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Quixabeira DCA, Pakola S, Jirovec E, Havunen R, Basnet S, Santos JM, Kudling TV, Clubb JHA, Haybout L, Arias V, Grönberg-Vähä-Koskela S, Cervera-Carrascon V, Kerkelä E, Pasanen A, Anttila M, Tapper J, Kanerva A, Hemminki A. Boosting cytotoxicity of adoptive allogeneic NK cell therapy with an oncolytic adenovirus encoding a human vIL-2 cytokine for the treatment of human ovarian cancer. Cancer Gene Ther 2023; 30:1679-1690. [PMID: 37949944 PMCID: PMC10721546 DOI: 10.1038/s41417-023-00674-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/31/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Despite good results in the treatment of hematological malignancies, Natural killer (NK) cells have shown limited effectiveness in solid tumors, such as ovarian cancer (OvCa). Here, we assessed the potential of an oncolytic adenovirus expressing a variant interleukin-2 (vIL-2) cytokine, Ad5/3-E2F-d24-vIL2 (vIL-2 virus), also known as TILT-452, to enhance NK cell therapy efficacy in human OvCa ex vivo. Human OvCa surgical specimens were processed into single-cell suspensions and NK cells were expanded from healthy blood donors. OvCa sample digests were co-cultured ex vivo with NK cells and vIL-2 virus and cancer cell killing potential assessed in real time through cell impedance measurement. Proposed therapeutic combination was evaluated in vivo with an OvCa patient-derived xenograft (PDX) in mice. Addition of vIL-2 virus significantly enhanced NK cell therapy killing potential in treated OvCa co-cultures. Similarly, vIL-2 virus in combination with NK cell therapy promoted the best in vivo OvCa tumor control. Mechanistically, vIL-2 virus induced higher percentages of granzyme B in NK cells, and CD8+ T cells, while T regulatory cell proportions remained comparable to NK cell monotherapy in vivo. Ad5/3-E2F-d24-vIL2 virus treatment represents a promising strategy to boost adoptive NK cell therapeutic effect in human OvCa.
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Affiliation(s)
- D C A Quixabeira
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - S Pakola
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Jirovec
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - R Havunen
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - S Basnet
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J M Santos
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - T V Kudling
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J H A Clubb
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - L Haybout
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - V Arias
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Grönberg-Vähä-Koskela
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - V Cervera-Carrascon
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - E Kerkelä
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - A Pasanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Anttila
- Pathology, Finnish Food Authority, Helsinki, Finland
| | - J Tapper
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - A Kanerva
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - A Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- TILT Biotherapeutics Ltd, Helsinki, Finland.
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.
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Quixabeira DCA, Jirovec E, Pakola S, Havunen R, Basnet S, Santos JM, Kudling TV, Clubb JHA, Haybout L, Arias V, Grönberg-Vähä-Koskela S, Cervera-Carrascon V, Pasanen A, Anttila M, Tapper J, Kanerva A, Hemminki A. Improving the cytotoxic response of tumor-infiltrating lymphocytes towards advanced stage ovarian cancer with an oncolytic adenovirus expressing a human vIL-2 cytokine. Cancer Gene Ther 2023; 30:1543-1553. [PMID: 37666898 PMCID: PMC10645590 DOI: 10.1038/s41417-023-00658-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
While the presence of tumor-infiltrating lymphocytes (TILs) associates with improved survival prognosis in ovarian cancer (OvCa) patients, TIL therapy benefit is limited. Here, we evaluated an oncolytic adenovirus coding for a human variant IL-2 (vIL-2) cytokine, Ad5/3-E2F-d24-vIL2 (vIL-2 virus), also known as TILT-452, as an immunotherapeutic strategy to enhance TIL responsiveness towards advanced stage OvCa tumors. Fragments of resected human OvCa tumors were processed into single-cell suspensions, and autologous TILs were expanded from said samples. OvCa tumor specimens were co-cultured with TILs plus vIL-2 virus, and cell killing was assessed in real time through cell impedance measurement. Combination therapy was further evaluated in vivo through a patient-derived xenograft (PDX) ovarian cancer murine model. The combination of vIL-2 virus plus TILs had best cancer cell killing ex vivo compared to TILs monotherapy. These results were supported by an in vivo experiment, where the best OvCa tumor control was obtained when vIL-2 virus was added to TIL therapy. Furthermore, the proposed therapy induced a highly cytotoxic phenotype demonstrated by increased granzyme B intensity in NK cells, CD4+ T, and CD8+ T cells in treated tumors. Our results demonstrate that Ad5/3-E2F-d24-vIL2 therapy consistently improved TILs therapy cytotoxicity in treated human OvCa tumors.
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Affiliation(s)
- D C A Quixabeira
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - E Jirovec
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Pakola
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - R Havunen
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - S Basnet
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J M Santos
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - T V Kudling
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J H A Clubb
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - L Haybout
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - V Arias
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Grönberg-Vähä-Koskela
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - V Cervera-Carrascon
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- TILT Biotherapeutics Ltd, Helsinki, Finland
| | - A Pasanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Anttila
- Pathology, Finnish Food Authority, Helsinki, Finland
| | - J Tapper
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - A Kanerva
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - A Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- TILT Biotherapeutics Ltd, Helsinki, Finland.
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.
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Sharma NR, Basnet A, Lamichhane S, Kansakar S, Seitillari A, Rivera Boadla ME, Gautam S, Kc P, Tiwari K, Singh A, Basnet S, Lamichhane B, Pokhrel M. Outcome of Atrial Fibrillation Ablation in Cancer Patients: A Review. Cureus 2023; 15:e47818. [PMID: 38022229 PMCID: PMC10676746 DOI: 10.7759/cureus.47818] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Atrial fibrillation (AF), a cardiac arrhythmia, exhibits a heightened prevalence among individuals diagnosed with cancer, notably prominent in cases of lung and gastrointestinal malignancies. Robust evidence from extensive studies underscores this association, emphasizing its clinical significance. However, the precise mechanistic underpinnings and specific risk factors linking cancer and AF remain a subject of incomplete understanding. Notably, the prevalence of AF in cancer patients substantially exceeds that in non-cancer counterparts, prompting further exploration of the underlying pathophysiological processes. This review aims to address the existing knowledge void regarding AF management in cancer patients, with a specific focus on the potential role of ablation procedures. While catheter and surgical ablation techniques have been thoroughly investigated and validated as effective treatments within non-cancer populations, their applicability and outcomes in cancer patients have remained inadequately explored. The principal objective of this exhaustive review is to bridge this research gap by conducting a meticulous examination of the feasibility, safety, and effectiveness of ablation interventions for AF in the context of cancer patients. By amalgamating existing evidence and pinpointing critical areas necessitating additional investigation, this review endeavors to provide invaluable insights into AF management in cancer patients, with the ultimate goal of enhancing their clinical care and optimizing outcomes.
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Affiliation(s)
- Nava R Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Arjun Basnet
- Cardiology, Tower Health Medical Group, West Reading, USA
| | | | - Sajog Kansakar
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | | | | | - Prabal Kc
- Internal Medicine, Rasuwa District Hospital, Kathmandu, NPL
| | - Kripa Tiwari
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | | | - Sijan Basnet
- Internal Medicine, The Reading Hospital and Medical Center, Wyomissing, USA
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Quixabeira D, Pakola S, Jirovec E, Basnet S, Santos J, Kudling T, Clubb J, Haybout L, Arias V, Grönberg-Vähä-Koskela S, Havunen R, Cervera-Carrascon V, Pasanen A, Tapper J, Kanerva A, Hemminki A. 50P Enhancing TIL and NK cells adoptive therapies with an engineered oncolytic adenovirus encoding a human vIL-2 cytokine for the treatment of human ovarian cancer. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Basnet S, Santos J, Quixabeira D, Clubb J, Grönberg-Vähä-Koskela S, Pakola S, Kudling T, Heiniö C, Havunen R, Cervera-Carrascon V, Sorsa S, Anttila M, Kanerva A, Hemminki A. 52P MUC1 targeted immunotherapy with an oncolytic adenovirus coding for a bispecific T cell engager. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Karmacharya RM, Singh AK, Vaidya S, Tuladhar SM, Devbhandari M, Lama B, Kharel BB, Basnet S. Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:452-455. [PMID: 37795723] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A K Singh
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Vaidya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S M Tuladhar
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Lama
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B B Kharel
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Basnet
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Suwal A, Shrestha B, Paudel A, Paudel R, Basnet S. A Case of Macrophage Activation Syndrome Manifesting as the Initial Presentation of Systemic Lupus Erythematosus. Cureus 2022; 14:e26375. [PMID: 35911271 PMCID: PMC9328934 DOI: 10.7759/cureus.26375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Macrophage activation syndrome (MAS) is a potentially fatal complication of an autoimmune rheumatologic disease characterized by overwhelming inflammation, multiorgan failure, and high mortality if untreated. We report a rare case of a 56-year-old man who presented with fever for three weeks and had a constellation of clinical features and laboratory findings, meeting the diagnostic criteria for systemic lupus erythematosus (SLE) and SLE-associated MAS. He was treated with high dose intravenous corticosteroid and hydroxychloroquine, resulting in resolution of fever and dramatic clinical improvement.
