25 results on '"Basel Abdelazeem"'
Search Results
2. Emergent Hemodialysis Followed by Continuous Renal Replacement Therapy: A Management Challenge in a Patient With Life-Threatening Metabolic Acidosis of Multifactorial Etiology
- Author
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Amman Yousaf, Bilal Malik, Basel Abdelazeem, and Arvind Kunadi
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General Engineering - Published
- 2022
3. Edema of the Ligamentum Teres as a Novel MRI Marker for Non-Traumatic Painful Hip Pathology: A Retrospective Observational Study
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Syed, Alam, Amman, Yousaf, Yahya, Alborno, Mohammad, Shujauddin, Syed Imran, Ghouri, Basel, Abdelazeem, Ahmad L F, Yasin, Syeda, Shabistan, and Ghalib, Ahmed
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General Engineering - Abstract
Background The ligamentum teres has been recognized as an important stabilizer of the hip joint and can be affected by various hip pathologies. This study aims to introduce ligamentum teres edema as an MRI marker to diagnose the underlying cause of hip pathology, mainly femoral acetabular impingement (FAI) and adult developmental dysplasia of the hip (ADDH), in non-traumatic patients. Methodology Adult patients presenting with non-traumatic hip pain of variable duration and ligamentum teres edema on MRI between 2014 and 2020 were included. A high-resolution standard MRI hip protocol was used for all patients in this series. MRI and plain radiographs were assessed. Ligamentum teres edema, alpha angle, center edge angle of Wiberg, and retroversion were assessed. Results In total, 55 patients with 110 hip joints (males: 29 (52.7%), females: 26 (47.3%)) of different ethnicities were included in this study. Out of the 55 patients with ligamentum teres edema, one had only unilateral right-sided FAI, seven had only unilateral left-sided FAI, and 46 (94 hip joints) had either bilateral FAI or ADDH. Therefore, eight (14.5%) patients with unilateral FAI had the absence of the contralateral FAI or ADDH (6.5% false-positive) despite the presence of ligamentum teres edema bilaterally, and the rest of the patients with bilateral ligamentum teres edema (102 joints: 92.7% positive predictive value) had findings of either FAI or ADDH. Conclusions Ligamentum teres edema can be considered as an early MRI marker to diagnose the underlying pathology of symptomatic painful hip disorders, especially FAI.
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- 2022
4. Infectious Aortitis: Case Report and Literature Review
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Basel Abdelazeem, Soumya Kambalapalli, Abdelilah Lahmar, Amman Yousaf, and Halina Kusz
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General Engineering - Published
- 2022
5. Extracorporeal Membrane Oxygenation (ECMO): A Life Saver in Near-Fatal Asthma
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Emad Kandah, Basel Abdelazeem, Sarah Al Qasem, Ahmed Jamal Chaudhary, and Nouraldeen Manasrah
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invasive mechanical ventilation ,Pulmonology ,Near fatal asthma ,business.industry ,medicine.medical_treatment ,General Engineering ,vv ecmo ,asthma exacerbations ,Anesthesia ,Emergency Medicine ,Internal Medicine ,Extracorporeal membrane oxygenation ,medicine ,abg ,near fatal asthma ,business - Abstract
Near-fatal asthma (NFA) is a life-threatening condition that represents the most severe clinical phenotype of asthma and can progress to fatal asthma. Patients with NFA do not respond adequately to conventional medical therapy and urgent intervention is needed to provide adequate oxygenation by invasive mechanical ventilation. While mechanical ventilation is a potentially life-saving intervention, it could cause lung injury, barotrauma, and dynamic hyperinflation due to high ventilator settings resulting in hemodynamic instability. Extracorporeal membrane oxygenation (ECMO) provides full respiratory support with adequate gas exchange in patients with NFA and improves survival rate. We present a case of a young female patient who presented with NFA, and her clinical condition was worsening despite invasive positive pressure mechanical ventilation.
- Published
- 2021
6. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO): A Case Report
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Amman Yousaf, Syed I. Alam, Ahmed Mounir Elsyaed, Shoaib Muhammad, and Basel Abdelazeem
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musculoskeletal diseases ,Hyperostosis ,medicine.medical_specialty ,business.industry ,General Engineering ,medicine.disease ,Pustulosis ,Dermatology ,sapho ,Orthopedics ,sapho syndrome ,Synovitis ,Internal Medicine ,synovitis acne pustulosis hyperostosis osteitis ,medicine ,cellulitis ,medicine.symptom ,Osteitis ,Radiology ,synovitis ,business ,Acne - Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an uncommon adulthood disorder that presents as focal swellings and pain accompanied by abnormal changes in bone and surrounding soft tissues. X-rays of the involved region are usually insignificant; however, CT and MRI show excellent visualization of the affected structures. Typical radiological images show cortical thickening leading to decreased marrow cavity, bony erosion, and ligament ossifications. Other associated findings are synovitis and joint effusions. It is usually diagnosed on the basis of clinical as well as radiological findings. The treatment initially relies on non-steroidal anti-inflammatory drugs (NSAIDs). Patients showing poor response are started on corticosteroids and disease-modifying antirheumatic drugs (DMARDs). We report two patients who presented with joint swellings. Their workup unmasked the underlying SAPHO, which was managed well with NSAIDs.
