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Kichloo A, Aljadah M, Albosta M, El-Amir Z, Goldar G, Khan MZ, Dahiya DS, Wani F. Cirrhosis: Primary care approaches to screening, immunization, and lifestyle modifications. Cleve Clin J Med 2023; 90:693-701. [PMID: 37914201 DOI: 10.3949/ccjm.90a.21043] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
For patients with decompensated cirrhosis, health maintenance is critical to improve survival rates and prevent adverse outcomes. We review the primary care management of cirrhosis and its complications, such as esophageal varices, hepatocellular carcinoma, and chemical or medication exposures. We also highlight specific immunizations and lifestyle modifications to prevent decompensation, and we summarize current screening guidelines.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY; Associate Professor of Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Erie, PA
| | - Michael Aljadah
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Michael Albosta
- Department of Internal Medicine, University of Miami, Miami, FL
| | - Zain El-Amir
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Ghazaleh Goldar
- Department of Cardiology, University of Iowa Health Care, Iowa City, IA
| | - Muhammed Zatmar Khan
- Department of Medicine, Virginia Commonwealth University Health System, Henrico, VA
| | - Dushyant Singh Dahiya
- Department of Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, KS
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center, Watertown, NY
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El-Amir Z, Choi EYK, Krauss JC. Successful Treatment of Recurrent Colonic Adenocarcinoma with Metastatic Tumor Thrombus in the Superior Mesenteric Vein with Surgical Excision and Venous Reconstruction. Am J Case Rep 2023; 24:e939156. [PMID: 37403331 DOI: 10.12659/ajcr.939156] [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] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Patients cured of Hodgkin lymphoma (HL) are at increased risk of second malignancies, such as lung, breast, and colon cancer. Isolated metastasis of these malignancies to the vasculature is rare. We present a unique case of a patient cured of HL who developed colon cancer and later presented with an isolated metastases of colon cancer to the superior mesenteric vein. The patient is now in complete remission 5 years after surgical excision of the superior mesenteric vein metastases followed by chemotherapy. CASE REPORT A 56-year-old woman presented with a past medical history notable for stage III HL diagnosed at age 13 years that was treated by splenectomy, chemotherapy, and mantle with inverted Y radiation. She underwent a right nephrectomy at age 51 years for renal cell carcinoma. At age 56, an 8-cm mass in the transverse colon was found during surveillance imaging. She underwent right hemicolectomy for pathological stage IIA (T3N0M0) adenocarcinoma. A liver adenoma was identified a year later. Two years after hemicolectomy, an abdominal recurrence was identified, and she underwent a resection of a superior mesenteric vein mass with porto-mesenteric reconstruction. Pathology revealed metastatic colonic adenocarcinoma, 1 of 7 lymph nodes positive for cancer, and clear margins. She received 6 months of fluorouracil chemotherapy and remained free of recurrences for 5 years. CONCLUSIONS Isolated vascular recurrences of colon cancer can be cured with resection and systemic chemotherapy. Diagnosis and treatment of venous recurrences remains challenging owing to the lack or percutaneous access for biopsy and the difficulty of venous reconstruction.
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Affiliation(s)
- Zain El-Amir
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - John C Krauss
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Kichloo A, El-Amir Z, Dahiya DS, Al-Haddad M, Singh J, Singh G, Corpuz C, Shaka H. Rate and predictors of 30-day readmission for clostridiodes difficile: a United States analysis. Ann Med 2022; 54:150-158. [PMID: 34989297 PMCID: PMC8741240 DOI: 10.1080/07853890.2021.2023211] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clostridiodes difficile is a leading cause of healthcare-associated diarrhea. In this study, we aimed to identify the rates and predictors for 30-day readmissions of Clostridiodes difficile Enterocolitis (CDE) in the United States. METHODS We conducted a retrospective study of the Nationwide Readmissions Database to identify adult hospitalizations with a principal diagnosis of CDE for 2018. Individuals <18 years old and elective hospitalizations were excluded. Primary outcomes included readmission rate and the top ten principal diagnosis on readmission, while the secondary outcomes were inpatient mortality, hospital costs and independent predictors of 30-day all-cause readmissions. Furthermore, we devised a scoring system to estimate the risk of CDE readmissions. Stata® Version 16 was used for statistical analysis and p-values ≤0.05 were statistically significant. RESULTS We identified 94,668 index hospitalizations and 18,296 readmissions at 30-days for CDE in 2018. The 30-day all-cause readmission rate was 25.7%. On readmission, CDE was the most common principal diagnosis (25.7%), followed by unspecified sepsis, and acute renal failure. A female predominance was also noted for index and 30-day readmissions of CDE. Compared to index admissions, we noted higher odds of inpatient mortality [4.4 vs 1.4%, Odds Ratio (OR):3.32, 95% Confidence Interval (CI):2.87-3.84, p < 0.001], longer mean length of stay (LOS) [6.4 vs 5.6 days, Mean Difference (MD):0.9, 95% CI:0.7-1.0, p < 0.001), and higher mean total hospital charge (THC) [$56,015 vs $40,871, MD:15,144, 95% CI:13,260-17,027, p < 0.001] for 30-day readmissions of CDE. Independent predictors for 30-day all-cause readmissions of CDE included discharged against medical advice (AMA) [Adjusd Hazard Ratio (aHR):2.01, 95% CI:1.73-2.53, p < 0.001], diabetes mellitus (DM) [aHR:1.22, 95% CI:1.16-1.29, p < 0.001], and chronic kidney disease (CKD) [aHR:1.29, 95% CI:1.21-1.37, p < 0.001]. CONCLUSION The all-cause 30-day readmission rate and inpatient mortality for CDE was 25.7% and 4.4%, respectively. Discharge AMA, DM and CKD were independent predictors for 30-day all-cause readmissions of CDE.KEY MESSAGEThe 30-day all-cause readmission rate for Clostridiodes difficile Enterocolitis was noted to be 21.4% in 2018.Independent predictors of 30-day all-cause readmissions for Clostridiodes difficile Enterocolitis include diabetes mellitus, discharged against medical advice and chronic kidney disease.Readmissions of Clostridiodes difficile Enterocolitis had higher mortality rates, healthcare cost and length of hospital stay compared to index admissions.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.,Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jagmeet Singh