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8
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Suwal A, Rijal SS, Shrestha M, Munankami S, Basnet S. Paget-Schroetter Syndrome: A Rare Case of Upper Extremity Deep Vein Thrombosis in a Young Swimmer. Cureus 2022; 14:e26060. [PMID: 35865424 PMCID: PMC9293272 DOI: 10.7759/cureus.26060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/06/2022] Open
Abstract
Paget-Schroetter syndrome (PSS) is a rare form of spontaneous upper extremity deep vein thrombosis associated with vigorous activity of the upper extremities. We present a rare case of a young swimmer who presented with a painful right upper extremity swelling, with compression ultrasound (CUS) revealing extensive venous clots in the basilic, axillary, and subclavian veins. Venous duplex revealed extrinsic compression of the subclavian vein, and catheter-based contrast venography confirmed our diagnosis of PSS. The patient was started on a therapeutic dose of subcutaneous enoxaparin and referred to a higher center for further intervention.
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9
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Munankami S, Shrestha M, Basnet S, Rijal SS. A Rare Case of Leptomeningeal Carcinomatosis Secondary to Metastatic Non-Small Cell Lung Carcinoma. Cureus 2022; 14:e25436. [PMID: 35774640 PMCID: PMC9237378 DOI: 10.7759/cureus.25436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Leptomeningeal carcinomatosis is a rare complication of metastatic systemic malignancy, with lung cancer being the most common cause. We present a case of a 75-year-old man with a past medical history of right non-small cell lung carcinoma and ischemic stroke who presented with a persistent headache and swallowing difficulties. On evaluation, the patient was initially diagnosed with a subacute infarct of the right posterior frontal lobe following magnetic resonance imaging (MRI). The patient’s headache and dysphagia worsened, increasing the possibility of brain metastasis. The patient underwent cerebrospinal fluid analysis including cytology and multiple MRI studies with no obvious explanation for the symptoms. The patient eventually developed multiple cranial nerve palsies, and a diagnosis of leptomeningeal carcinomatosis was made with neuroradiology consultation for the MRI.
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10
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Shrestha B, Rijal SS, Pokhrel A, Paudel A, Baral K, Poudel B, Basnet S, Donato A. Pseudohyperkalemia Associated With Leukemia. Cureus 2022; 14:e23978. [PMID: 35541290 PMCID: PMC9084244 DOI: 10.7759/cureus.23978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/11/2022] Open
Abstract
Elevated potassium levels can be a life-threatening emergency. We describe a case of falsely elevated serum potassium level in a patient with leukemia, which was suspected to be falsely elevated because the patient was asymptomatic with a normal electrocardiogram (EKG). Common reasons behind such a discrepancy in leukemia patients are the use of a tourniquet before collection, use of vacuum/pneumatic tubes for transportation, prolonged periods of incubation, use of heparin for sample collection, and processing of samples via centrifugation. Since the process is related to the method of collection and processing, we recommend using rapid point of care testing in such cases to differentiate between false and true potassium elevation, as it is a well-validated tool. Moreover, there is a good correlation between potassium measured with the blood gas, point of care, and central laboratory analyzers when the concentration of potassium is above 3 mEq/L.
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11
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Poudel DR, Basnet S, Shrestha LP. Clinico-epidemiological Profile of Children with Chronic Kidney Disease in Tertiary Care Referral Center in Nepal: Prospective observational study. Kathmandu Univ Med J (KUMJ) 2022; 20:198-202. [PMID: 37017166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background Chronic kidney disease in children has been increasing over the years and is associated with high degree of morbidity and mortality. The cost of treating children with chronic kidney disease is also substantial. Prevention of this disease is the only long term solution in our context. Till date, there is limited data on chronic kidney disease in Nepalese children. Objective To study the epidemiological, clinical and etiological profile of children with Chronic Kidney Disease from 2 to 16 years of age presenting for the first time in tertiary care hospital. Method This is the prospective observational study carried out at the tertiary care hospital over a period of 3 years. Children between 2-16 years who were first time diagnosed of chronic kidney disease and had estimated glomerular filtration rate < 60 ml/ min/1.73 m2 for last 3 months were enrolled. Result There were total of 124 patients, of whom 78 were male with male to female ratio of 5:3 with mean age of 11.8±2.2 years. Chronic glomerulonephritis (23%), reflux nephropathy (23%) and nephrolithiasis (16%) were the commonest etiological diagnosis. Rapidly progressive glomerulonephritis and systemic lupus erythematous accounted for 85% cases of chronic glomerulonephritis. Vesicoureteric reflux and posterior urethral valve accounted for 85% cases of reflux nephropathy. In 32%, the cause could not be determined. Swelling (45%) and dyspnea (20%) were the chief presenting complaints. Pallor were seen in all cases (100%) followed by hypertension in 68% and short stature in 64%. Majority (60%) of the patients with chronic kidney disease presented in the stage V. Conclusion Chronic glomerulonephritis and reflux nephropathy were the commonest etiologies of chronic kidney disease, majority of them following rapidly progressive glomerulonephritis, systemic lupus erythematosis, vesicoureteric reflux and posterior urethral valve. The commonest clinical features were swelling, dyspnea, pallor and hypertension.
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Affiliation(s)
- D R Poudel
- Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - S Basnet
- Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - L P Shrestha
- Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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12
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Shrestha B, Pokhrel A, Oke I, Paudel A, Timlisina B, Parajuli P, Basnet S, Poudel B. Lambl’s Excrescences Associated with Cardioembolic Stroke. Am J Case Rep 2022; 23:e934859. [PMID: 35314665 PMCID: PMC8948441 DOI: 10.12659/ajcr.934859] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 73-year-old
Final Diagnosis: Lambl’s excrescence • stroke
Symptoms: Blurring of vision • weakness
Medication: —
Clinical Procedure: —
Specialty: Cardiology • Neurology
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Affiliation(s)
- Biraj Shrestha
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Arpan Pokhrel
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Ibiyemi Oke
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Anish Paudel
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Bidhya Timlisina
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Prem Parajuli
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Sijan Basnet
- Department of Medicine, Reading Hospital – Tower Health, West Reading, USA
| | - Bidhya Poudel
- Department of Medicine, AMITA Health Saint Francis Hospital, Evanston, USA
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13
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Shakya KN, Bhatta A, Yadav A, Gautam U, Basnet S. Sydenham's Chorea with Silent Cardiac Lesions, Mimicking. Kathmandu Univ Med J (KUMJ) 2021; 19:282-284. [PMID: 34819453] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sydenham's chorea is an uncommon neurological manifestation of rheumatic fever and has many and varied differential diagnosis. It may mimic encephalitis when presents as an isolated feature even when silent cardiac lesions are present. Early diagnosis, treatment and penicillin prophylaxis prevents recurrence and progression of cardiac lesions. Prompt symptomatic relief and alleviation of distress is obtained with therapeutic intervention. A case of rheumatic chorea with silent cardiac valve lesions which mimicked herpes simplex encephalitis with choreoathetosis, in a 13 year old girl is presented along with review of literature.
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Affiliation(s)
- K N Shakya
- Department of Pediatrics, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - A Bhatta
- Department of Pediatrics, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - A Yadav
- Department of Pediatrics, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - U Gautam
- Department of Pediatrics, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - S Basnet
- Department of Pediatrics, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
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Bhetuwal D, Matter J, Szumila-Vance H, Kabir ML, Dutta D, Ent R, Abrams D, Ahmed Z, Aljawrneh B, Alsalmi S, Ambrose R, Androic D, Armstrong W, Asaturyan A, Assumin-Gyimah K, Ayerbe Gayoso C, Bandari A, Basnet S, Berdnikov V, Bhatt H, Biswas D, Boeglin WU, Bosted P, Brash E, Bukhari MHS, Chen H, Chen JP, Chen M, Christy EM, Covrig S, Craycraft K, Danagoulian S, Day D, Diefenthaler M, Dlamini M, Dunne J, Duran B, Evans R, Fenker H, Fomin N, Fuchey E, Gaskell D, Gautam TN, Gonzalez FA, Hansen JO, Hauenstein F, Hernandez AV, Horn T, Huber GM, Jones MK, Joosten S, Karki A, Keppel C, Khanal A, King PM, Kinney E, Ko HS, Kohl M, Lashley-Colthirst N, Li S, Li WB, Liyanage AH, Mack D, Malace S, Markowitz P, Meekins D, Michaels R, Mkrtchyan A, Mkrtchyan H, Nazeer SJ, Nanda S, Niculescu G, Niculescu I, Nguyen D, Pandey B, Park S, Pooser E, Puckett A, Rehfuss M, Reinhold J, Santiesteban N, Sawatzky B, Smith GR, Sun A, Tadevosyan V, Trotta R, Wood SA, Yero C, Zhang J. Ruling out Color Transparency in Quasielastic ^{12}C(e,e^{'}p) up to Q^{2} of 14.2 (GeV/c)^{2}. Phys Rev Lett 2021; 126:082301. [PMID: 33709760 DOI: 10.1103/physrevlett.126.082301] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Quasielastic ^{12}C(e,e^{'}p) scattering was measured at spacelike 4-momentum transfer squared Q^{2}=8, 9.4, 11.4, and 14.2 (GeV/c)^{2}, the highest ever achieved to date. Nuclear transparency for this reaction was extracted by comparing the measured yield to that expected from a plane-wave impulse approximation calculation without any final state interactions. The measured transparency was consistent with no Q^{2} dependence, up to proton momenta of 8.5 GeV/c, ruling out the quantum chromodynamics effect of color transparency at the measured Q^{2} scales in exclusive (e,e^{'}p) reactions. These results impose strict constraints on models of color transparency for protons.