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- 2021
7. Light Chain (AL) Cardiac Amyloidosis: A Diagnostic Dilemma
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Basel Abdelazeem, Arvind Kunadi, Rudin Gjeka, Amman Yousaf, and Nouraldeen Manasrah
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amyloidosis ,Pathology ,medicine.medical_specialty ,business.industry ,General Engineering ,Cardiology ,Diagnostic dilemma ,light chain ,Immunoglobulin light chain ,transthyretin ,Cardiac amyloidosis ,Cardiac/Thoracic/Vascular Surgery ,medicine ,Internal Medicine ,case report ,cardiac imagings ,business - Abstract
Amyloidosis is a clinical condition characterized by amyloid fibril deposition into different organ systems. The most common types are light chain (AL) amyloidosis and transthyretin amyloidosis (ATTR) amyloidosis. Amyloidosis involves the heart with an incidence of 1.38 to 3.69 per 100,000 person-years and a prevalence of 14.85 per 100,000 person-years between 2004 and 2018. Diagnosis of cardiac amyloidosis can be made through cardiac imaging, including cardiac magnetic resonance imaging (CMR) and 99mTc-labeled pyrophosphate (PYP) cardiac scan. However, a tissue biopsy is frequently needed to confirm the diagnosis. Herein, we report such a case of cardiac amyloidosis. The patient presented with pericardial effusion and acute kidney injury as the initial presentation. The presumptive diagnosis was ATTR amyloidosis, but the endomyocardial biopsy confirmed the diagnosis of AL amyloidosis. The patient was started on bortezomib, cyclophosphamide, and dexamethasone therapy. We aimed to highlight the different diagnostic modalities of cardiac amyloidosis and the importance of obtaining tissue biopsy to confirm the amyloidosis type before starting the treatment.
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- 2021
8. Fever and Hyponatremia Unmasking Brugada Pattern Electrocardiogram in a Patient With SARS-CoV-2 Infection
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Sherif Elkattawy, Raja Pullatt, Kirolos Gergis, Ramez Alyacoub, Muhammad Atif Masood Noori, Sarah Ayad, and Basel Abdelazeem
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medicine.medical_specialty ,hyponatremia ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Cardiology ,Infectious Disease ,electrocardiogram ,Chest pain ,Sudden cardiac death ,Internal medicine ,medicine ,cardiovascular diseases ,Brugada syndrome ,fever ,Productive Cough ,business.industry ,General Engineering ,Genetic disorder ,medicine.disease ,sars-cov-2 ,covid-19 ,Chills ,medicine.symptom ,business ,Hyponatremia ,brugada syndrome - Abstract
Brugada syndrome is an autosomal dominant genetic disorder that primarily affects myocardial sodium channels and has been associated with an increased risk of ventricular tachyarrhythmias and sudden cardiac death. Here, we report a case of a 58-year-old Hispanic male with a history significant for prior pulmonary tuberculosis infection who presented with pleuritic left-sided chest pain associated with body aches, productive cough, fevers, and chills and was found to be positive for SARS-CoV-2 by real-time reverse-transcription-polymerase chain reaction (rRT-PCR). Electrocardiogram (ECG, EKG) on presentation demonstrated a coved ST-segment elevation in V1-V2, suggesting Brugada pattern type 1 without evidence of ischemic changes. EKG changes normalized once fever and hyponatremia improved.
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- 2021
9. Outpatient Management of COVID-19 With Monoclonal Antibody Therapy in a Young Renal Transplant Patient
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Kamal Rikabi, Arvind Kunadi, Bilal Haider Malik, Basel Abdelazeem, and Atefeh Kalantary
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immunocompromised patient ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,solid organ transplant ,General Engineering ,Immunosuppression ,medicine.disease ,covid-19 ,Nephrology ,Renal transplant ,Internal medicine ,renal transplant ,Internal Medicine ,medicine ,Public Health ,monoclonal antibodies ,Outpatient management ,Solid organ transplantation ,business ,Sinusitis ,Lower mortality ,Monoclonal antibody therapy - Abstract
At baseline, solid organ transplant recipients are at an increased risk for infectious complications due to the complex immunosuppressive regimens. The available data in renal transplant patients who contract coronavirus disease 2019 (COVID-19) demonstrates dangerously high mortality rates (33%) in those who require hospitalization and/or ICU level care. Interestingly, the data for transplant patients who do not require hospitalization shows significantly lower mortality (3%) despite being on an immunosuppressive regimen. We present the case of a young male patient with a history of renal transplant who tested positive for COVID-19; he was mildly symptomatic with cough, sinusitis, and headache, was worked up as an outpatient, and treated as an outpatient with bamlanivimab monotherapy with no adjustment to his immunosuppressive regimen. This case aims to highlight the possibility of safely managing mild cases of COVID-19 in solid organ transplant patients receiving immunosuppression as an outpatient with monoclonal antibody (mAb) therapy.