- Department of Nephrology, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Gurdeep Singh
- Department of Medicine and Endocrinology, Our Lady of Lourdes Memorial Hospital, Binghamton, NY, USA
| | - Carlos Corpuz
- Department of Internal Medicine, John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA
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Kichloo A, Edigin E, Jamal S, El-Amir Z, Aucar MI, Wani F, Eseaton PO, Annapureddy N, Cabling MG, Manadan AM. Thirty-Day Hospital Readmissions for Acute Gout in the United States: Analysis of the Nationwide Readmission Database. J Clin Rheumatol 2022; 28:e467-e472. [PMID: 34176884 DOI: 10.1097/rhu.0000000000001761] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE The aims of this study were to describe the rates and characteristics of nonelective 30-day readmission among adult patients hospitalized for acute gout and to assess predictors of readmission. METHODS We analyzed the 2017 Nationwide Readmission Database. Gout hospitalizations were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification code. Hospitalizations for adult patients were included. We excluded planned or elective readmissions. We utilized χ2 tests to compare baseline characteristics between readmissions and index hospitalizations. We used multivariate Cox regression to identify independent predictors of readmissions. RESULTS A total of 11,727 index adult hospitalizations with acute gout listed as the principal diagnosis were discharged alive and included. One thousand five hundred ninety-four (13.6%) readmissions occurred within 30 days. Acute gout was the most common reason for readmission. Readmissions had higher inpatient mortality (2.4% vs 0.1%, p < 0.0001), greater mean age (68.1 vs 67.0 years, p = 0.021), and longer hospital length of stay (5.9 vs 3.8 days, p < 0.0001) compared with index hospitalizations. Charlson Comorbidity Index scores of ≥2 (score 2: adjusted hazards ratio [AHR], 1.67; p = 0.001; score ≥3: AHR, 2.08; p < 0.0001), APR-DRG (All Patients Refined Diagnosis Related Groups) severity levels ≥2 (level 2: AHR, 1.43; p = 0.044; level 3: AHR, 1.83; p = 0.002; level 4: AHR, 2.38; p = 0.002), admission to metropolitan hospital (AHR, 1.83; p = 0.012), atrial fibrillation (AHR, 1.31; p = 0.004), and anemia (AHR, 1.30; p = 0.001) were significantly associated with 30-day readmissions. CONCLUSIONS Acute gout readmissions were associated with worse outcomes compared with index hospitalizations. Charlson Comorbidity Index scores ≥2, APR-DRG severity levels ≥2, admission to metropolitan hospital, atrial fibrillation, and anemia were significant predictors of readmission.
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Affiliation(s)
| | - Ehizogie Edigin
- Department of Internal Medicine, John H. Stronger, Jr. Hospital of Cook County, Chicago, IL
| | - Shakeel Jamal
- From the Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI
| | - Zain El-Amir
- From the Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI
| | - Maria Isabel Aucar
- From the Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI
| | - Farah Wani
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY
| | | | | | - Marven G Cabling
- Division of Rheumatology, Loma Linda University Medical Center, Loma Linda, CA
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Shaka H, El-Amir Z, Wani F, Albosta M, Dahiya DS, Alabi O, Muojieje CC, Kichloo A. Hospitalizations and inpatient mortality for hyperosmolar hyperglycemic state over a decade. Diabetes Res Clin Pract 2022; 185:109230. [PMID: 35122906 DOI: 10.1016/j.diabres.2022.109230] [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: 06/02/2021] [Revised: 12/29/2021] [Accepted: 01/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to describe rates and trends in hospitalizations, inpatient mortality, total hospital charges, and mean lengths of stay among adult patients hospitalized for hyperosmolar hyperglycemic state (HHS). METHODS The study included NIS databases 2008, 2010, 2012, 2014, 2016, and 2018. These databases were searched for hospitalizations with a principal discharge diagnosis of HHS in patients with T2DM using ICD codes (25020, 25022, and E110). Patients less than 18 years, elective hospitalizations, HHS in patients with T1DM or secondary diabetes mellitus were excluded. We used multivariable regression analysis to obtain trends in mortality, length of stay (LOS), and total hospital charges (THC). RESULTS Between 2008 and 2018, there was a trend towards increasing hospitalizations for T2DM with HHS (p trend < 0.001). The mean age over the period ranged from 56.9 to 59.1 years old. Men made up the majority of hospitalizations. Over the decade, there was a steady rise in the proportion of Whites and Hispanics with HHS, and Medicare was the most prevalent insurer overall. Inpatient mortality for HHS decreased from 1.44% in 2008 to 0.77% in 2018 (p trend 0.007). There was also a statistically significant decrease in both LOS and THC over the studied period. CONCLUSIONS Trends in HHS showed increased hospitalizations, LOS, and THC over the decade in the study period, but inpatient mortality declined.
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Affiliation(s)
- Hafeez Shaka
- Department of Internal Medicine, John H. Stroger Jr. Hospital, Chicago, IL, USA.