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Affiliation(s)
- D Bhetuwal
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - J Matter
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - H Szumila-Vance
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M L Kabir
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Dutta
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - R Ent
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D Abrams
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - Z Ahmed
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - B Aljawrneh
- North Carolina A & T State University, Greensboro, North Carolina 27411, USA
| | - S Alsalmi
- Kent State University, Kent, Ohio 44240, USA
| | - R Ambrose
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - D Androic
- University of Zagreb, Zagreb, Croatia
| | - W Armstrong
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - A Asaturyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - K Assumin-Gyimah
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C Ayerbe Gayoso
- Mississippi State University, Mississippi State, Mississippi 39762, USA
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A Bandari
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - S Basnet
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - V Berdnikov
- Catholic University of America, Washington, DC 20064, USA
| | - H Bhatt
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - W U Boeglin
- Florida International University, University Park, Florida 33199, USA
| | - P Bosted
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - E Brash
- Christopher Newport University, Newport News, Virginia 23606, USA
| | | | - H Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - J P Chen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - E M Christy
- Hampton University, Hampton, Virginia 23669, USA
| | - S Covrig
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K Craycraft
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Danagoulian
- North Carolina A & T State University, Greensboro, North Carolina 27411, USA
| | - D Day
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - M Diefenthaler
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Dlamini
- Ohio University, Athens, Ohio 45701, USA
| | - J Dunne
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - R Evans
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Fenker
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - N Fomin
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - D Gaskell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - F A Gonzalez
- Stony Brook University, Stony Brook, New York 11794, USA
| | - J O Hansen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - A V Hernandez
- Catholic University of America, Washington, DC 20064, USA
| | - T Horn
- Catholic University of America, Washington, DC 20064, USA
| | - G M Huber
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - M K Jones
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Joosten
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A Karki
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C Keppel
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Khanal
- Florida International University, University Park, Florida 33199, USA
| | - P M King
- Ohio University, Athens, Ohio 45701, USA
| | - E Kinney
- University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - H S Ko
- Institut de Physique Nucleaire, Orsay, France
| | - M Kohl
- Hampton University, Hampton, Virginia 23669, USA
| | | | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - W B Li
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A H Liyanage
- Hampton University, Hampton, Virginia 23669, USA
| | - D Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Malace
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - P Markowitz
- Florida International University, University Park, Florida 33199, USA
| | - D Meekins
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - R Michaels
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - H Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - S J Nazeer
- Hampton University, Hampton, Virginia 23669, USA
| | - S Nanda
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - G Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - I Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - D Nguyen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - S Park
- Stony Brook University, Stony Brook, New York 11794, USA
| | - E Pooser
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Puckett
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - M Rehfuss
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - J Reinhold
- Florida International University, University Park, Florida 33199, USA
| | - N Santiesteban
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B Sawatzky
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - G R Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Sun
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - V Tadevosyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - R Trotta
- Catholic University of America, Washington, DC 20064, USA
| | - S A Wood
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - C Yero
- Florida International University, University Park, Florida 33199, USA
| | - J Zhang
- Stony Brook University, Stony Brook, New York 11794, USA
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15
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Basnet S, Dahal S, Tamrakar D, Shakya YR, Jacobson C, Shrestha J, Shrestha SK. Knowledge, Attitude, and Practices Related to COVID-19 among Healthcare Personnel in a Tertiary Care Hospital in Nepal: A Cross-sectional Survey. Kathmandu Univ Med J (KUMJ) 2021; 18:21-28. [PMID: 33605234] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19- .96) and more than 5 years (OR: .16, 95% CI: .04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers' attitude and practices.
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Affiliation(s)
- S Basnet
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Dahal
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Tamrakar
- Department of Community Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Y R Shakya
- Department of General Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - C Jacobson
- Fulbright U.S. Student Program, The United States Education Foundation, Kathmandu 44600, Nepal
| | - J Shrestha
- Department of Nursing, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S K Shrestha
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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16
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Shrestha AP, Bhushal N, Shrestha A, Tamrakar D, Adhikari P, Shrestha P, Shrestha A, Karmacharya BM, Basnet S, Tamrakar SR, Shrestha R, Shrestha R. First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt. Kathmandu Univ Med J (KUMJ) 2021; 18:117-119. [PMID: 33605254] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of "safety first" in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study.
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Affiliation(s)
- A P Shrestha
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Bhushal
- Department of Microbiology, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Community Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Tamrakar
- Department of Community Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Adhikari
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Shrestha
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B M Karmacharya
- Department of Public Health and Community Program, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Basnet
- Department of General Practice and Emergency Medicine, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S R Tamrakar
- Department of Obstetrics and Gynecology, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Pharmacology, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Pharmacology, Pharmacovigilance Unit/Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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17
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Acharya R, Kafle S, Basnet S, Poudel D, Ghimire S. Delayed onset serotonin syndrome in the setting of polypharmacy. J Community Hosp Intern Med Perspect 2021; 11:76-78. [PMID: 33552421 PMCID: PMC7850348 DOI: 10.1080/20009666.2020.1834929] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/06/2020] [Indexed: 12/04/2022] Open
Abstract
Serotonin syndrome is a rare but well-known condition that can be life-threatening if not diagnosed early. Onset is usually within 4 to 13 h of starting the offending medication. We present a case of delayed onset of serotonin syndrome that presented after 48 h. Polypharmacy played a role in causing the onset of symptoms. Clinicians should keep a high index of suspicion for serotonin syndrome when dealing with elderly confused patients who take multiple medications even when the onset is delayed or atypical because the outcome can be disastrous.
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Affiliation(s)
- Roshan Acharya
- Department of Medicine, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Smita Kafle
- Fayetteville State University, Fayetteville, NC, USA
| | - Sijan Basnet
- Department of Medicine, Reading Hospital, Reading, PA, USA
| | - DilliRam Poudel
- Department of Rheumatology, Indiana Regional Medical Center, Indiana, PA, USA
| | - Sushil Ghimire
- Department of Hematology and Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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18
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Yero C, Abrams D, Ahmed Z, Ahmidouch A, Aljawrneh B, Alsalmi S, Ambrose R, Armstrong W, Asaturyan A, Assumin-Gyimah K, Ayerbe Gayoso C, Bandari A, Bane J, Basnet S, Berdnikov VV, Bericic J, Bhatt H, Bhetuwal D, Biswas D, Boeglin WU, Bosted P, Brash E, Bukhari MHS, Chen H, Chen JP, Chen M, Christy ME, Covrig S, Craycraft K, Danagoulian S, Day D, Diefenthaler M, Dlamini M, Dunne J, Duran B, Dutta D, Ent R, Evans R, Fenker H, Fomin N, Fuchey E, Gaskell D, Gautam TN, Gonzalez FA, Hansen JO, Hauenstein F, Hernandez AV, Horn T, Huber GM, Jones MK, Joosten S, Kabir ML, Karki A, Keppel CE, Khanal A, King P, Kinney E, Lashley-Colthirst N, Li S, Li WB, Liyanage AH, Mack DJ, Malace SP, Matter J, Meekins D, Michaels R, Mkrtchyan A, Mkrtchyan H, Nazeer SJ, Nanda S, Niculescu G, Niculescu M, Nguyen D, Nuruzzaman N, Pandey B, Park S, Perdrisat CF, Pooser E, Rehfuss M, Reinhold J, Sawatzky B, Smith GR, Sun A, Szumila-Vance H, Tadevosyan V, Wood SA, Zhang J. Probing the Deuteron at Very Large Internal Momenta. Phys Rev Lett 2020; 125:262501. [PMID: 33449750 DOI: 10.1103/physrevlett.125.262501] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
We measure ^{2}H(e,e^{'}p)n cross sections at 4-momentum transfers of Q^{2}=4.5±0.5 (GeV/c)^{2} over a range of neutron recoil momenta p_{r}, reaching up to ∼1.0 GeV/c. We obtain data at fixed neutron recoil angles θ_{nq}=35°, 45°, and 75° with respect to the 3-momentum transfer q[over →]. The new data agree well with previous data, which reached p_{r}∼500 MeV/c. At θ_{nq}=35° and 45°, final state interactions, meson exchange currents, and isobar currents are suppressed and the plane wave impulse approximation provides the dominant cross section contribution. We compare the new data to recent theoretical calculations, where we observe a significant discrepancy for recoil momenta p_{r}>700 MeV/c.