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- 2021
10. An Unusual Presentation of Cholesterol Embolization Syndrome
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Abdul-Fatawu Osman, Arvind Kunadi, Sarah Ayad, Basel Abdelazeem, and Rudin Gjeka
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renal failure ,medicine.medical_specialty ,hypertension ,business.industry ,cholesterol embolization syndrome ,High mortality ,Cardiology ,General Engineering ,atheroembolism ,Disease ,behavioral disciplines and activities ,medicine.anatomical_structure ,Cardiac/Thoracic/Vascular Surgery ,Intervention (counseling) ,Internal medicine ,Internal Medicine ,case report ,Medicine ,In patient ,Cholesterol embolization syndrome ,Presentation (obstetrics) ,business ,Artery - Abstract
Cholesterol embolization syndrome (CES) is a rare presentation of systemic atherosclerosis, which commonly presents in patients with risk factors of coronary artery disease and usually occurs after cardiac or vascular procedures. Laboratory tests are nonspecific, and imaging studies may visualize the plaque. Management includes supportive care directed to relieve the end-organ damage. The prognosis of CES is poor, with high mortality of up to 29% if the CES resulted in atheroembolic renal disease (AERD). In our report, we present a 90-year-old Caucasian female who was diagnosed with CES and complicated with AERD. The patient did not undergo any cardiac or vascular procedures. This case highlights the importance of considering CES and AERD as a potential cause of renal failure, especially in high-risk patients, even if the patients did not have any history of cardiac or vascular intervention.
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- 2021
11. A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19
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Sarah Ayad, Basel Abdelazeem, Ari Eckman, Afrah Talpur, Chidinma Ejikeme, Mohammad Nabil Rayad, Latika Patel, and Kirolos Gergis
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Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Diabetic ketoacidosis ,endocrine system diseases ,Infectious Disease ,diabetes type ii ,New onset diabetes ,Diabetes mellitus ,medicine ,Internal Medicine ,diabetes typee i ,Past medical history ,business.industry ,diabetic ketoacidosis (dka) ,General Engineering ,Endocrinology/Diabetes/Metabolism ,medicine.disease ,Pathophysiology ,Ketoacidosis ,sars-cov-2 ,covid-19 ,hyperglycemia ,business ,Complication ,hemoglobin a1c - Abstract
Diabetic ketoacidosis (DKA) is a significant complication of poorly controlled diabetes. In diabetics, it typically occurs due to insulin deficiency resulting in lipolysis and subsequent ketone body formation and acidosis. The emergence of the COVID-19 infection has been associated with several complications, with the most prominent being pulmonary and cardiovascular-related. However, in some cases, patients with COVID-19 infection present with diabetic ketoacidosis. The pathophysiology of DKA in COVID-19 infection is different and currently not completely understood. The manifestation of DKA in COVID-19 patients is associated with increased severity of mortality and length of stay in these patients. Here, we describe a patient with no past medical history who presented with COVID-19 symptoms and was found to be in DKA. This case report highlights the possible underlying pathophysiology associated with this complication.
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- 2021
12. Azithromycin-Induced Bradycardia
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Basel Abdelazeem, Rachel M Hollander, Kirolos Gergis, Mohamed E Gismalla, and Sarah Ayad
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Bradycardia ,Cardiology ,Infectious Disease ,Aspiration pneumonia ,Azithromycin ,Drug overdose ,QT interval ,bradycardia ,medicine ,Internal Medicine ,case report ,cardiovascular diseases ,azithromycin ,Past medical history ,bradyarrhythmia ,business.industry ,General Engineering ,macrolide ,medicine.disease ,Obstructive sleep apnea ,Polysubstance dependence ,Anesthesia ,medicine.symptom ,business ,medicine.drug ,circulatory and respiratory physiology - Abstract
Azithromycin is a broad-spectrum antibiotic of the macrolide class and has multiple effects on the cardiovascular system, including prolonged corrected QT (QTc) interval. However, there is limited literature on the association between azithromycin and bradyarrhythmias. Monitoring the patient via telemetry can detect bradycardia. The diagnosis of azithromycin-induced bradycardia is usually made by the exclusion of other causes of bradycardia. We report a case of a 44-year-old female with past medical history of obstructive sleep apnea who presented to our hospital due to polysubstance drug overdose with possible aspiration pneumonia. The patient received azithromycin and subsequently developed symptomatic bradycardia two days post-onset of antibiotic treatment. This case raises awareness amongst physicians about the possibility of azithromycin-induced bradycardia and explains the different mechanisms that can cause it.