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA
| | - Farah Wani
- Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Michael Albosta
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA
| | | | - Omolabake Alabi
- Department of Internal Medicine, Jacobi Medical Center, NY, USA
| | | | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA; Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
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Kichloo A, El-Amir Z, Wani F, Shaka H. Hospitalizations for ketoacidosis in type 1 diabetes mellitus, 2008 to 2018. Proc AMIA Symp 2022; 35:1-5. [PMID: 34970023 DOI: 10.1080/08998280.2021.1978741] [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: 10/20/2022] Open
Abstract
The objective of this study was to characterize epidemiological trends, outcomes in hospitalized patients, and the disease burden of hospitalizations for diabetic ketoacidosis (DKA) in patients with type 1 diabetes mellitus (T1DM). This was a retrospective interrupted trends study involving hospitalizations for DKA in patients with T1DM in the US from 2008 to 2018 using data from the Nationwide Inpatient Sample. The total number of hospitalizations during each calendar year was obtained, and trends in inpatient mortality rate, mean length of hospital stay (LOS), and mean total hospital cost (THC) were calculated. Between 2008 and 2018, there was a trend toward increasing hospitalizations for T1DM with DKA (P-trend <0.001). Over the decade, there was a steady rise in the proportion of patients with a Charlson comorbidity index >1. There was no statistically significant change in adjusted inpatient mortality in patients with T1DM admitted for DKA over the study period despite an apparent trend of a decreasing crude mortality rate (P-trend = 0.063). There was a statistically significant decrease in both LOS and THC over the study period. In conclusion, there was a significant decrease in both LOS and THC, potentially reflecting improvements in the management of DKA in patients with T1DM.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan.,Department of Medicine, Samaritan Medical Center, Watertown, New York
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan
| | - Farah Wani
- Department of Medicine, Samaritan Medical Center, Watertown, New York
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stronger Jr. Hospital, Chicago, Illinois
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Kichloo A, El-Amir Z, Dahiya DS, Wani F, Singh J, Solanki D, Edigin E, Eseaton P, Mehboob A, Shaka H. Trends of alcoholic liver cirrhosis readmissions from 2010 to 2018: Rates and healthcare burden associated with readmissions. World J Hepatol 2021; 13:2128-2136. [PMID: 35070013 PMCID: PMC8727209 DOI: 10.4254/wjh.v13.i12.2128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/29/2021] [Revised: 08/24/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alcoholic liver cirrhosis (ALC) is a chronic liver disease with varying disease severity. Readmissions of ALC are associated with poor outcomes.
AIM To identify and assess trends of readmissions for ALC over an eight-year period.
METHODS This retrospective interrupted trend study analysed 30-d readmissions of ALC in the United States from 2010 to 2018 using the National Readmissions Database. Hospitalization for ALC was the reason for index admission obtained using the International Classification of Diseases codes (571.2 and K70.3X). Biodemographic characteristics and hospitalization trends were highlighted over time. A multivariate regression analysis model was used to calculate the trend for risk-adjusted odds of 30-d all-cause ALC readmissions, ALC specific readmission rate, ALC readmission proportion, inpatient mortality, mean length of stay (LOS) and mean total hospital cost (THC) following adjustments for age, gender, grouped Charlson Comorbidity Index, insurance, mean household income, and hospital characteristics.
RESULTS There was a trend towards increasing total 30-d readmissions of ALC from 7660 in 2010 to 15085 in 2018 (P < 0.001). Patients readmitted for ALC were noted to have an increasing comorbidity burden over time. We noted a rise in the risk-adjusted 30-d all-cause readmission of ALC from 24.9% in 2010 to 29.9% in 2018 (P < 0.001). ALC-specific readmission rate increased from 6.3% in 2010 to 8.4% in 2018 (P < 0.001) while ALC readmission proportion increased from 31.4% in 2010 to 36.3% in 2018 (P < 0.001). Inpatient mortality for 30-d readmissions of ALC declined from 10.5% in 2010 to 8.2% in 2018 (P = 0.0079). However, there was a trend towards increasing LOS from 5.6 d in 2010 to 6.3 d in 2018 (P < 0.001) and increasing THC from 13790 dollars in 2010 to 17150 dollars in 2018 (P < 0.001). The total days of hospital stay attributable to 30-d readmissions of ALC increased by 119.2% while the total attributable hospital costs increased by 149% by the end of 2018.
CONCLUSION There was an increase in the 30-d readmission rate and comorbidity burden for ALC; however, inpatient mortality declined. Additionally, there was a trend towards increasing LOS and THC for these readmissions.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
| | - Farah Wani
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Jagmeet Singh
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Dhanshree Solanki
- Department of Internal Medicine, Rutgers University, New Brunswick, NJ 07103, United States
| | - Ehizogie Edigin
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Precious Eseaton
- Department of Internal Medicine, University of Benin School of Medicine, Edo 300213, Nigeria
| | - Asad Mehboob
- Division of Gastroenterology, Department of Internal Medicine, Covenant Healthcare, Saginaw, MI 48602, United States
| | - Hafeez Shaka
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States
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Murthi M, Shaka H, El-Amir Z, Velagapudi S, Jamil A, Wani F, Atluri R, Kumar A, Kichloo A. Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample. BMC Pulm Med 2021; 21:410. [PMID: 34895211 PMCID: PMC8665606 DOI: 10.1186/s12890-021-01784-0] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022] Open
Abstract
Background Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS).
Methods In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality. Results In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia. Conclusion PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.