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Affiliation(s)
- C Yero
- Florida International University, University Park, Florida 33199, USA
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D Abrams
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - Z Ahmed
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - A Ahmidouch
- North Carolina Agricultural and Technical State University, Greensboro, North Carolina 27411, USA
| | - B Aljawrneh
- North Carolina Agricultural and Technical State University, Greensboro, North Carolina 27411, USA
| | - S Alsalmi
- Kent State University, Kent, Ohio 44240, USA
| | - R Ambrose
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - W Armstrong
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A Asaturyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - K Assumin-Gyimah
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C Ayerbe Gayoso
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A Bandari
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - J Bane
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Basnet
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - V V Berdnikov
- Catholic University of America, Washington, D.C. 20064, USA
| | - J Bericic
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - H Bhatt
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Bhetuwal
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - W U Boeglin
- Florida International University, University Park, Florida 33199, USA
| | - P Bosted
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - E Brash
- Christopher Newport University, Newport News, Virginia 23606, USA
| | | | - H Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - J P Chen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - M E Christy
- Hampton University, Hampton, Virginia 23669, USA
| | - S Covrig
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K Craycraft
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Danagoulian
- North Carolina Agricultural and Technical State University, Greensboro, North Carolina 27411, USA
| | - D Day
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - M Diefenthaler
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Dlamini
- Ohio University, Athens, Ohio 45701, USA
| | - J Dunne
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - D Dutta
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - R Ent
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - R Evans
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Fenker
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - N Fomin
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - D Gaskell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - F A Gonzalez
- Stony Brook University, Stony Brook, New York 11794, USA
| | - J O Hansen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - A V Hernandez
- Catholic University of America, Washington, D.C. 20064, USA
| | - T Horn
- Catholic University of America, Washington, D.C. 20064, USA
| | - G M Huber
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - M K Jones
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Joosten
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - M L Kabir
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - A Karki
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C E Keppel
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Khanal
- Florida International University, University Park, Florida 33199, USA
| | - P King
- Ohio University, Athens, Ohio 45701, USA
| | - E Kinney
- University of Colorado Boulder, Boulder, Colorado 80309, USA
| | | | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - W B Li
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A H Liyanage
- Hampton University, Hampton, Virginia 23669, USA
| | - D J Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S P Malace
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Matter
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - D Meekins
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - R Michaels
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - H Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - S J Nazeer
- Hampton University, Hampton, Virginia 23669, USA
| | - S Nanda
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - G Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - M Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - D Nguyen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - N Nuruzzaman
- Rutgers University, New Brunswick, New Jersey 08854, USA
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - S Park
- Stony Brook University, Stony Brook, New York 11794, USA
| | - C F Perdrisat
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - E Pooser
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Rehfuss
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - J Reinhold
- Florida International University, University Park, Florida 33199, USA
| | - B Sawatzky
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - G R Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Sun
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - H Szumila-Vance
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - V Tadevosyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - S A Wood
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Zhang
- Stony Brook University, Stony Brook, New York 11794, USA
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Chaudhary P, Basnet S, Chaulagain M, Khadgi A, Bk S. Oropharyngeal Candidiasis (OPC) in hiv infected patients and its antifungal susceptiblity pattern by disc diffusion method. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Basnet S, Zafar S, Launonen IM, Quixabeira D, Santos J, Hemminki O, Malmstedt M, Cervera-Carrascon V, Aronen P, Kalliokoski R, Havunen R, Rannikko A, Mirtti T, Matikainen M, Kanerva A, Hemminki A. 80P Oncolytic adenovirus type 3 coding for CD40L facilitates dendritic cell therapy of prostate cancer in humanized mice and patient samples. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
We present a rare case of recurrent nonbacterial thrombotic endocarditis (NBTE) and stroke despite anticoagulation. A 48-year-old man with history of antiphospholipid syndrome, prior nonbacterial aortic valve endocarditis status post valve replacement and prior stroke was found to have acute ischemic stroke while on apixaban and nonbacterial thrombotic endocarditis of mitral valve. This was initially managed conservatively with therapeutic dose of enoxaparin, but the patient later underwent mitral valve replacement. Unfortunately, the patient later passed away with hemorrhagic stroke while on enoxaparin.
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Affiliation(s)
- Sijan Basnet
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Thomas Stauffer
- Department of Emergency Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Amar Jayswal
- Department of Medicine, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Biswaraj Tharu
- Department of Medicine, Trumbull Regional Medical Center, Warren, OH, USA
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22
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Acharya R, Basnet S, Tharu B, Koirala A, Dhital R, Shrestha P, Poudel D, Ghimire S, Kafle S. Obstructive Sleep Apnea: Risk Factor for Arrhythmias, Conduction Disorders, and Cardiac Arrest. Cureus 2020; 12:e9992. [PMID: 32855898 PMCID: PMC7447149 DOI: 10.7759/cureus.9992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) has been described as a risk factor for cardiac arrhythmias. Its association with atrial fibrillation has been established. However, relationships with other arrhythmias and conduction disorders have not been fully studied. Methods We used the National Inpatient Sample database from 2009 to 2011 to explore the relationship between OSA and arrhythmias and conduction disorders. The presence of diagnosis was determined based on the International Classification of Disease-9 (ICD-9) codes. Univariate and multivariate logistic regressions were used to establish mortality risks among all groups. Results Multivariate logistic regression showed increased mortality in patients with OSA in comparison to patients without OSA and patients across all categories of arrhythmias and conduction disorders. One significant finding was the increased association of cardiac arrest in patients with OSA versus patients without OSA (OR: 95.72; CI: 89.13-105.81, p < 0.001). Conclusions OSA is significantly associated with non-atrial fibrillation arrhythmias, conduction disorders, and sudden cardiac arrest. Awareness regarding this association is important for early screening for OSA in obese patients to prevent cardiovascular morbidity and mortality. The use of continuous positive airway pressure (CPAP) might be beneficial against all kinds of arrhythmias and sudden cardiac death.
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Affiliation(s)
- Roshan Acharya
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA.,Internal Medicine, Campbell University School of Osteopathic Medicine, Fayetteville, USA
| | - Sijan Basnet
- Internal Medicine, The Reading Hospital and Medical Center, Reading, USA
| | - Biswaraj Tharu
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University, Youngstown, USA
| | - Ajay Koirala
- Internal Medicine, The Reading Hospital and Medical Center, Reading, USA
| | - Rashmi Dhital
- Internal Medicine, The Reading Hospital and Medical Center, Reading, USA
| | - Pragya Shrestha
- Internal Medicine, The Reading Hospital and Medical Center, Reading, USA
| | | | - Sushil Ghimire
- Hematology, Thomas Jefferson University, Philadelphia, USA
| | - Smita Kafle
- Nursing, Fayetteville State University, Fayetteville, USA
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23
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Paudel A, Basnet S, Tharu B, Bohra N. Diffuse exanthematous drug eruption associated with intravenous immunoglobulin. Proc AMIA Symp 2020; 34:81-82. [PMID: 33456151 DOI: 10.1080/08998280.2020.1805672] [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: 10/23/2022] Open
Abstract
Diffuse exanthematous drug eruption due to intravenous immunoglobulin (IVIg) is a rare adverse event reported only in case reports. We present a case of a 71-year-old woman with a diffuse maculopapular rash 5 days after receiving an IVIg infusion for treatment of chronic inflammatory demyelinating polyneuropathy. She was managed conservatively with antihistamines; she was already receiving prednisone 25 mg daily as part of treatment for the neuropathy. The rash resolved over 2 weeks.
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Affiliation(s)
- Anish Paudel
- Department of Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Sijan Basnet
- Department of Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Biswaraj Tharu
- Department of Medicine, Trumbull Regional Medical Center, Warren, Ohio
| | - Nidrit Bohra
- Department of Medicine, Reading Hospital, West Reading, Pennsylvania
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24
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Abstract
Centers for Disease Control and Prevention has reported that tetanus infection in a fully immunized person with the last dose within 10 years is extremely rare. The prevalence of localized tetanus in such a scenario is unknown. Only two case reports of localized tetanus in previously immunized patients have been reported so far, making this the third one. Also, this is the first case of its kind to demonstrate evolving localized tetanus. Our patient is a 19-year-old man who presented with shortness of breath, pain in right upper extremity, shoulder, and neck. His chest X-ray and creatine kinase were normal. The patient was sent home. He presented again to our hospital two days later with difficulty swallowing and speaking as well as chest tightness. Routine blood tests, electrocardiogram, CT angiography of the chest, and transthoracic echocardiogram were normal. He gave a history of a cut in the right middle finger while removing the carpet a week before his presentation. His immunization history was complete with documented last tetanus shot nine years and two months ago. He was treated with tetanus vaccine and penicillin. His tetanus antitoxoid titer came out protective.
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Affiliation(s)
- Biswaraj Tharu
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University, Warren, USA
| | - Safa Ibrahim
- Endocrinology and Diabetes, Baylor University Medical Center, Temple, USA
| | - Munir Shah
- Infectious Disease, Western Reserve Health Education/Northeast Ohio Medical University, Warren, USA
| | - Sijan Basnet
- Internal Medicine, Reading Hospital - Tower Health, Reading, USA
| | - Terrence Park
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University, Warren, USA
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25
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Sullivan A, Shrestha P, Basnet S, Herb R, Zagorski E. A rare case of Whipple's disease with endocarditis in a patient with dextrocardia. SAGE Open Med Case Rep 2020; 8:2050313X20936952. [PMID: 32655867 PMCID: PMC7328352 DOI: 10.1177/2050313x20936952] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/31/2020] [Indexed: 12/18/2022] Open
Abstract
We report a case of an elderly Caucasian male with past medical history of dextrocardia
with situs inversus totalis, polymyalgia rheumatica, history of cryptogenic stroke, and
severe mitral regurgitation with mitral valve prolapse, who presented with acute heart
failure symptoms, including severe dyspnea on exertion and worsening lower extremity edema
in the setting of immunosuppression with steroids for a year-old diagnosis of polymyalgia
rheumatica. One month prior to this presentation, the patient suffered a transient
ischemic attack and during the workup, his transthoracic echocardiography showed
myxomatous degeneration of posterior mitral leaflet, partially flail, with severe mitral
regurgitation, which required mitral valve replacement. Genome sequencing of mitral valve
anterior leaflet pathology detected Tropheryma whipplei as a causal agent
of culture-negative endocarditis. The patient was treated with 6 weeks of ceftriaxone and
ampicillin–sulbactam and further continued trimethoprim–sulfamethoxazole for 1 year. He
continued antibiotic treatment with resolution of shortness of breath along with
arthralgia.
