9.1%. High-income countries had a higher rate (11.3%) compared to lower-middle-income (8.1%) and upper-middle-income countries (9%). Central and North Asia had the highest rate (17.5%) and Southeast Asia had the lowest rate (6.8%). Studies conducted after 2015 had a higher thrombolysis rate (11.3%) compared to those before 2015 (1.5%). Presence of hospital stroke protocols (10.7%) and national stroke guidelines (10.1%) were associated with higher thrombolysis rates. CONCLUSION The overall utilization rate of IVT for AIS in Asia stood at 9.1%, showcasing noteworthy disparities across countries, regions, and income brackets. To improve thrombolysis rates in the region, addressing prehospital delays, increasing public awareness, and implementing stroke protocols and national guidelines are key strategies.
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Affiliation(s)
- Bikram Prasad Gajurel
- Department of Neurology, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Gaurav Nepal
- Department of General Medicine, Rani Primary Healthcare Centre, Biratnagar, Nepal
| | | | - Song Peng Ang
- Division of Internal Medicine, Rutgers Health/Community Medical Center, NJ
| | - Priyanshu Nain
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nishat Shama
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - F.N.U. Ruchika
- Department of Surgery, JJM Medical College, Davangere, India
| | - Sujan Bohara
- Department of Internal Medicine, Nepalese Army Institute of Health Science, Kathmandu, Nepal
| | - Sanjeev Kharel
- Department of Internal Medicine, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | | | - Jillian Reeze T. Medina
- Manila Central University - Filemon D. Tanchoco Medical Foundation College of Medicine, Philippines
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
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Antony MA, Chowdhury A, Edem D, Raj R, Nain P, Joglekar M, Verma V, Kant R. Gut microbiome supplementation as therapy for metabolic syndrome. World J Diabetes 2023; 14:1502-1513. [PMID: 37970133 PMCID: PMC10642415 DOI: 10.4239/wjd.v14.i10.1502] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023] Open
Abstract
The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body. Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bacterial homeostasis, and recent evidence has shown that dysbiosis is related to chronic inflammation, insulin resistance, cardiovascular diseases (CVD), type 2 diabetes mellitus (T2DM), and obesity. It is well known that obesity, T2DM and CVD are caused or worsened by multiple factors like genetic predisposition, environmental factors, unhealthy high calorie diets, and sedentary lifestyle. However, recent evidence from human and mouse models suggest that the gut microbiome is also an active player in the modulation of metabolic syndrome, a set of risk factors including obesity, hyperglycemia, and dyslipidemia that increase the risk for CVD, T2DM, and other diseases. Current research aims to identify treatments to increase the number of beneficial microbiota in the gut microbiome in order to modulate metabolic syndrome by reducing chronic inflammation and insulin resistance. There is increasing interest in supplements, classified as prebiotics, probiotics, synbiotics, or postbiotics, and their effect on the gut microbiome and metabolic syndrome. In this review article, we have summarized current research on these supplements that are available to improve the abundance of beneficial gut microbiota and to reduce the harmful ones in patients with metabolic syndrome.
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Affiliation(s)
- Mc Anto Antony
- Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina/AnMed Campus, Anderson, SC 29621, United States
| | - Aniqa Chowdhury
- Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina/AnMed Campus, Anderson, SC 29621, United States
| | - Dinesh Edem
- Department of Endocrinology, Diabetes and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AK 72205, United States
| | - Rishi Raj
- Department of Endocrinology, Diabetes and Metabolism, Pikeville Medical Center, Pikeville, KY 41501, United States
| | - Priyanshu Nain
- Department of Graduate Medical Education, Maulana Azad Medical College, Delhi 110002, India
| | - Mansi Joglekar
- Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina/AnMed Campus, Anderson, SC 29621, United States
| | - Vipin Verma
- Department of Internal Medicine, Medical University of South Carolina/AnMed Campus, Anderson, SC 29621, United States
| | - Ravi Kant
- Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina/AnMed Campus, Anderson, SC 29621, United States