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Affiliation(s)
- Mukunthan Murthi
- John H Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA.
| | - Hafeez Shaka
- John H Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Sujitha Velagapudi
- John H Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA
| | - Abdul Jamil
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Farah Wani
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Ramtej Atluri
- John H Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Centre, Pittsburgh, USA
| | - Asim Kichloo
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA
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Shaka H, El-Amir Z, Aljadah M, Wani F, Velazquez G, Kichloo A. Comparing outcomes of diabetic ketoacidosis hospitalisations in patients with diastolic heart failure: A retrospective propensity matched analysis of the nationwide inpatient sample. Diabetes Metab Res Rev 2021; 37:e3435. [PMID: 33440066 DOI: 10.1002/dmrr.3435] [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: 11/29/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is a known complication of patients with diabetes mellitus. The aim of this study was to compare the outcomes of patients admitted with a diagnosis of DKA with, and without, diastolic heart failure (DHF). METHODS This was a population-based, retrospective, observational study using data from the National Inpatient Sample database for the years 2016 and 2017. The primary outcome was in-hospital mortality. Secondary outcomes were rates of sepsis, non-ST elevation myocardial infarctions (NSTEMI), acute kidney failure, acute respiratory failure (ARF), deep vein thrombosis, pulmonary embolism, mean length of hospital stay (LOS) and total hospital charges (THC). RESULTS There was no statistically significant difference for the adjusted odds for in-hospital mortality between patients with and without DHF (adjusted odds ratio [aOR]: 0.55, 95% confidence interval [CI] 0.28-1.08, p = 0.081). Patients with DKA and DHF had increased odds of developing an NSTEMI (aOR: 1.31, 95% CI: 1.01-1.70, p = 0.045) or ARF (aOR: 1.82, 95% CI: 1.38-2.40, p < 0.001) during the same admission compared to patients without DHF. Patients with DKA and DHF also had an increased mean THC (6500 CI: 1900-11,200, p = 0.0006) in US dollars and increased LOS (0.7, 95% CI: 0.2-1.3, p = 0.011) in days when compared to patients without DHF. CONCLUSIONS Patients with DKA showed no statistically significant difference in mortality if they did or did not have a secondary diagnosis of DHF within the same admission.
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Affiliation(s)
- Hafeez Shaka
- John H. Stronger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Zain El-Amir
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | | | - Farah Wani
- Samaritan Medical Center, Watertown, New York, USA
| | - Genero Velazquez
- John H. Stronger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Asim Kichloo
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
- Samaritan Medical Center, Watertown, New York, USA
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Kichloo A, El-Amir Z, Dahiya DS, Wani F, Shaka H. Trends in hospitalizations and mortality for inflammatory bowel disease from a nationwide database study between 2008 and 2018. Proc AMIA Symp 2021; 34:550-554. [PMID: 34456471 DOI: 10.1080/08998280.2021.1919009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/12/2023] Open
Abstract
This study aimed to describe the trends, inpatient outcomes, and disease burden of hospitalizations for ulcerative colitis (UC) and Crohn's disease (CD). Our study included data on hospitalizations with a principal discharge diagnosis of CD and UC gathered from the Nationwide Inpatient Sample for the years 2008, 2010, 2012, 2014, 2016, and 2018. Individuals ≤18 years and elective hospitalizations were excluded. From 2008 to 2018, we noted a rising trend for UC hospitalizations (P trend < 0.001). However, there was no statistically significant trend for CD hospitalizations (P trend = 0.249). The overall inpatient mortality for UC downtrended from 1.09% in 2008 to 0.42% in 2014 (P trend < 0.001). Additionally, inpatient mortality for CD also downtrended with a decrease from 0.28% in 2008 to 0.17% in 2016 (P trend = 0.002). Odds of inpatient mortality from 2008 to 2018 were significantly higher for UC than for CD. In conclusion, both CD and UC saw a significant decline in mortality over the study period, but UC hospitalizations had a higher odds of inpatient mortality for all study years.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine , Saginaw , Michigan.,Department of Internal Medicine, Samaritan Medical Center , Watertown , New York
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University College of Medicine , Saginaw , Michigan
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine , Saginaw , Michigan
| | - Farah Wani
- Department of Internal Medicine, Samaritan Medical Center , Watertown , New York
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County , Chicago , Illinois
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11
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Shaka H, Aguilera M, Aucar M, El-Amir Z, Wani F, Muojieje CC, Kichloo A. Rate and Predictors of 30-day Readmission Following Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A US Analysis. J Clin Endocrinol Metab 2021; 106:2592-2599. [PMID: 34043791 DOI: 10.1210/clinem/dgab372] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/10/2021] [Indexed: 01/12/2023]
Abstract
CONTEXT Diabetic ketoacidosis (DKA) is a serious endocrine emergency, associated with morbidity and mortality. Readmissions play a significant but sometimes preventable role in healthcare cost burden on the US. OBJECTIVE This study aimed to describe rates and characteristics of nonelective 30-day readmission among adult patients with diabetes mellitus type 1 (T1DM) hospitalized for DKA and also identify predictors of readmission. METHODS The study analyzed the 2018 Nationwide Readmission Database. DKA hospitalizations in patients with T1DM were classified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We utilized chi-squared tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariable Cox regression was employed to identify independent predictors of readmission. Following this, we developed a 30-day readmission risk scoring system based on independent predictors. RESULTS The 30-day all-cause readmission rate for DKA was 19.4%. A majority of patients (64.8%) had DKA as the principal diagnosis on readmission. Readmitted patients had a significantly higher mean age (35.3 vs 34.9 years, P = .018) and a higher proportion of females (52.8 vs 49.6%, P < .001) than the index admission. Readmission following DKA was associated with higher odds of inpatient mortality (0.69 vs 0.24%, OR 2.84, 95% CI 1.99-4.06, P < .001). Independent predictors of 30-day all-cause readmission included female sex, index hospitalizations with Charlson Comorbidity Index (CCI) score of 3 or greater, and being discharged against medical advice (AMA). CONCLUSION The readmission rate for DKA in T1DM patients is high, and most patients have DKA as the principal diagnosis on readmission. A CCI equal to or greater than 3, hypertension, female sex, and being discharged AMA were significant predictors of readmission.