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Affiliation(s)
- Abigayle Sullivan
- Department of Internal Medicine, Reading Hospital-Tower Health System, PA, USA
| | - Pragya Shrestha
- Department of Internal Medicine, Reading Hospital-Tower Health System, PA, USA
| | - Sijan Basnet
- Department of Internal Medicine, Reading Hospital-Tower Health System, PA, USA
| | - Ronald Herb
- Department of Internal Medicine, Reading Hospital-Tower Health System, PA, USA
| | - Emily Zagorski
- Department of Internal Medicine, Reading Hospital-Tower Health System, PA, USA
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26
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Paudel A, Dhital R, Areoye G, Basnet S, Tachamo N. Sweet's syndrome in a granulocytopenic patient with acute myeloid leukemia on FLT3 inhibitor. J Community Hosp Intern Med Perspect 2020; 10:275-278. [PMID: 32850078 PMCID: PMC7426991 DOI: 10.1080/20009666.2020.1766818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/02/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Gilteritinib is a FLT3 kinase inhibitor approved for FLT3-mutated acute myeloid leukemia (AML). We present a case of febrile neutropenia and neutrophilic dermatosis consistent with Sweet's syndrome (SS). CASE HISTORY A 55-year-old woman presented with fever and skin lesions after 4 weeks of initiation of Gilteritinib for AML. She was febrile, pancytopenic and neutropenic with absolute neutrophil count (ANC) of 0.1x10E3/UI. Examination revealed reddish and violaceous rashes on her extremities. Pathology showed superficial dermal edema, widespread epidermal spongiosis and multiple neutrophils in the dermal infiltrate. Rash improved with prednisone 60 mg daily and started to flare with taper. She was still on Gilteritinib all this time. Gilteritinib was finally stopped due to non-response and possible contribution in flaring her SS. Shortly after, the patient succumbed to progressive disease and complications of sepsis. DISCUSSION There have been reports of SS in neutropenic patients although SS is typically a neutrophilic dermatosis. The pathogenesis of SS in neutropenia remains uncertain. Our study represents an additional medication-associated cutaneous complication of AML therapy. Clinicians need to be aware of potential neutrophilic dermatoses with FLT-3 inhibition, even with peripheral neutropenia.
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Affiliation(s)
- Anish Paudel
- Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Rashmi Dhital
- Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Gabriel Areoye
- Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Sijan Basnet
- Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Niranjan Tachamo
- Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
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Tharu B, Bishal K, Basnet S, Adhikari N, Tharu S. MON-LB63 Hypocalcemia-A Clue to Digeorge Syndrome; A Very Rare Case Diagnosed in a 41 Year Male. J Endocr Soc 2020. [PMCID: PMC7208414 DOI: 10.1210/jendso/bvaa046.2242] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
41-year-old male with history of anxiety, bipolar disorder, depression, cognitive developmental delay, Idiopathic Thrombocytopenic Purpura (ITP), Vit D deficiency, tinnitus, suicidal attempt, auditory hallucination, borderline intellectual functioning comes to the PCP’s office for regular follow-up. The PCP has noted that the patient was hypocalcemic on multiple visits. On exam, vitals were in normal range, height 5 feet 2 inches, BMI 31 kg/m2.Despite the patient being on calcium and Vit D2 pills for a couple of months, his Calcium level were low ranging from 5.8–7.8mg/dl (normal 8.5-10.1) with normal albumin; ionized calcium was low 0.9-0.97mmol/l (normal 1.12-1.23); Magnesium was normal 2mEq/L (normal 1.5-2.5), phosphorus slightly high 5 mg/dL (normal 2.5-4.9), PTH (ParaThyroid Hormone level) was low-normal 18.8pg/ml (normal 11.1-79.5), vitamin D 25 OH low 16ng/ml (normal 30-100); 1,25 di OH vitamin D low 8ng/ml (normal25-40).Thyroid ultrasound showed 2 benign nodules, no further work-up done. TSH and free T4 were normal. FISH (Fluorescence In Situ Hybridization) came positive for DiGeorge syndrome (deletion at 22q11.2). He was treated with calcium 600 mg 4 pills daily, calcitriol 0.25 mcg two pills daily, Vit D2 50000 IU weekly and thiazide diuretic. His labs improved. DISCUSSIONHypocalcemia can be due to low magnesium level, drugs or associated with high or low PTH. The patient had normal magnesium and he was not on any medication that causes hypocalcemia. This rules out first two casues. Hypocalcemia with high PTH (pseudohypoparathyroidism or low vit D levels) doesn’t fall in our differential because our patient had low PTH. For hypocalcemia with low PTH, differentials include post-surgical condition (no surgical history), autoimmune (history and labs not suggestive of), infiltrative diseases (eg hemochromatosis- he had normal iron study, Wilson disease- normal copper level, granulomas- contrary he had low 1,25 Di OH vit D). Hypocalcemia secondary to genetic parthyroid gland anomaly was thought to be most likely in our patient. So FISH was pursued. Conclusion: For patients with cognitive issues, persistence of chronic hypocalcemia (with low PTH) despite treatment should prompt for genetic disorders like DiGeorge. DiGeorge is usually the diagnosis of children. Perhaps this is the first case of DiGeorge diagnosed so late at age of 41.
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Affiliation(s)
- Biswaraj Tharu
- Western Reserve Health Education/NEOMED, Youngstown, OH, USA
| | - Khanal Bishal
- Western Reserve Health Education/NEOMED, Youngstown, OH, USA
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Basnet S, Dhital R, Tharu B, Poudel DR, Donato A. Yearly trend of acute venous thromboembolism in patients admitted with heart failure in the United States. J Community Hosp Intern Med Perspect 2019; 9:287-289. [PMID: 31528274 PMCID: PMC6735359 DOI: 10.1080/20009666.2019.1634408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/03/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Heart failure (HF) patients are at risk for venous thromboembolism (VTE) during the hospital stay. We aim to study the recent trend of deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE in heart failure patients from years 2000-2013. Methods: We utilized the National (Nationwide) Inpatient Sample database and selected non-pregnant patients over the age of 18 years for this purpose. We selected HF, DVT, PE, and VTE based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We used STATA for analysis. Results: We noted an increase in prevalence of DVT, PE and composite VTE among HF hospitalizations from 0.55%, 0.17% and 0.76% in 2000 to 0.96%, 0.4% and 1.46%, respectively, in 2013 and a decrease in trend of mortality among HF hospitalizations associated with DVT, PE and VTE from 8.95%, 16.36% and 10.80% in 2000 to 6.78%, 7.92% and 7.20%, respectively, in 2013. Conclusion: Increasing prevalence of VTE is concerning and suggests that we still need to work on delivering prophylaxis to all HF inpatients.
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Affiliation(s)
- Sijan Basnet
- Department of Internal Medicine, Reading Hospital, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Internal Medicine, Reading Hospital, West Reading, PA, USA
| | - Biswaraj Tharu
- Department of Internal Medicine, Trumbull Regional Medical Center, Warren, OH, USA
| | - Dilli Ram Poudel
- Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony Donato
- Department of Internal Medicine, Reading Hospital, West Reading, PA, USA
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29
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Basnet S, Rajagopalan P, Dhital R, Qureshi A. Symmetrical Peripheral Gangrene Associated with Low Output Cardiac Failure. Medicina (Kaunas) 2019; 55:E383. [PMID: 31319486 PMCID: PMC6681386 DOI: 10.3390/medicina55070383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/22/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022]
Abstract
Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.
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Affiliation(s)
- Sijan Basnet
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA 19611, USA.
| | - Priya Rajagopalan
- Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Rashmi Dhital
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA 19611, USA
| | - Ataul Qureshi
- Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA
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Basnet S, Dhital R, Tharu B. Acute generalized exanthematous pustulosis: a rare side effect of clindamycin. J Community Hosp Intern Med Perspect 2019; 9:285-286. [PMID: 31258877 PMCID: PMC6586120 DOI: 10.1080/20009666.2019.1601057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/27/2018] [Accepted: 03/25/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Acute generalized exanthematous pustulosis (AGEP) is a rare adverse effect of clindamycin characterized by widespread papules and pustulosis 1 – 3 weeks of its use. Case description: We present a case of a 71-year-old woman diagnosed with AGEP after clindamycin use for a tooth infection. She had been started on empiric prednisone without benefit. She did not have any systemic involvement and had an unremarkable blood work . Her rash resolved completely in a month.