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- 2021
13. A Case Report of Brown Recluse Spider Bite
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Kianna Eurick-Bering, Zirka Kalynych, Sarah Ayad, Bilal Haider Malik, and Basel Abdelazeem
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spider bite ,medicine.medical_specialty ,genetic structures ,brown recluse spider ,Dermatology ,Multiple risk factors ,complex mixtures ,Brown Recluse Spider Bites ,Internal Medicine ,case report ,Medicine ,cellulitis ,Spider ,business.industry ,General Engineering ,Against medical advice ,Violin spider ,medicine.disease ,necrotic ulcer ,medicine.drug_formulation_ingredient ,nervous system ,Cellulitis ,business ,Brown Recluse Spider ,Genus Loxosceles - Abstract
Brown recluse spider is a spider of the genus Loxosceles and also known as violin spider or fiddle-back spider. Brown recluse spider is characterized by having six eyes, with a pair in front, a pair on both sides, and a gap between the pairs. The other spiders have eight eyes in two rows of four. Brown recluse spider bites are challenging to verify but may be clinically diagnosed with consideration of geographic location, seasonality, and clinical characteristics. We present a case that involves a brown recluse spider bite in a 59-year-old female with malnutrition and polysubstance use who developed systemic symptoms and a dermonecrotic wound. Local wound care and intravenous (IV) antibiotics lead to clinical improvement by hospital day three, at which time the patient left against medical advice. The case highlights the challenges of diagnosing a brown recluse spider bites, particularly in a patient with multiple risk factors for necrotizing soft tissue infection. Furthermore, the present case represents one of the few case reports of a brown recluse spider bite in Michigan.
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- 2021
14. Magnetic Resonance Features of a Recent Catheter Ablation of Left Posterior Fascicular Ventricular Tachycardia
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Sarah Ayad, Saed Alnaimat, Mustafa Hassan, Taylor A Revere, and Basel Abdelazeem
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medicine.medical_specialty ,Lidocaine ,medicine.medical_treatment ,Cardiology ,Catheter ablation ,electrocardiogram ,Amiodarone ,Cardioversion ,Ventricular tachycardia ,Electrophysiology study ,Internal medicine ,catheter ablation ,Internal Medicine ,medicine ,case report ,magnetic resonance imaging ,Sinus rhythm ,cardiovascular diseases ,medicine.diagnostic_test ,business.industry ,General Engineering ,Ablation ,medicine.disease ,ventricular tachycardia ,business ,medicine.drug - Abstract
A 71-year-old male patient with a past medical history of hypertension, hyperlipidemia, and chronic kidney disease stage II presented with a complaint of intermittent palpitations for three months and was found to have wide complex tachycardia on the electrocardiogram (ECG). The patient was given adenosine and amiodarone, following which he underwent synchronized cardioversion at 150 Joules followed by 200 Joules without successful conversion. He was subsequently initiated on lidocaine drip at the rate of 1 to 4 mg/minute to maintain adequate rhythm control, which converted him to sinus rhythm and relieved his symptoms. An eventual assessment with an electrophysiology study identified the presence of incessant left ventricular tachycardia (VT). The mechanism was confirmed to be left posterior fascicular ventricular tachycardia (LPF-VT). Successful mapping and ablation for the LPF-VT were achieved. Post-procedure cardiac MRI showed two small areas of near-transmural delayed enhancement. These areas are associated with nulled areas in the inferolateral wall at the left posterior His-Purkinje fascicle. This case highlights fascicular VT as a separate clinical entity, with its characteristic ECG features and acute MRI features after ablation.
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- 2021
15. Cancer-Related Non-Bacterial Thrombotic Endocarditis Presenting as Acute Ischemic Stroke
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Nischit Baral, Sakiru Isa, Mustafa Hassan, Basel Abdelazeem, and Pramod Savarapu
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medicine.medical_specialty ,Cardiology ,030204 cardiovascular system & hematology ,Nonbacterial thrombotic endocarditis ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Mitral valve ,Internal Medicine ,medicine ,Endocarditis ,Stroke ,non-bacterial thrombotic endocarditis ,business.industry ,General Engineering ,Cancer ,medicine.disease ,stroke ,marantic endocarditis ,medicine.anatomical_structure ,Neurology ,pancreatic-biliary cancer ,Etiology ,business ,030217 neurology & neurosurgery - Abstract
Non-bacterial thrombotic endocarditis (NBTE), also known as marantic endocarditis, is a rare form of noninfectious endocarditis presenting with thromboembolism including ischemic cerebral stroke. It is mostly associated with advanced malignancy and characterized by the presence of sterile vegetation on heart valves. The diagnosis is usually based on vegetations seen on an echocardiogram, with negative blood cultures suggesting a noninfectious etiology. The treatment for this condition includes systemic anticoagulation. In this report, we discuss the case of a 61-year-old Caucasian female who presented to our facility with an ischemic stroke. She was found to have vegetations on the mitral valve with negative blood cultures. Further studies revealed metastatic pancreatic cancer. The patient's condition improved following in-hospital management, and she was discharged home for outpatient follow-up and treatment. Through this report, we highlight the importance of considering a search for malignancy in patients presenting with these clinical features. Early diagnosis and prompt management are critical to reduce the complications of NBTE and improve the patients' quality of life.
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- 2021
16. Systematic Review and Meta-Analysis: Can We Compare Direct Oral Anticoagulants to Warfarin in Patients With Atrial Fibrillation and Bio-Prosthetic Valves?