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Affiliation(s)
- Hafeez Shaka
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Maria Aguilera
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Maria Aucar
- Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Zain El-Amir
- Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Farah Wani
- Samaritan Medical Center, Watertown, NY, USA
| | | | - Asim Kichloo
- Central Michigan University, College of Medicine, Saginaw, MI, USA
- Samaritan Medical Center, Watertown, NY, USA
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12
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Kichloo A, El-Amir Z, Shaka H, Wani F, Syed SJ. Predictors of 30-day readmissions for adrenal insufficiency: A retrospective national database study. Clin Endocrinol (Oxf) 2021; 95:269-276. [PMID: 33991345 DOI: 10.1111/cen.14500] [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: 02/03/2021] [Revised: 03/27/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to describe rates and characteristics of non-elective 30-day readmission among patients hospitalized for adrenal insufficiency and to assess predictors of readmission. DESIGN We analysed the 2018 National Readmission Database. Adrenal insufficiency hospitalizations were identified using the International Classification of Diseases, Tenth Revisions, Clinical Modification diagnosis codes for principal diagnostic codes of primary adrenal insufficiency, Addisonian crisis, drug-induced adrenocortical insufficiency, and other and unspecified adrenocortical insufficiency. PATIENTS During the study period, 7738 index hospitalizations were identified as patients with AI who met the inclusion criteria. Of these, 7691 were discharged alive. MEASUREMENTS We utilized chi-squared tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariate Cox regression was used to identify independent predictors of readmission. RESULTS The 30-day all-cause readmission rate for AI was 17.3%. About 1 in 5 readmissions was for AI. Other reasons for readmission included sepsis (10.8%), unspecified pneumonia (3.1%) and acute renal failure unspecified (1.6%). Readmission was associated with significantly higher odds of inpatient mortality. Independent predictors of 30-day all-cause readmissions included index hospitalizations with the Charlson Comorbidity Index (CCI) ≥3 (adjusted hazards ratio (aHR): 2.53, 95% CI: 1.85-3.46, p < .001), protein-energy malnutrition (aHR: 1.28, 95% CI: 1.02-1.60, p = .035) and obesity (aHR: 1.26, 95% CI: 1.02-1.56, p = .035). CONCLUSIONS The 30-day all-cause readmission rate was 17.3%. AI was the most common reason for readmission among other causes. Readmissions were associated with increased mortality. CCIs of 3 or more, protein-energy malnutrition and obesity were significant predictors of readmission.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
- Department of Medicine, Samaritan Medical Center, Watertown, New York, USA
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stronger Jr. Hospital, Chicago, Illinois, USA
| | - Farah Wani
- Department of Medicine, Samaritan Medical Center, Watertown, New York, USA
| | - Sofia Junaid Syed
- Department of Endocrinology, South Shore University Hospital, Bay Shore, New York, USA
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13
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Edigin E, El-Amir Z, Wani F, Kichloo A, Eseaton PO. Trends of readmissions of atopic dermatitis patients in the United States: a 9-year longitudinal analysis of the Nationwide readmission database. J Eur Acad Dermatol Venereol 2021; 35:e903-e904. [PMID: 34310773 DOI: 10.1111/jdv.17556] [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] [Received: 06/03/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- E Edigin
- Department of Internal Medicine, John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Z El-Amir
- Department of Internal Medicine, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - F Wani
- Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - A Kichloo
- Department of Internal Medicine, College of Medicine, Central Michigan University, Saginaw, MI, USA.,Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - P O Eseaton
- College of Medicine, University of Benin, Edo, Nigeria
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14
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Solanki D, Kichloo A, El-Amir Z, Dahiya DS, Singh J, Wani F, Solanki S. Clostridium difficile Infection Hospitalizations in the United States: Insights From the 2017 National Inpatient Sample. Gastroenterology Res 2021; 14:87-95. [PMID: 34007350 PMCID: PMC8110239 DOI: 10.14740/gr1371] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background There is a paucity of contemporary national estimates for Clostridium difficile infection (CDI) hospitalizations by age group, sex, and region in the US population. Also, there is lack of contemporary national statistics on CDI hospitalizations with comorbidities. Methods We analyzed the 2017 National Inpatient Sample (NIS) to determine the population-based rates of CDI hospitalizations, characteristics of hospitalizations with CDI, and the rates of comorbidities associated with CDI hospitalizations. Results There were 329,460 CDI-related hospitalizations in 2017 (almost 1% of all hospitalizations). The average age for patients admitted with CDI as a principal or secondary diagnosis was 64.7 years (almost 20 years older when compared with all other hospitalizations). Patients 85 years and older had the highest rate of CDI hospitalizations (716 per 100,000 hospitalizations), and patients less than 18 years of age had the lowest rate (12 per 100,000 hospitalizations). There was a progressive increase in the CDI hospitalization rates with each successive age group. The hospitalization rates were higher in females (114 per 100,000 hospitalizations) than males (88 per 100,000 hospitalizations). The CDI hospitalization rate was highest in the Northeast (109 per 100,000 hospitalizations) and lowest in the West (84 per 100,000 hospitalizations). Fluid and electrolyte disturbance (63.3%) and renal failure (33.4%) were the two most common comorbidities associated with CDI hospitalizations. When CDI is a secondary diagnosis, major loss of function, extreme likelihood of dying, septicemia, and septic shock were more common in comparison to CDI as a principal diagnosis. Conclusions CDI hospitalization rates were highest in the elderly over 85 years old and declined with successive decreases in age. Women had higher CDI hospitalization rates than men, and fluid and electrolyte disturbances and renal failure were the most common comorbid conditions. The presence of CDI as a comorbid condition at the time of hospitalization for other principal diagnoses or development of CDI during a hospitalization for other principal diagnoses significantly increases the risk of in-hospital morbidity and mortality.