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Affiliation(s)
- Sijan Basnet
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Biswaraj Tharu
- Department of Medicine, Trumbull Regional Medical Center, Warren, OH, USA
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Hao D, Basnet S, Melnick S, Kim J. Negative pressure pulmonary edema-related diffuse alveolar hemorrhage associated with Sevoflurane and cigarette smoking. J Community Hosp Intern Med Perspect 2019; 9:247-251. [PMID: 31258867 PMCID: PMC6586085 DOI: 10.1080/20009666.2019.1608140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/30/2019] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Negative-pressure pulmonary edema (NPPE)-related diffuse alveolar hemorrhage (DAH) is an underdiagnosed clinical entity seen with alveolar capillary damage. The pathophysiology of type I NPPE is generation of a negative pleural pressure against an upper airway obstruction. We suspect this process was facilitated by preexisting alveolar damage with smoking and administration of the irritating and coagulopathic inhaled anesthetic sevoflurane. We present a case of a healthy 31-year-old man who developed postoperative hemoptysis, diffuse ground-glass opacity and infiltrates on computed tomography (CT) of the chest, anemia, and hypoxic respiratory failure. A diagnosis of DAH was made and a serologic workup for systemic disorders including vasculitis and connective tissue diseases was negative. The patient rapidly improved with supportive care and had complete resolution of his bilateral infiltrates on repeat chest x-ray two weeks later. Our literature review identified three cases of DAH in the setting of sevoflurane administration. Our case illustrates the importance of including NPPE-related DAH on the differential of post-operative hemoptysis, especially in association with sevoflurane administration and a history of cigarette smoking.
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Affiliation(s)
- David Hao
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Sijan Basnet
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Stephen Melnick
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - James Kim
- Pulmonary and Critical Care Medicine, Respiratory Specialists, Reading, PA, USA
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32
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Tharu B, Poudel R, Basnet S, Khanal B. SUN-435 SIADH Precipitated by Pneumonia in a Background of Hypothyroidism and SSRI Use. J Endocr Soc 2019. [PMCID: PMC6553291 DOI: 10.1210/js.2019-sun-435] [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: 11/19/2022] Open
Abstract
Introduction: Hyponatremia is serum sodium levels below 135 meq/L. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of ADH leading to hyponatremia. Important causes of hyponatremia are heart failure, cirrhosis, diuretic induced, hypothyroids, cortisol deficiency and SIADH. Causes of SIADH are CNS disorders, malignancies, surgery, pulmonary disease (particularly pneumonia), hormone deficiency (both hypopituitarism, hypothyroidsm), HIV, drugs- esp. SSRIs. Clinical Case: 74 y/o F with past medical history of Diabetes, HTN, hypothyroidism, depression and chronic compensated hyponatremia under carvedilol, losartan, levothyroxine, citalopram, presented to ER with SOB with wheezing. Patient was admitted for pneumonia and treated with azithromycin and ceftriaxone. In Day 2, he developed intractable nausea and vomiting despite zofran and phenargan. IV NS was started. Patient developed hyponatremia, Na of 126 mEq/L, serum osmolality 240, Urine osm 457 mOsm/, TSH was 41 mIU/L. Levothyroxine was increased to 175 mcg. Fluid & Citalopram was stopped. Na was closely monitored. Over the next few days, patient and Na levels slowly improved with fluid restriction and Na tablets. Conclusion: Not all hyponatremia is SIADH while SIADH is a cause of hyponatremia. The diagnosis is often confusing. SIADH should be suspected in any patient with serum Na <135 mmol/L, serum osmolality <280 mOsm, and a inappropriate and relatively high urine osmolality (compared to serum osmolality). SIADH is more common in patients above age 65 years. Finding out the cause and fluid restriction is the mainstay of treatment in SIADH. Exception to this is brain surgeries & Sub Arachnoid Hemorrhage where there may be ongoing cerebral salt wasting and, fluid restriction can be deleterious as it can cause cerebral vasospasm. However for most cases of non-SIADH hyponatremia, Sodium chloride, (oral tablet or isotonic saline) is the therapy. Other ways to treat hyponatremia would be treating the underlying cause, restricting water intake or vasopressin receptor antagonist. For severe case (with seizure and severe neurological abnormalities) of any hyponatremia, intravenous hypertonic saline is the choice.
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Affiliation(s)
- Biswaraj Tharu
- Western Reserve Health Education, Youngstown, OH, United States
| | - Resham Poudel
- Western Reserve Health Education, Youngstown, OH, United States
| | - Sijan Basnet
- Reading Health System, Wyomissing, PA, United States
| | - Bishal Khanal
- Western Reserve Health Education, Youngstown, OH, United States
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Basnet S, Tachamo N, Nazir S, Dhital R, Jehangir A, Donato A. Severe anion gap metabolic acidosis associated with initiation of a very low-carbohydrate diet. J Community Hosp Intern Med Perspect 2019; 9:165-167. [PMID: 31044050 PMCID: PMC6484640 DOI: 10.1080/20009666.2019.1583534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/08/2019] [Indexed: 11/25/2022] Open
Abstract
Low carbohydrate diets have been popularized as an effective solution for weight loss. Although rare, life-threatening anion gap metabolic acidosis has been reported in patients on these diets. We present a case of a 31-year-old man with atypical symptoms of chest pain and shortness of breath found to have severe metabolic acidosis after starting low carbohydrate diet for a week.
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Affiliation(s)
- Sijan Basnet
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | | | - Salik Nazir
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Asad Jehangir
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Anthony Donato
- Department of Medicine, Reading Hospital, West Reading, PA, USA
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34
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Basnet S, Dhital R, Tharu B, Ghimire S, Poudel DR, Donato A. Influence of abnormal potassium levels on mortality among hospitalized heart failure patients in the US: data from National Inpatient Sample. J Community Hosp Intern Med Perspect 2019; 9:103-107. [PMID: 31044040 PMCID: PMC6484484 DOI: 10.1080/20009666.2019.1593778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Abnormalities in serum potassium levels have been associated with variable mortality risk among hospitalized patients with heart failure (HF). We aim to use a large database study to further characterize risk of mortality, demographic factors, and associated comorbidities among heart failure inpatients. Methods: Our sample population was from the US National Inpatient Sample database from the year 2009–2011. The inclusion criteria used to identify patients was those with a diagnosis of heart failure as per ICD-9 classification. Other demographic factors considered in data collection included income, and cardiac risk factors. Taking these factors into consideration, a univariate association of potassium level and mortality was performed, as well as multivariable logistic regression controlling for demographic factors and associated conditions. Results: Of the 2,660,609 patients who were discharged with a diagnosis of heart failure during this time period, patients with hypokalemia during hospitalization had increased mortality risk (OR: 1.96, 95% CI: 1.91–2.01) when compared with those with hyperkalemia who had decreased inpatient mortality risk OR: 0.94,95% CI: 0.91–0.96) versus those not coded for potassium abnormalities. This finding was significant even regardless of the etiology of the hypokalemia while the hyperkalemic patients were noted to have no difference or a decreased risk in all subtypes and groups. Conclusion: Unlike heart failure patients with hyperkalemia, those with hypokalemia are at an increased inpatient mortality risk. Whether our mortality findings translate to longer-term outpatient settings where significantly less monitoring is possible is a matter for further study.
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Affiliation(s)
- Sijan Basnet
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Biswaraj Tharu
- Department of Internal Medicine, Trumbull Regional Medical Center, Warren, OH, USA
| | - Sushil Ghimire
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Dilli Ram Poudel
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Anthony Donato
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
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Basnet S, Mohanty E, Mir I, Dhital R, Koirala A, Tachamo N. Atraumatic splenic rupture associated with apixaban. SAGE Open Med Case Rep 2019; 7:2050313X19832490. [PMID: 30815265 PMCID: PMC6385321 DOI: 10.1177/2050313x19832490] [Citation(s) in RCA: 5] [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: 12/22/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Apixaban is a direct oral anticoagulant that works by inhibiting factor Xa. It has been associated with adverse bleeding outcomes including atraumatic splenic rupture. We present the case of an 86-year-old man who presented with features of left upper abdominal pain and hemorrhagic shock found to have atraumatic splenic rupture and hemoperitoneum on imaging.
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Affiliation(s)
- Sijan Basnet
- Sijan Basnet, Department of Medicine, Reading Hospital and Medical Center, West Reading, PA 19611, USA.
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Dhital R, Basnet S, Poudel DR. Acute Proximal Myopathy in a Young Male—A Case of Infectious Myositis. Medicina (B Aires) 2019; 55:medicina55010019. [PMID: 30658484 PMCID: PMC6359648 DOI: 10.3390/medicina55010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background and objectives: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context. Case Presentation: A 40-year-old male with diabetes presented with exquisite pain and weakness of proximal extremities. He denied trauma, recent travel, new medications, or substance use. He denied prior rheumatologic, thyroid, or musculoskeletal disorders. The urine culture revealed staphylococcal infection with negative blood cultures. Rheumatologic and endocrine workups were negative. Random muscle biopsy was negative for inflammatory infiltrate. MRI of thighs and arms showed innumerable foci of nodular and ring enhancement in the proximal muscle groups. The patient noted improvement after about 10 days of antibiotics with complete resolution at 2 months. Discussion and Conclusion: Bacterial myositis is most often due to Staphylococcus aureus (70%) and affects a single muscle. Multifocal abscesses are rare and strongly suggest transient bacteremia. Our patient most likely had transient initiating staphylococcal bacteremia leading to diffuse myositis and hematogenous urinary tract infection (UTI). A delay in treatment can be life-threatening.