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Nischit Baral, Govinda Adhikari, Pramod Savarapu, Sakiru Isa, Hafiz Khan, Sandip Karki, Hameem Changezi, Mahin Khan, Basel Abdelazeem, and Rohit Rauniyar
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medicine.medical_specialty ,Cardiology ,030204 cardiovascular system & hematology ,systematic review and meta-analysis ,law.invention ,stroke occurrence ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Internal Medicine ,Medicine ,atrial fibrillation ,Stroke ,major bleeding events ,business.industry ,Standard treatment ,valvular heart disease ,General Engineering ,Warfarin ,Atrial fibrillation ,Hematology ,bio-prosthetic valve ,medicine.disease ,direct oral anticoagulant therapy ,Meta-analysis ,business ,intracranial hemorrhage ,030217 neurology & neurosurgery ,Cohort study ,medicine.drug - Abstract
Background There are no clear consensus guidelines on the indications and types of anticoagulation therapies in patients with bio-prosthetic valves either with concomitant atrial fibrillation (AF) or sinus rhythm. In our meta-analysis, we assessed the safety and efficacy of DOACs as compared to the standard treatment with warfarin in patients with AF and bioprosthetic valves. Methods We included randomized controlled trials (RCTs), cohort studies in the English language, and studies reporting patients with valvular heart disease that included bioprosthetic valvular disease. A systematic literature review using Embase, PubMed, and Web of Science was performed using the terms “Direct Acting Oral Anticoagulant,” “Oral Anticoagulants,” “Non-Vitamin K Antagonist Oral Anticoagulant,” “Atrial Fibrillation,” “Bioprosthetic Valve” for literature published prior to January 2021. Extraction of data from included studies was carried out independently by three reviewers from Covidence. We assessed the methodical rigor of the included studies using the modified Downs and Black checklist. Results Four RCTs and one observational study (n=1776) were included in our study. A random-effect model using RevMan (version 5.4; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen) was used for data analysis. The pooled data showed that there was a non-significant reduction in the incidence of stroke and systemic embolism in the patients taking DOACs as compared to warfarin (HR 0.69; 95% CI, 0.29, 1.67; I2 = 50%). The incidence of major bleeding was lower in the DOACs group; the difference was statistically significant (HR 0.42; 95% CI, 0.26, 0.67; I2 = 7%). The difference was not statistically significant for all-cause mortality in both groups (HR 1.24; 95% CI, 0.91, 1.67; I2 = 0%). Conclusion Our results showed that there was no difference in the outcomes of stroke and systemic embolism between DOACs and warfarin but there were statistically significantly lower major bleeding events. We conclude that larger clinical trials are needed to assess the true safety and efficacy of DOACs in patients with AF and bioprosthetic valves.
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- 2021
17. Persistent Cardiac Magnetic Resonance Imaging Features of Myocarditis Detected Months After COVID-19 Infection
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Basel Abdelazeem, Sagar Mallikethi-Reddy, Mariem Borcheni, Saed Alnaimat, and Abdulbaset Sulaiman
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medicine.medical_specialty ,Myocarditis ,Cardiology ,Infectious Disease ,030204 cardiovascular system & hematology ,Chest pain ,cardiac magnetic resonance ,03 medical and health sciences ,0302 clinical medicine ,sars-cov2 ,Cardiac magnetic resonance imaging ,Internal medicine ,medicine ,Internal Medicine ,echocardiography ,cardiovascular diseases ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,General Engineering ,Dilated cardiomyopathy ,medicine.disease ,covid-19 ,Heart failure ,cardiovascular system ,medicine.symptom ,Transthoracic echocardiogram ,myocarditis ,business ,030217 neurology & neurosurgery - Abstract
Acute myocarditis is commonly caused by viral infections resulting from viruses such as adenovirus, enteroviruses, and, rarely, coronavirus. It presents with nonspecific symptoms like chest pain, dyspnea, palpitation, or arrhythmias and can progress to dilated cardiomyopathy or heart failure. Fulminant myocarditis is a potentially life-threatening form of the condition and presents as acute, severe heart failure with cardiogenic shock. In this report, we discuss a case of a 41-year-old female who presented with cough and chest pain of two days' duration. The patient had a new-onset atrial flutter. Her chest auscultation revealed bilateral crackles. Laboratory workup revealed elevated troponin levels, and the patient tested positive for coronavirus disease 2019 (COVID-19) by nasopharyngeal swab polymerase chain reaction (PCR). Transthoracic echocardiogram revealed a low left ventricular (LV) ejection fraction of 35-40% compared to 55% one year prior, as well as a granular appearance of LV myocardium. The patient's condition subsequently improved clinically and she was discharged home. Due to cardiac involvement and characteristic myocardial appearance on the echocardiogram, cardiac magnetic resonance (CMR) imaging was performed for further evaluation about two months from the date of admission. CMR showed extensive myocardial inflammation with a typical pattern of sub-epicardial and mid-wall delayed enhancement, confirming the diagnosis of myocarditis. This case highlights myocarditis as a potential complication of COVID-19 that requires early diagnosis and proper management to improve patients' quality of life. Additionally, we highlight the features of myocarditis on CMR in the acute phase and two months after clinical recovery.