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Affiliation(s)
| | - Asim Kichloo
- Department of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Zain El-Amir
- Department of Medicine, Central Michigan University, Saginaw, MI, USA
| | | | - Jagmeet Singh
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Farah Wani
- Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Shantanu Solanki
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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15
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Shaka H, Wani F, El-Amir Z, Dahiya DS, Singh J, Edigin E, Eseaton P, Kichloo A. Comparing patient characteristics and outcomes in type 1 versus type 2 diabetes with diabetic ketoacidosis: a review and a propensity-matched nationwide analysis. J Investig Med 2021; 69:1196-1200. [PMID: 33972382 DOI: 10.1136/jim-2021-001901] [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] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
Diabetic ketoacidosis (DKA) is a known complication of patients with type 1 diabetes mellitus (T1DM), but less common in type 2 diabetes mellitus (T2DM). The aim of this study was to compare the outcomes of patients admitted to the hospital with DKA in T1DM versus T2DM. This was a population-based, retrospective, cohort study using data from the Nationwide Inpatient Sample. The group of patients hospitalized for DKA was divided based on a secondary diagnosis of either T1DM or T2DM. The primary outcome was inpatient mortality, and the secondary outcomes were rate of complications, length of hospital stay (LOS) and total hospital charge (THC). The inpatient mortality for DKA was 0.27% (650 patients). In T2DM, the adjusted OR (aOR) for mortality was 2.13 (95% CI 1.38 to 3.28, p=0.001) with adjusted increase in mean THC of $6035 (95% CI 4420 to 7652, p<0.001) and mean LOS of 0.5 day (95% CI 0.3 to 0.6, p<0.001) compared with T1DM. Patients with T2DM had significantly higher odds of having septic shock (aOR 2.02, 95% CI 1.160 to 3.524, p=0.013) compared with T1DM. T2DM was associated with higher inpatient mortality, septic shock and increase in healthcare utilization costs compared with T1DM.
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Affiliation(s)
- Hafeez Shaka
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Farah Wani
- Department of Internal Medicine, Samaritan Medical Center, Watertown, New York, USA
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Ehizogie Edigin
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Precious Eseaton
- Department of Medicine and Surgery, University of Benin, Benin City, Edo, Nigeria
| | - Asim Kichloo
- CMU Medical Education Partners, Saginaw, Michigan, USA
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16
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Kichloo A, Shaka H, El-Amir Z, Wani F, Singh J, Velazquez GR, Edigin E, Dahiya D. In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017. Postgrad Med 2021; 133:854-859. [PMID: 33858299 DOI: 10.1080/00325481.2021.1916231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/21/2022]
Abstract
Introduction:Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM).Methods:This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. Hospitalizations of adults >/ = 18 years old with a principal diagnosis of DKA were obtained using ICD-10 codes and divided into groups based on a secondary diagnosis of PEM. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), and system-based complications.Results:Patients with PEM had a statistically significant difference in the adjusted odds for in-hospital mortality compared to patients without PEM (aOR 1.73, 95% CI: 1.20-2.49, p = 0.004). Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49-3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31-4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17-1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83-2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43-2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42-3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000-22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96-2.57, p < 0.001) in days when compared to patients without PEM.Conclusion:Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality.
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Affiliation(s)
- Asim Kichloo
- Central Michigan University, College of Medicine, Saginaw, Michigan, USA.,Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Hafeez Shaka
- Department of Internal Medicine., John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Zain El-Amir
- Central Michigan University, College of Medicine, Saginaw, Michigan, USA
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Jagmeet Singh
- Department of Internal Medicine., Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Genaro Romario Velazquez
- Department of Internal Medicine., John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Ehizogie Edigin
- Department of Internal Medicine., John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Dushyant Dahiya
- Central Michigan University, College of Medicine, Saginaw, Michigan, USA
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17
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Kichloo A, El-Amir Z, Dahiya DS, Singh J, Solanki D, Wani F, Shaka H. Impact of coexisting pneumonia in the patients admitted with Clostridium difficile infection: a retrospective study from a national inpatient database. J Investig Med 2021; 69:976-982. [PMID: 33785548 DOI: 10.1136/jim-2021-001820] [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] [Accepted: 03/05/2021] [Indexed: 11/04/2022]
Abstract
Clostridium difficile is a gram-positive anaerobic spore forming bacillus that can cause infection in a setting of antibiotic use. Pneumonia is a major cause of morbidity and mortality in an inpatient setting and is frequently associated with significant antibiotic administration. This study aims to compare the outcomes of C. difficile infection (CDI) with and without pneumonia to determine the impact of pneumonia in hospitalized patients with CDI. This population-based retrospective observational propensity matched analysis study uses data from the National Inpatient Sample database for the years 2016 and 2017. The primary outcomes were in-hospital mortality, total hospital charges, and mean length of stay. Secondary outcomes were the rates of sepsis, septic shock, non-ST elevation myocardial infarction (NSTEMI), acute renal failure, deep vein thrombosis, and pulmonary embolism. In-hospital mortality was noted to be higher in patients with pneumonia than those without (6.5% vs 1.2%, adjusted OR (aOR) 3.85; 95% CI 2.90 to 5.11, p<0.001). The following outcomes were more prevalent in patients with pneumonia compared with those without pneumonia: sepsis (9.8% vs 1.8%, aOR 4.69, 95% CI 3.73 to 5.87, p<0.001), septic shock (4.0% vs 0.5%, aOR 6.32, 95% CI 4.43 to 9.03, p<0.001), NSTEMI (1.9% vs 0.5%, aOR 2.95, 95% CI 1.85 to 4.71, p<0.001), and acute renal failure (31.5% vs 23.1%, aOR 1.23, 95% CI 1.07 to 1.40, p=0.003). In conclusion, patients with pneumonia were associated with significantly higher rates of system-based complications and higher in-hospital mortality rates.