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Kant R, Antony MA, Joglekar M, Chandra R, Nain P. PSAT203 Acquired Resistance to Medical Management in a Patient with Parathyroid Crisis due to a Parathyroid Adenoma. J Endocr Soc 2022. [PMCID: PMC9624786 DOI: 10.1210/jendso/bvac150.433] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Parathyroid crisis is a characterized by severe hypercalcemia associated with multiple organ dysfunction. Case 90 years-old Caucasian man was hospitalized for progressive confusion over 3 days and was noted to have a critically elevated serum calcium (S Ca) 16.8 mg/dl (8.6-10.0) with albumin 4.1 mg/dl. Patient had a good functional status prior to the hospitalization. On further evaluation, patient was diagnosed with primary hyperparathyroidism with a high suspicion for parathyroid cancer, with labs showing a markedly elevated PTH 1183 pg/ml (15-65) and ionized Ca >1.85 mmol/L (1.15-1.35). Of note, S Ca was normal at 9.5 mg/dl (no albumin) approximately 20 months prior to the hospitalization. Parathyroid ultrasound showed a 1.8×1.7×1.1 cm left superior parathyroid mass with ill-defined margins. Sestamibi scan confirmed a left superior parathyroid mass. CT neck/chest/abdomen/pelvis with contrast showed a 1.8×1.1×1.9 cm left superior parathyroid mass with enhancement and punctate non-obstructing right kidney stones. Hypercalcemia responded extremely well to medical management (calcitonin, 4 mg of zoledronic acid infusion and 13 days of cinacalcet 30 mg daily) resulting in normalization of S Ca. However, patient required a prolonged hospitalization for aspiration pneumonia and severe electrolyte disturbances. Since patient was not a good surgical candidate and hypercalcemia resolved on medical management, patient was discharged to a rehab facility with the plan to pursue parathyroidectomy as outpatient. S Ca worsened progressively and was 10.4 mg/dl (albumin 3.6 mg/dl) with PTH 130 pg/ml on day 15 after discharge. Cinacalcet was added when hypercalcemia further worsened to 11.7 mg/dl (albumin 3.6 mg/dl) on day 38. However, patient was hospitalized again for altered mental status, recurrent severe hypercalcemia (S Ca 15.7 mg/dl, albumin 3.8 mg/dl, PTH 1299 pg/ml), hypokalemia and urinary tract infection. In the ED, patient developed complete heart block that responded to atropine. Interestingly, hypercalcemia was recalcitrant to aggressive medical management during this hospitalization (zoledronic acid 4 mg infusion, calcitonin IM- increased up to 6 mg IM q6hr, cinacalcet- increased to 60 mg PO BID and IV fluid resuscitation with furosemide as needed). S Ca was 14.2 mg/dl (albumin 3.4 mg/dl) on day 8 of hospitalization. Therefore, urgent left superior parathyroidectomy was performed. Surgical pathology revealed a 3.1 gm parathyroid adenoma. Post-operative day#1 labs showed normal PTH 17.3 pg/ml, S Ca 12.1 mg/dl and albumin 3.2 mg/dl. S Ca and patient's mental status normalized over next few days. Discussion Urgent parathyroidectomy has shown to have excellent outcomes in patients with parathyroid crisis. Our patient's severe hypercalcemia initially responded excellently to medical management but recurred within few weeks and developed resistance to medical management. Our case highlights the importance of performing surgical exploration as soon as possible after initial medical stabilization in patients with parathyroid crisis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Jaiswal V, Nain P, Mukherjee D, Joshi A, Savaliya M, Ishak A, Batra N, Maroo D, Verma D. Symptomatology, prognosis, and clinical findings of Monkeypox infected patients during COVID-19 era: A systematic-review. Immun Inflamm Dis 2022; 10:e722. [PMID: 36301040 PMCID: PMC9552975 DOI: 10.1002/iid3.722] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The recent outbreak of Human Monkeypox (MPXV) in nonendemic regions of the world is of great concern. OBJECTIVE We aimed to systematically analyze the current epidemiology, clinical presentation, and outcomes of the Monkeypox virus. METHOD Systematic literature was conducted in PubMed, Embase, Google Scholar, and Scopus using predefined MESH terms by using "AND" and "OR." The following search terms were used: Monkeypox [MeSH] OR "Monkeypox virus" [MeSH] OR "POX" OR "Monkeypox" AND "Outbreak" AND "Outcomes" from December 2019 till 14th June 2022 without restrictions of language. RESULTS A total of 1074 (99.90%) patients tested positive for Monkeypox virus through RT-PCR while 1 (0.09) patient was suspected. There was a gender difference with male predominance (54.23% vs. 45.48%) compared with female patients. Mean age (±SD) of patients was 20.66 ± 16.45 years. The major symptoms were rash (100%), fever (96%), and other important symptoms were upper respiratory symptoms (97%), headache (95%), vomiting (95%), oral ulcers (96%), conjunctivitis (96%) and lymphadenopathy (85%). The average mean duration of treatment was 5 days, while the mean hospitalization duration was 13.3 ± 6.37 days. The outcome of 20 patients was available, 19 of 20 patients recovered fully from monkeypox, however, 1 patient was not able to survive resulting in death. CONCLUSION The recent monkeypox virus outbreak has shown that the virus could transmit in ways that were not previously expected. Further research is needed to understand the possible outcomes and association with humans and their different organ systems.