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- 2021
18. A Case Report of Sick Sinus Syndrome as an Initial Presentation of Primary Amyloidosis
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Rudin Gjeka, Bilal Haider Malik, Basel Abdelazeem, Arvind Kunadi, and Nischit Baral
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medicine.medical_specialty ,restrictive cardiomyopathy ,Cardiology ,heart failure ,030204 cardiovascular system & hematology ,Sick sinus syndrome ,03 medical and health sciences ,0302 clinical medicine ,sick sinus syndrome ,Biopsy ,Internal Medicine ,medicine ,AL amyloidosis ,heart block ,case report ,amyloidosis ,medicine.diagnostic_test ,Esophagogastroduodenoscopy ,business.industry ,Amyloidosis ,General Engineering ,medicine.disease ,Dysphagia ,Surgery ,Renal biopsy ,medicine.symptom ,Transthoracic echocardiogram ,business ,Family/General Practice ,030217 neurology & neurosurgery - Abstract
Primary light chain amyloidosis (AL amyloidosis) rarely presents as sick sinus syndrome (SSS), and only a few cases have been reported in the literature. A higher index of suspicion is needed to diagnose AL amyloidosis in patients presenting with SSS. Recognizing the electrocardiography (ECG) and transthoracic echocardiogram (TTE) findings for amyloidosis are crucial for early recognition, proper management, and to improve the patients' quality of life. A 79-year-old female initially presented with dyspnea and was diagnosed with SSS that required a pacemaker insertion. Ten days later, the patient had complained of dysphagia and difficulty swallowing. She underwent an esophagogastroduodenoscopy (EGD) to investigate further, and it revealed esophageal and duodenal ulcers, and biopsy was positive for amyloidosis. The patient was worked up for amyloidosis, including bone marrow biopsy, renal biopsy, frees light chains, and serum electrophoresis, which all confirmed the diagnosis of primary amyloidosis. Unfortunately, due to the terminal nature of her condition, the patient was discharged with comfort measures to hospice care.
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- 2021
19. Primary Central Nervous System Vasculitis as an Unusual Cause of Intracerebral Hemorrhage: A Case Report
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Bilal Haider Malik, Simhachalam Gurugubelli, Basel Abdelazeem, Arvind Kunadi, and Mariem Borcheni
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Pathology ,medicine.medical_specialty ,Anti-nuclear antibody ,030204 cardiovascular system & hematology ,Transverse myelitis ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,Anti-neutrophil cytoplasmic antibody ,Intracerebral hemorrhage ,primary cns vasculitis ,biology ,medicine.diagnostic_test ,business.industry ,Brain biopsy ,induction therapy ,General Engineering ,Hepatitis B ,medicine.disease ,intracerebral hemorrhage ,Neurology ,cns angiitis ,Immunoglobulin M ,biology.protein ,Vasculitis ,business ,030217 neurology & neurosurgery - Abstract
A 64-year-old male with a history of transverse myelitis presented to the hospital with a decreased level of consciousness of one day's duration. CT of the head revealed intracranial hemorrhage measuring 2 x 1.2 cm in the right temporal lobe and multiple small hemorrhages in the left hemisphere, suggestive of vasculitis. Initial vasculitis workup was negative for antinuclear antibody (ANA), complement component 3 (C3), and antineutrophil cytoplasmic antibodies: P-ANCA, C-ANCA. Syphilis, hepatitis B and C, West Nile virus antibody [immunoglobulin G (IgG) and immunoglobulin M (IgM)], herpes simplex virus (HSV) polymerase chain reaction (PCR), and HIV 1 and 2 were also negative. In view of the CT scan findings suggestive of vasculitis and the vague presentation of primary central nervous system vasculitis (PCNSV), a brain biopsy was performed. It revealed angiocentric granulomatous inflammation with focal vessel disruption and associated parenchymal hemorrhage, consistent with a diagnosis of granulomatous vasculitis. The patient received levetiracetam, multiple high doses of steroids, and six cycles of cyclophosphamide for a six-month duration. After induction, he has remained in remission without any maintenance therapy until now (eight years post-presentation).