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Affiliation(s)
- Asim Kichloo
- Department of Medicine, Samaritan Medical Center, Watertown, New York, USA .,Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Guthrie Healthcare System, Sayre, Pennsylvania, USA.,Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Dhanshree Solanki
- Department of Public Health, Rutgers University System, New Brunswick, New Jersey, USA
| | - Farah Wani
- Department of Medicine, Samaritan Medical Center, Watertown, New York, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
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18
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Kichloo A, Albosta M, Aljadah M, El-Amir Z, Goldar G, Khan MZ, Dahiya DS, Vallabhaneni S, Wani F, Singh J. Marijuana: A systems-based primer of adverse effects associated with use and an overview of its therapeutic utility. SAGE Open Med 2021; 9:20503121211000909. [PMID: 33786179 PMCID: PMC7958160 DOI: 10.1177/20503121211000909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/08/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
Marijuana use is on the rise in the United States. By the end of 2019, 33 states have legalized marijuana use and marijuana byproduct use for medical purposes. However, marijuana use does not come without side effects. This manuscript reviews the increasing usage of marijuana and the different forms (natural and synthetic) that patients may use when presenting to clinicians. It also addresses the biochemical and behavioral changes observed with marijuana use, including the location and changes associated with cannabinoid receptors (abbreviated CB1 and CB2). These two topics lead into an extensive review of the side effects of marijuana use. This manuscript discusses gastrointestinal side-effects, such as Cannabinoid Hyperemesis Syndrome, pancreatitis, and hepatotoxicity. It also briefly reviews cardiovascular, neurologic, and pulmonary side effects. This article provides an overview of therapeutic effects of marijuana including the antiemetic effect, its medical utility as an appetite stimulant, and usefulness in cancer patients post-chemotherapy. A thorough social history pertaining to marijuana use is an important consideration for clinicians in patients presenting with a variety of symptoms, including those effecting the gastrointestinal, cardiovascular, pulmonary, or neurologic systems.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Michael Albosta
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Michael Aljadah
- Department of Internal Medicine,
Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zain El-Amir
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Ghazaleh Goldar
- Department of Internal Medicine,
Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Muhammed Zatmar Khan
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | | | - Farah Wani
- Department of Family Medicine,
Samaritan Medical Center, Watertown, NY, USA
| | - Jagmeet Singh
- Department of Nephrology, Guthrie
Robert Packer Hospital, Sayre, PA, USA
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19
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Kichloo A, El-Amir Z, Wani F, Beiz H. Mortal remains disposal in the wake of the COVID-19 pandemic. Cleve Clin J Med 2021:ccjm.88a.ccc070. [PMID: 33500271 DOI: 10.3949/ccjm.88a.ccc070] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
When dealing with infectious disease-related deaths, it is important to handle the remains of the deceased in a respectful and safe manner. There is no known evidence of SARS-CoV-2 transmission through handling of COVID-19 victim remains. However, guidelines recommend appropriate precautions to ensure safety from any potential risk. Discussions of safe and dignified postmortem care in COVID-19 cases can guide future decision making to encourage safety, dignity, and respect for all.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI; Department of Internal Medicine, Samaritan Medical Center, Watertown, NY
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center, Watertown, NY
| | - Hassan Beiz
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI
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20
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Kichloo A, Albosta M, Kumar A, Aljadah M, Mohamed M, El-Amir Z, Wani F, Jamal S, Singh J, Kichloo A. Emerging therapeutics in the management of COVID-19. World J Virol 2021; 10:1-29. [PMID: 33585175 PMCID: PMC7852573 DOI: 10.5501/wjv.v10.i1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/18/2020] [Revised: 12/02/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019, COVID-19) pandemic has placed a tremendous burden on healthcare systems globally. Therapeutics for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical trials. Currently, there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19. A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 pandemic. We used PubMed, Google Scholar, and Clinicaltrials.gov to search for articles relative to the topic of interest. We used the following keywords: "COVID-19", "therapeutics", "clinical trials", "treatment", "FDA", "ICU", "mortality", and "management". In addition, searches through the references of retrieved articles was also performed. In this paper, we have elaborated on the therapeutic strategies that have been hypothesized or trialed to-date, the mechanism of action of each therapeutic, the clinical trials finished or in-process that support the use of each therapeutic, and the adverse effects associated with each therapeutic. Currently, there is no treatment that has been proven to provide significant benefit in reducing morbidity and mortality. There are many clinical trials for numerous different therapeutic agents currently underway. By looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research, we provide ourselves with the greatest opportunity to find treatments that are beneficial.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Michael Albosta
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Michael Aljadah
- Deparment of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Mohamed Mohamed
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
| | - Jagmeet Singh
- Department of Transplant Nephrology, Geisinger Commonwealth School of Medicine, Sayre, PA 18510, United States
| | - Akif Kichloo
- Department of Anesthesiology and Critical Care, Saraswathi Institue of Medical Sciences, Uttar Pradesh 245304, India
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21
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Kichloo A, Kumar A, Amir R, Aljadah M, Farooqi N, Albosta M, Singh J, Jamal S, El-Amir Z, Kichloo A, Lone N. Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic. World J Crit Care Med 2021; 10:1-11. [PMID: 33505868 PMCID: PMC7805254 DOI: 10.5492/wjccm.v10.i1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/16/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