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Affiliation(s)
- Rashmi Dhital
- Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
| | - Sijan Basnet
- Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
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Basnet S, Dhital R, Tharu B, Ghimire S, Poudel DR. Association between thyroid abnormalities and hypertension among hospitalized US patients: data from the National Inpatient Sample. Cardiovasc Endocrinol Metab 2018; 7:97-98. [DOI: 10.1097/xce.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
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Dhital R, Mir I, Basnet S, Poudel D, Patel N. ACUTE LOCALIZED EXANTHEMATOUS PUSTULOSIS: A RARE CUTANEOUS DRUG ERUPTION. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dhital R, Mir I, Shrestha P, Basnet S, Poudel D. FACTORS ASSOCIATED WITH EARLY READMISSION IN ACUTE ASTHMA EXACERBATION - RESULTS FROM NATIONAL READMISSION DATABASE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dhital R, Basnet S, Paudel P, Acharya YP, Poudel DR. Prevalence of chronic obstructive pulmonary disease (COPD) among rheumatoid arthritis: results from national inpatient database. J Community Hosp Intern Med Perspect 2018; 8:211-214. [PMID: 30181828 PMCID: PMC6116144 DOI: 10.1080/20009666.2018.1485460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/21/2018] [Indexed: 01/12/2023] Open
Abstract
Rheumatoid arthritis (RA) is being increasingly recognized as an important contributor to chronic obstructive pulmonary disease (COPD). Although smoking is a major risk factor, other factors may play a role. We used National Inpatient Sample (NIS) from 2013 to explore this relationship. We used propensity matching with a 1:3 nearest-neighbor-matching algorithm to match 1 RA hospitalization to 3 age- and-sex-matched comparators. In the age- and-sex-matched population, RA had a higher odds of COPD (OR 1.20, 95% CI: 1.17-1.22, p < 0.0001). RA is associated with increased COPD prevalence, independent of smoking. COPD might fall within the spectrum of RA complications, likely due to autoimmune and inflammatory mechanisms.
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Affiliation(s)
- Rashmi Dhital
- Internal Medicine, Tower Health System, West Reading, PA, USA
| | - Sijan Basnet
- Internal Medicine, Tower Health System, West Reading, PA, USA
| | - Prakash Paudel
- Internal Medicine, Berkshire Medical Center, Pittsfield, MA, USA
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Basnet S, Tachamo N, Dhital R, Tharu B. Daptomycin associated eosinophilic pneumonia: case report and differential diagnoses. J Community Hosp Intern Med Perspect 2018; 8:152-155. [PMID: 29915657 PMCID: PMC5998295 DOI: 10.1080/20009666.2018.1475188] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022] Open
Abstract
Daptomycin is a bactericidal antibiotic approved for treatment of gram-positive skin and soft tissue infections. We present a case of an 89-year-old man who presented with fever, shortness of breath and nonproductive cough on week 4 of starting daptomycin for infective endocarditis. Computerized tomography scan showed bilateral interstitial infiltrates predominantly affecting the lower lobes. He also had peripheral eosinophilia of 6%. He was diagnosed with eosinophilic pneumonia secondary to daptomycin use. His symptoms improved with discontinuation of daptomycin and initiation of corticosteroids. Clinical correlation of pneumonia-like presentation with recent use of daptomycin should make physicians rule out this rare adverse effect for early institution of correct treatment.
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Affiliation(s)
- Sijan Basnet
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Niranjan Tachamo
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Biswaraj Tharu
- Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal
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Basnet S, Tachamo N, Dhital R, Tharu B. Multifactorial aetiology for non-uremic calciphylaxis: a case report. J Community Hosp Intern Med Perspect 2018; 8:163-166. [PMID: 29915661 PMCID: PMC5998291 DOI: 10.1080/20009666.2018.1479617] [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: 02/14/2018] [Accepted: 05/17/2018] [Indexed: 10/27/2022] Open
Abstract
Calciphylaxis is commonly associated with end-stage renal disease patients on haemodialysis. We present a rare case of calciphylaxis in a non-uremic patient. The diagnosis was made clinically and confirmed with skin biopsy showing calcification of the dermal and subcutaneous tissues in the von Kossa stain. We believe that the combination of uncontrolled diabetes mellitus, a non-functioning paraganglioma and vitamin D deficiency in a susceptible female patient was responsible for causing calciphylaxis in our patient. An index of suspicion should be maintained by clinicians for calciphylaxis even in patients without uremia.
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Affiliation(s)
- Sijan Basnet
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Niranjan Tachamo
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Biswaraj Tharu
- Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal
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Dhital R, Basnet S, Poudel DR. Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample. J Community Hosp Intern Med Perspect 2018; 8:49-52. [PMID: 29686786 PMCID: PMC5906765 DOI: 10.1080/20009666.2018.1450592] [Citation(s) in RCA: 8] [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: 11/01/2017] [Accepted: 03/02/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Sepsis is a significant cause of mechanical ventilation in hospitalized patients. Objective: The aim of our study was to recognize the demographic and clinical characteristics associated with an increased need for invasive mechanical ventilation in hospitalized sepsis patients. Methods: We used National Inpatient Sample database from the years 2009-2011 to identify sepsis patients requiring invasive mechanical ventilation. We compared demographic and clinical characteristics of sepsis patients requiring and not requiring ventilator support and conducted univariate and multivariate analyses to determine odds ratio (OR) of association. Results: A total of 4,827,769 sepsis patients were identified among which 21.38% required invasive ventilation. Multivariate logistic regression [OR (95% CI), p<0.001] determined the following to be associated with increased odds of ventilator use: morbid obesity [1.37 (1.31-1.42)] and age group 35-64 years [1.18 (1.14-1.22)] compared to 18-34 years, whereas females [0.90 (0.88-0.91)] and age >85 years [0.49 (0.47-0.52)] had reduced odds of invasive ventilation. Hyperkalemia [1.12 (1.09-1.16)] and hypernatremia [2.26 (2.16-2.36)] were associated with increased odds while hypokalemia [0.94 (0.91-0.97)] had reduced odds of invasive ventilation. Septic patients requiring IMV had higher length of stay by 9.72 ± 0.17 days, hospitalization cost by US $ 43010.31 ± 988.24 and in-hospital mortality (41.33% vs 8.91%). Conclusion: Sepsis is a major cause of intensive care unit admission and initiation of invasive ventilation. Baseline demographic and clinical features affect the need for invasive ventilation. A clear understanding of these risk factors is integral for an appropriate and timely management.
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Affiliation(s)
- Rashmi Dhital
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Sijan Basnet
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Dilli Ram Poudel
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
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Tachamo N, Donato A, Timilsina B, Nazir S, Lohani S, Dhital R, Basnet S. Hypercalcemia associated with cosmetic injections: a systematic review. Eur J Endocrinol 2018; 178:425-430. [PMID: 29453201 DOI: 10.1530/eje-17-0938] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/16/2018] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cosmetic injections with silicone and polymethylmethacrylate are not FDA approved for augmentation of body parts such as breast, buttock or legs, but they have been widely used for decades. Cosmetic injections can cause foreign body granulomas and occasionally severe and life-threatening hypercalcemia. We aimed to systematically analyze the published literature on cosmetic injection-associated hypercalcemia. METHODS We searched relevant articles on hypercalcemia associated with various cosmetic injections and extracted relevant data on demographics, cosmetic injections used, severity of hypercalcemia, management and outcomes. RESULTS We identified 23 eligible patients from 20 articles. Mean age was 49.83 ± 14.70 years with a female preponderance (78.26% including transgender females). Silicone was most commonly used, followed by polymethylmethacrylate and paraffin oil (43.48, 30.43, and 8.70% respectively). The buttock was the most common site followed by the breast (69.57% and 39.13% respectively). Hypercalcemia developed at mean duration of 7.96 ± 7.19 years from the initial procedure. Mean ionized calcium at presentation was 2.19 ± 0.61 mmol/L and mean corrected calcium at presentation was 3.43 ± 0.31 mmol/L. 1,25-Dihydroxyvitamin D (1,25(OH)2D or calcitriol) was elevated while 25-hydroxyvitamin D (25(OH)D) and PTH were low in majority of cases. Hypercalcemia was managed conservatively with hydration, corticosteroids and bisphosphonates in majority of cases. Surgery was attempted in 2 cases but was unsuccessful. Renal failure was the most common complication (82.35% cases) and 2 patients died. CONCLUSION Hypercalcemia from cosmetic injections can be severe and life threatening and can present years after the initial procedure. Cosmetic injection-associated granuloma should be considered a cause of hypercalcemia, especially in middle-aged females presenting with non-PTH-mediated, non-malignant hypercalcemia, which is often associated with elevated calcitriol; however, it should be noted that calcitriol level may be normal as well.