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- 2021
20. Sudden Cardiac Death and Sudden Cardiac Arrest in Patients with Human Immunodeficiency Virus: A Systematic Review
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Kirolos Gergis, Basel Abdelazeem, Govinda Adhikari, Rohit Rauniyar, and Nischit Baral
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medicine.medical_specialty ,medicine.medical_treatment ,Cardiology ,sudden death ,heart failure ,hiv ,cardiac arrest ,030204 cardiovascular system & hematology ,Sudden death ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,systematic review ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,Internal Medicine ,medicine ,Cardiopulmonary resuscitation ,business.industry ,Incidence (epidemiology) ,General Engineering ,acquired immune deficiency syndrome (aids) ,Sudden cardiac arrest ,medicine.disease ,Heart failure ,HIV/AIDS ,medicine.symptom ,business ,Viral load ,030217 neurology & neurosurgery - Abstract
The importance of this review lies in its study of the risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA) in people living with the human immunodeficiency virus (PLWH). To the best of our knowledge, this is the first review investigating the effect of the human immunodeficiency virus (HIV) on SCD and SCA. The review's objective was to determine the risk of SCD and SCA in PLWH. To do this, the electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Scopus, and Google Scholar were systematically searched to identify eligible studies published before January 31, 2021. Reference lists of the included studies were searched for further identification of relevant studies. The search terms included: "Sudden Cardiac Death," "Sudden Cardiac Arrest," "Human Immunodeficiency virus," "HIV," "Acquired immunodeficiency syndrome," and "AIDS." Only observational studies that assessed the association between SCD and SCA in PWLH were selected. Data were extracted by two independent authors who screened titles, abstracts, and articles to meet the inclusion criterion. Quality assessment was done by using modified Downs and Black checklist. A total of seven studies were included in this review. Five studies revealed a higher incidence of SCD in PLWH, two of which focused on patients with HIV and low left ventricular ejection fraction (LVEF). The other two studies were about the association of HIV and SCA. Studies reported that PLWH had a three- to five-fold higher incidence of SCD as compared to non-HIV patients. HIV patients with low LVEF had a higher incidence of SCD than HIV patients with normal LVEF. PLWH had a higher incidence of SCA and less successful cardiopulmonary resuscitation (CPR) as compared to patients without HIV. After adjusting for various confounders in multiple studies, all the studies reported a higher incidence of SCD in PLWH. To conclude, PLWH is at an increased risk of SCD and SCA. Some risk factors for this include LVEF, viral load (VL), and the cluster of differentiation 4 (CD4) count. There is a paucity of data on the mechanisms involved, although a higher prevalence of cardiac fibrosis and interstitial fibrosis in PLWH may play a role. Because of the general suboptimal quality of the heterogeneous nature of the current evidence, further, rigorous studies are needed to determine the association of increased risk of SCD and SCA in PLWH.
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- 2021
21. Duloxetine-Induced Liver Injury: A Case Report
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Bilal Haider Malik, Taylor A Revere, Arvind Kunadi, Nischit Baral, and Basel Abdelazeem
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medicine.medical_specialty ,lfts ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Female patient ,Internal Medicine ,transaminitis ,medicine ,Duloxetine ,hepatitis ,Liver injury ,Hepatitis ,antidepressant ,medicine.diagnostic_test ,business.industry ,duloxetine ,Gastroenterology ,General Engineering ,medicine.disease ,chemistry ,inflammation ,Transaminitis ,Antidepressant ,Liver function tests ,business ,Family/General Practice ,030217 neurology & neurosurgery ,liver injury - Abstract
We present a case of a young (43-year-old), otherwise healthy, female patient who developed drug-induced liver injury (DILI) secondary to routine use of duloxetine. Our case aims to raise awareness amongst physicians about the possibility of duloxetine-induced liver injury. We recommend monitoring liver function tests (LFTs) when initiating or adjusting the dose of duloxetine, and intermittently thereafter, to facilitate early identification and management of potential DILI.
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- 2021
22. Pulmonary Fibrosis After COVID-19 Pneumonia
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Bilal Haider Malik, Abhijeet Ghatol, and Basel Abdelazeem
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pulmonology ,medicine.medical_treatment ,Pulmonary disease ,Infectious Disease ,030204 cardiovascular system & hematology ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,medical icu ,Oxygen therapy ,Internal medicine ,Pulmonary fibrosis ,medicine ,Internal Medicine ,Coronavirus ,pulmonary disease ,fibrotic lung disease ,pulmonary fibrosis ,business.industry ,Respiratory disease ,General Engineering ,covid ,Pirfenidone ,medicine.disease ,respiratory disease ,Pneumonia ,covid-19 ,business ,pulmonary critical care ,030217 neurology & neurosurgery ,medicine.drug - Abstract
A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), emerged in Wuhan, China, and rapidly spread across the world. Today, we present an interesting case of a patient with no prior history of pulmonary disease who was diagnosed with COVID-19, recovered after a prolonged hospital course, and was diagnosed with pulmonary fibrosis requiring oxygen therapy thereafter. The patient is currently on pirfenidone and has had a significant improvement in his functional status. His oxygen requirements have decreased, and repeat computed tomography (CT) scanning has demonstrated improvement in the extent of his pulmonary fibrosis. This case highlights the possibility of pulmonary fibrosis being a major complication among COVID-19 survivors and the importance of using pirfenidone in the management of such cases.