The ongoing outbreak of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2, or coronavirus disease 2019 (COVID-19)] was declared a pandemic by the World Health Organization on March 11, 2020. Worldwide, more than 65 million people have been infected with this SARS-CoV-2 virus, and over 1.5 million people have died due to the viral illness. Although a tremendous amount of medical progress has been made since its inception, there continues to be ongoing research regarding the pathophysiology, treatments, and vaccines. While a vast majority of those infected develop only mild to moderate symptoms, about 5% of people have severe forms of infection resulting in respiratory failure, myocarditis, septic shock, or multi-organ failure. Despite maximal cardiopulmonary support and invasive mechanical ventilation, mortality remains high. Extracorporeal membrane oxygenation (ECMO) remains a valid treatment option when maximal conventional strategies fail. Utilization of ECMO in the pandemic is challenging from both resource allocation and ethical standpoints. This article reviews the rationale behind its use, current status of utilization, and future considerations for ECMO in critically ill COVID-19 patients.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Rawan Amir
- Department of Internal Medicine, University of Maryland, Baltimore, MD 20742, United States
| | - Michael Aljadah
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Najiha Farooqi
- Department of Surgery, Central Michigan University, Saginaw, MI 48603, United States
| | - Michael Albosta
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Jagmeet Singh
- Department of Nephrology and Transplant Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Akif Kichloo
- Department of Anesthesiology and Critical Care, Saraswathi Institute of Medical Sciences, Uttar Pradesh 245304, India
| | - Nazir Lone
- Department of Pulmonology and Critical Care, Northwell Health, Riverhead, NY 11901, United States
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22
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Kichloo A, Albosta M, Dettloff K, Wani F, El-Amir Z, Singh J, Aljadah M, Chakinala RC, Kanugula AK, Solanki S, Chugh S. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Fam Med Community Health 2020; 8:fmch-2020-000530. [PMID: 32816942 PMCID: PMC7437610 DOI: 10.1136/fmch-2020-000530] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [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] [Indexed: 12/15/2022] Open
Abstract
A narrative review was conducted to examine the current state of the utilisation of telemedicine amid the current COVID-19 pandemic and to evaluate the benefits of continuing telemedicine usage in the future. A literature review was performed for articles related to telemedicine. Databases including PubMed, Google Scholar, Cochrane Library and Ovid MEDLINE were searched. Three reviewers independently performed article selection based on relevance to our topic. We included all articles between 1990 and 2020 related to telemedicine using the following keywords: ‘telemedicine’, ‘telehealth’, ‘policy’, ‘COVID-19’, ‘regulation’, ‘rural’, ‘physical examination’, ‘future’. A total of 60 articles were identified, and through careful selection we narrowed the final number of articles to 42 based on relevance to our topic. Telemedicine has been rapidly evolving over the past several decades. Issues with regulation and reimbursement have prevented its full immersion into the healthcare system. During the current pandemic, Centers for Medicare and Medicaid services have expanded access to telemedicine services. The advantages of telemedicine moving forward include its cost-effectiveness, ability to extend access to specialty services and its potential to help mitigate the looming physician shortage. Disadvantages include lack of available technological resources in certain parts of the country, issues with security of patient data, and challenges in performing the traditional patient examination. It is critically important that changes are made to fully immerse telemedicine services into the healthcare landscape in order to be prepared for future pandemics as well as to reap the benefits of this service in the future.
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Affiliation(s)
- Asim Kichloo
- Internal Medicine, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Michael Albosta
- Internal Medicine, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Kirk Dettloff
- Internal Medicine, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Farah Wani
- Family Medicine, Samaritan Medical Center, Watertown, New York, USA
| | - Zain El-Amir
- Internal Medicine, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Jagmeet Singh
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Michael Aljadah
- Internal Medicine, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | | | | | - Shantanu Solanki
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Savneek Chugh
- Nephrology, Westchester Medical Center, Valhalla, New York, USA
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23
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Abstract
Caroli disease is a rare congenital disorder resulting from the dilation of large intrahepatic bile ducts. Patients affected with Caroli disease are at increased risk of complications resulting from bile stasis and stone formation. We report the case of a 37-year-old woman with a past surgical history of cholecystectomy who presented to the emergency room with a chief complaint of abdominal pain and nausea. The pain was characteristic of acute pancreatitis but she was hemodynamically stable. Total bilirubin was 4.1 mg/dL with a direct fraction of 3.1 mg/dL, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were 850 IU/L and 1025 IU/L, respectively. Serum amylase and lipase were elevated at 581 IU/L and 1328 IU/L, respectively. CT scan of abdomen/pelvis without contrast showed common bile duct (CBD) measuring 1.6 cm with intrahepatic biliary system dilation and mild peripancreatic fat stranding. She was diagnosed with acute pancreatitis. On the second day, she developed a temperature of 99.6°F. Hepatitis immunity panel was negative for acute hepatitis. The patient was started on antibiotics (IV ciprofloxacin and metronidazole) for suspicion of acute cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) was done which showed mild dilated intrahepatic ducts and CBD dilation of 1.6 cm, and a choledochal cyst at CBD. Sphincterotomy was done and good bile drainage was reported. She was later discharged in a stable condition. Caroli disease affects males and females equally and most are diagnosed before the age of 30 years correlated with the onset of symptoms. By far, the most commonly reported symptom is acute cholangitis but pancreatitis occurs rarely. Recurrent bouts of infection lead to portal hypertension, fibrosis of the liver and ultimately end up with an orthotopic liver transplant (OLT). Regular follow-ups are important for disease surveillance and monitoring.
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Affiliation(s)
- Muhammad Z Khan
- Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA
| | - Asim Kichloo
- Internal Medicine, Central Michigan University, Saginaw, USA
| | - Zain El-Amir
- Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA
| | | | - Farah Wani
- Family Medicine, Samaritan Medical Center, Watertown, USA
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