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Affiliation(s)
- Vikash Jaiswal
- Department of ResearchLarkin Community HospitalSouth MiamiFloridaUSA
| | - Priyanshu Nain
- Department of MedicineMaulana Azad Medical CollegeNew DelhiIndia
| | - Dattatreya Mukherjee
- Department of MedicineRaiganj Government Medical College and HospitalRaiganjWest BengalIndia
| | - Amey Joshi
- Department of ResearchLarkin Community HospitalSouth MiamiFloridaUSA
| | - Mittal Savaliya
- Department of MedicineGMERS Medical CollegeJunagadhGujaratIndia
| | - Angela Ishak
- Department of ResearchLarkin Community HospitalSouth MiamiFlUSA
| | - Nitya Batra
- Department of MedicineMaulana Azad Medical CollegeNew DelhiIndia
| | - Dipansha Maroo
- Department of MedicineMaulana Azad Medical CollegeNew DelhiIndia
| | - Deepak Verma
- Department of MedicineJanaki Medical CollegeDhanushaNepal
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Kant R, Chandra L, Verma V, Nain P, Bello D, Patel S, Ala S, Chandra R, Antony MA. Gut microbiota interactions with anti-diabetic medications and pathogenesis of type 2 diabetes mellitus. World J Methodol 2022; 12:246-257. [PMID: 36159100 PMCID: PMC9350729 DOI: 10.5662/wjm.v12.i4.246] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Microorganisms including bacteria, viruses, protozoa, and fungi living in the gastrointestinal tract are collectively known as the gut microbiota. Dysbiosis is the imbalance in microbial composition on or inside the body relative to healthy state. Altered Firmicutes to Bacteroidetes ratio and decreased abundance of Akkermansia muciniphila are the predominant gut dysbiosis associated with the pathogenesis of type 2 diabetes mellitus (T2DM) and metabolic syndrome. Pathophysiological mechanisms linking gut dysbiosis, and metabolic diseases and their complications include altered metabolism of short-chain fatty acids and bile acids, interaction with gut hormones, increased gut microbial metabolite trimethylamine-N-oxide, bacterial translocation/Leaky gut syndrome, and endotoxin production such as lipopolysaccharides. The association between the gut microbiota and glycemic agents, however, is much less understood and is the growing focus of research and conversation. Recent studies suggest that the gut microbiota and anti-diabetic medications are interdependent on each other, meaning that while anti-diabetic medications alter the gut microbiota, the gut microbiota also alters the efficacy of anti-diabetic medications. With increasing evidence regarding the significance of gut microbiota, it is imperative to review the role of gut microbiota in the pathogenesis of T2DM. This review also discusses the interaction between gut microbiota and the various medications used in the treatment of T2DM.
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Affiliation(s)
- Ravi Kant
- Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina, Anderson, SC 29621, United States
- Department of Endocrinology, Diabetes and Metabolism, AnMed Health, Anderson, SC 29621, United States
| | - Lakshya Chandra
- Department of Internal Medicine, St Francis Hospital, Greenville, SC 29601, United States
| | - Vipin Verma
- Department of Internal Medicine, Medical University of South Carolina, Anderson, SC 29621, United States
- Department of Internal Medicine, AnMed Health, Anderson, SC 29621, United States
| | - Priyanshu Nain
- Department of Graduate Medical Education, Maulana Azad Medical College, Delhi 110002, India
| | - Diego Bello
- Department of Surgery, AnMed Health, Anderson, SC 29621, United States
| | - Siddharth Patel
- Department of Internal Medicine, Decatur Morgan Hospital, Decatur, AL 35601, United States
| | - Subash Ala
- Department of Internal Medicine, St Francis Hospital, Greenville, SC 29601, United States
| | - Rashmi Chandra
- Department of Internal Medicine, Medical University of South Carolina, Anderson, SC 29621, United States
| | - Mc Anto Antony
- Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina, Anderson, SC 29621, United States
- Department of Endocrinology, Diabetes and Metabolism, AnMed Health, Anderson, SC 29621, United States
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