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Affiliation(s)
| | - Anthony Donato
- Internal MedicineSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Salik Nazir
- Internal MedicineReading Hospital, Reading, Pennsylvania, USA
| | - Saroj Lohani
- Internal MedicineReading Hospital, Reading, Pennsylvania, USA
| | - Rashmi Dhital
- Internal MedicineReading Hospital, Reading, Pennsylvania, USA
| | - Sijan Basnet
- Internal MedicineReading Hospital, Reading, Pennsylvania, USA
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Dhital R, Basnet S, Poudel DR. Impact of Hypothyroidism on Occurrence and Outcome of Acute Coronary Syndrome from the National Inpatient Sample. Am J Cardiol 2017; 120:2160-2163. [PMID: 29102035 DOI: 10.1016/j.amjcard.2017.08.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/19/2022]
Abstract
Thyroid hormones have a profound effect on cardiovascular physiology. We utilized a large national inpatient database in the United States (National Inpatient Sample) to study hypothyroidism in relation to the prevalence of coronary heart disease (CHD) and its impact on outcomes (mortality, the length of stay, and hospitalization cost) in the acute coronary syndrome (ACS) subgroup of CHD patients. We found that although hypothyroidism has an increased association with CHD (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.09 to 1.12, p <0.001), the odds of developing ACS in these CHD patients is lower in the hypothyroid group (OR 0.71, 95% CI 0.70 to 0.72, p <0.001) after adjusting for multiple risk factors. Additionally, patients with hypothyroid ACS have a reduced odds of in-hospital mortality (OR 0.86, 95% CI 0.83 to 0.88, p <0.001), shorter length of stay by 0.45 days (p <0.001), and lower hospitalization cost by $1,531.45 (p <0.001) compared with the euthyroid group. Our findings suggest that hypothyroidism has an increased CHD risk but a lower risk of development of ACS in hospitalized CHD patients, as well as a better short-term prognosis including ACS-associated mortality.
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Affiliation(s)
- Rashmi Dhital
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
| | - Sijan Basnet
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania
| | - Dilli Ram Poudel
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania
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Thapa NB, Shah S, Pradhan A, Rijal K, Pradhan A, Basnet S. Sonographic Assessment of the Normal Dimensions of Liver, Spleen, and Kidney in Healthy Children at Tertiary Care Hospital. Kathmandu Univ Med J (KUMJ) 2017; 13:286-91. [PMID: 27423276 DOI: 10.3126/kumj.v13i4.16825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Ultrasonography is one of the most common imaging modality to measure dimensions of visceral organs in children. However, the normal limit of size of visceral organs according to age and body habitus has not been specified in the standard textbooks. This might result in under detection of organomegaly in pediatrics population. Objective The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy children. Method This is prospective cross-sectional, hospital-based study done at Tertiary-care teaching hospital. Participants included 272 pediatric subjects (152 male and 120 female) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were one month to 15 year (180 months) old. All measured organs were sonographically normal. Relationships of the dimensions of these organs with sex, age, body weight and height were investigated. Limits of normal dimensions of these organs were defined. Result Normal length of liver, kidneys and spleen were obtained sonographically for 272 children (152 male [55.9%] and 120 female [44.1%]) in the age group from 1 months to 15 (180 months) years. The mean age was 45.78 months (SD, 44.73). The measured dimensions of all these organs showed highest correlation with height and age so the descriptive analysis of the organ dimensions (mean, minimum, and maximum values, SD and 5th and 95th percentiles) were expressed in 10 age groups along with height range of the included children. The mean length of right kidney was shorter than the left kidney length, and the difference was statistically significant (p = 0.001). Conclusion This study provides practical and comprehensive guide to the normal visceral organ dimension in pediatric population. The normal range limit of the liver, spleen, and kidney determined in this study could be used as a reference in daily practice in local radiology clinics.
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Affiliation(s)
- N B Thapa
- Department of Radiology Kist Medical College Teaching Hospital, Gwarko, Lalitpur, Nepal
| | - S Shah
- Department of Pediatrics Kist Medical College Teaching Hospital, Gwarko, Lalitpur, Nepal
| | - A Pradhan
- Department of Community Medicine Kist Medical College Teaching Hospital, Gwarko, Lalitpur, Nepal
| | - K Rijal
- Department of Radiology Kist Medical College Teaching Hospital, Gwarko, Lalitpur, Nepal
| | - A Pradhan
- Department of Radiology Kist Medical College Teaching Hospital, Gwarko, Lalitpur, Nepal
| | - S Basnet
- Department of Pediatrics Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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Basnet S, Mainali NR, Tharu B, Dhital R, Poudel DR. An extensive chronic aortic dissection presenting with acute embolic stroke. J Community Hosp Intern Med Perspect 2017; 7:314-317. [PMID: 29147475 PMCID: PMC5676796 DOI: 10.1080/20009666.2017.1379854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/01/2017] [Accepted: 09/08/2017] [Indexed: 01/16/2023] Open
Abstract
Herein, we present a rare case of extensive chronic aortic dissection with extension to bilateral subclavian arteries, bilateral common carotid arteries, right internal carotid artery, bilateral proximal external iliac arteries and simultaneous presentation of acute embolic stroke and seizure. The rarity of this case presentation and the presence of neurological features necessitated a high index of clinical suspicion to reach the definitive diagnosis. This study also demonstrates a unique situation requiring correlation between chronic aortic dissection and multi-organ system dysfunction from chronic ischemia.
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Affiliation(s)
- Sijan Basnet
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | | | - Biswaraj Tharu
- Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal
| | - Rashmi Dhital
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Dilli Ram Poudel
- Department of Medicine, Reading Health System, West Reading, PA, USA
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Devkota H, Sibakoti YC, Menyangbo S, Basnet S, Jha MK, Banstola L. Correlation of Fine Needle Aspiration Cytology and Histopathology of the Neck Swellings Presenting at National Academy of Medical Sciences, Kathmandu, Nepal. Birat J Health Sci 2017. [DOI: 10.3126/bjhs.v2i2.18528] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IntroductionNeck masses are frequently found in clinical practice. A spectrum of pathological lesions ranging from inflammation to benign and highly malignant manifestation is observed. Fine needle aspiration cytology (FNAC) of neck masses is a quick, easy, safe and cheap technique in the diagnosis which has been a well-accepted procedure in diagnosing various swellings. Histopathology is a gold standard technique in diagnosing any swelling which also provide detail architecture, however it also requires OT setings, more manpower, expensive, time consuming, more traumatic and can sometimes become difficult.ObjectiveThe objective of our study was to evaluate the frequencies of neck swellings and how efficacy FNAC is in diagnosing neck masses by correlating the gold standard histopathological examination.MethodologyA Hospital based descriptive cross sectional prospective study was conducted in 50 patients with neck swellings presenting in the surgery OPD and admitied patient for some other reasons. FNAC and histopathological examinations were done from those lesions and were compared. The sensitivity, specificity and accuracy rates were calculated. Data entry and analysis was performed using SPSS.ResultsA total of 50 patient were subjected to both FNAC and histopathology examination (HPE). Out of 50 cases, 25 were male and 25 were female. The age ranged from 16 to 82 years. Lymph nodes 22 (44%) was the most common case, followed by thyroid 17 (34%), salivary glands 10 (20%) and soft issue 1 (2%).Among all Tubercular lymphadenitis (18%) followed by papillary carcinoma of thyroid (14%),metastatic carcinoma of lymph node, NHL, and pleomorphic adenoma 10% each. The sensitivity of FNAC in diagnosing neck masses is 90.08%, specificity is of 98.53%, and diagnostic accuracy is of 87.64%.ConclusionFNAC is a simple, fast, inexpensive, and minimally invasive technique which can be used as the first line investigation in diagnosing neck swellings.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, page: 206-210
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Shrestha P, Poudel D, Dhital R, Karmacharya P, Basnet S. OR047 Seasonal and regional variation of asthma-related hospitalization and mortality in the United States. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Basnet S, Dhital R, Tharu B, Ghimire S, Poudel DR. Abstract P144: Association Between Hypertension and Thyroid Abnormalities Among Hospitalized United States Patients: Data From National Inpatient Sample. Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p144] [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: 11/16/2022]
Abstract
Introduction:
Disorders of thyroid, hyperthyroidism and hypothyroidism, are established risk factors for hypertension. Comparison of these risk factors in terms of association has not been done.
Methods:
National Inpatient Sample database from 2009 - 2011 was utilized to explore relationship between hypertension and three categories of thyroid hormone levels (hyperthyroidism, hypothyroidism and euthyroidism). Multivariate logistic regressions were used to establish the association among all thyroid hormone level groups. We utilized STATA version 13.0 (College Station, TX) to perform the analyses.
Results:
Hypertension was more common in patients with hypothyroidism and hyperthyroidism in comparison to euthyroidism (Table 1). Multivariate analysis with logistic regression (controlled for age, sex, race, smoking, obesity, dyslipidemia, diabetes, Charlson comorbidity index) demonstrated that hypertension had a greater association with hyperthyroidism (OR 1.20; CI: 1.17 - 1.23) than hypothyroidism (OR 1.09; CI: 1.08 - 1.10).
Discussion:
T3 dilates peripheral arterioles and decreases systemic vascular resistance which stimulates renin secretion and increases effective arterial blood volume. Also, it increases heart rate and cardiac contractility. These mechanisms lead to increase in blood pressure. On the other hand, the mechanism with hypothyroidism is not fully recognized. It is thought to be secondary to increase in systemic vascular resistance. Through our study, we can conclude that the risk of hypertension is greater in patients with hyperthyroidism than with hypothyroidism.
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Affiliation(s)
| | | | - Biswaraj Tharu
- Maharajgunj Med Campus, Tribhuvan Univ, Kathmandu, Nepal
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