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- 2021
23. Inspiratory Muscle Training in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis
- Author
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Nischit Baral, Andrew Champine, Hafiz Khan, Shashi Sigdel, Mahin Khan, Prakash Adhikari, Govinda Adhikari, Basel Abdelazeem, Abhushan Poudyal, and Hameem Changezi
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heart failure with preserved ejection fraction ,medicine.medical_specialty ,Physical Medicine & Rehabilitation ,Cardiology ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Internal Medicine ,Prospective cohort study ,peak oxygen consumption ,6 minute walk distance ,inspiratory muscle training ,business.industry ,diastolic heart failure ,General Engineering ,Diastolic heart failure ,Inspiratory muscle training ,Cardiorespiratory fitness ,medicine.disease ,Pooled variance ,Meta-analysis ,respiratory muscle exercise ,business ,Heart failure with preserved ejection fraction ,030217 neurology & neurosurgery - Abstract
Objectives To explore the role of inspiratory muscle training (IMT) in improving cardiorespiratory fitness of stable heart failure with preserved ejection fraction (HFpEF) patients. Background There is a paucity of data on the role of IMT in patients with HFpEF. HFpEF is a growing problem in the developed world, especially in the aging population. Methods We conducted a systematic literature search for English studies in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. We searched databases using terms relating to or describing breathing exercise, IMT, and HFpEF. RevMan 5.4 (The Cochrane Collaboration, 2020) was used for data analysis, and two independent investigators performed literature retrieval and data extraction. Results We identified three randomized controlled trials (RCTs) and one prospective study on the role of IMT in HFpEF. We calculated the pooled mean difference of peak oxygen consumption (Peak VO2) and six-min walk distance (6MWD) between the IMT and standard care (SC) groups. Our meta-analysis showed that compared with SC, IMT could significantly improve peak VO2 with a mean difference (MD) of 2.82 ml/kg/min, 95% CI [1.90, 3.74] P < 0.00001 and improve 6MWD with MD of 83.97 meters, 95% CI [59.18, 108.76] P< 0.00001 to improve cardiorespiratory fitness at 12 weeks of IMT and improve peak VO2 with MD of 2.18 ml/kg/min, 95% CI [0.38, 3.99] P < 0.00001 at 24 weeks of therapy. Conclusion IMT should be further studied as a possible treatment option to improve cardiorespiratory fitness for patients with stable HFpEF.
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- 2021
24. Spodick’s Sign: A Case Report and Review of Literature
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Basel Abdelazeem, Mariem Borcheni, Emad Kandah, Arvind Kunadi, and Saed Alnaimat
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medicine.medical_specialty ,Cardiology ,030204 cardiovascular system & hematology ,Chest pain ,Coronary artery disease ,03 medical and health sciences ,Pericarditis ,0302 clinical medicine ,Acute pericarditis ,Internal medicine ,Internal Medicine ,medicine ,acute pericarditis ,case report ,cardiovascular diseases ,Myocardial infarction ,spodick’s sign ,biology ,business.industry ,ST elevation ,General Engineering ,medicine.disease ,Troponin ,stemi ,biology.protein ,medicine.symptom ,business ,Family/General Practice ,030217 neurology & neurosurgery ,Myopericarditis - Abstract
Acute pericarditis is commonly diagnosed in patients who present with chest pain. Accurate diagnosis of acute pericarditis is essential because of its relative similarity to ST-elevation myocardial infarction (STEMI) in both clinical presentation and electrocardiogram (EKG) changes. Additionally, troponin elevation is occasionally seen in acute pericarditis due to myocardial involvement (myopericarditis), which makes accurate diagnosis more challenging. A 12-lead EKG remains the most useful diagnostic test in differentiating acute pericarditis from STEMI. Spodick's sign is a less recognized electrocardiographic feature of acute pericarditis and is frequently overlooked by clinicians. We present a case of a 52-year-old male who initially presented with acute onset substernal chest pain. His EKG revealed diffuse subtle ST elevation and downsloping TP segment (Spodick's sign). A coronary angiogram demonstrated normal coronaries which eliminated the possibility of coronary artery disease. In this article, we will discuss how to differentiate between acute pericarditis and myocardial infarction, with a focus on Spodick's sign, amongst other EKG findings suggestive of pericarditis.
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- 2020
25. Unusual Cause of Stroke
- Author
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Saed Alnaimat, Basel Abdelazeem, Mariem Borcheni, Arvind Kunadi, and Emad Kandah
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medicine.medical_specialty ,cardiac tumor ,medicine.medical_treatment ,Cardiology ,Posterior cerebral artery ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,Mitral valve ,atrial myxoma ,Internal Medicine ,medicine ,cardiovascular diseases ,Embolization ,Stroke ,business.industry ,General Engineering ,Type 2 Diabetes Mellitus ,Myxoma ,medicine.disease ,stroke ,echocardiogram ,medicine.anatomical_structure ,Neurology ,cardiovascular system ,cardioembolic stroke ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Tinnitus ,Dyslipidemia - Abstract
Every year, more than 795,000 people in the United States have a stroke, the vast majority of which are ischemic. Cardiac myxoma is an unusual cause of stroke and accounts for less than 1% of ischemic strokes. We present a case of a 56-year-old male with a history of hypertension, dyslipidemia, and type 2 diabetes mellitus, who presented with altered mental status, tinnitus, double vision, and diaphoresis. Due to concern for a cerebral vascular accident, a CT scan of the brain was obtained and showed no acute intracranial process. Brain MRI revealed multiple small acute infarcts involving bilateral posterior cerebral artery distribution. Further evaluation included transthoracic echocardiography that showed a large mobile mass in the left atrium measuring 3.5 x 2 cm intermittently projecting through the mitral valve. The patient underwent successful surgical resection of the left atrial mass. The pathology report confirmed the diagnosis of atrial myxoma. This case further highlights the importance of complete evaluation of stroke, including echocardiography, as well as the importance of careful surgical resection to prevent recurrence of systemic embolization and other complications of atrial myxoma.
- Published
- 2020
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