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1. Pneumomediastinum in a Heavy Weightlifter

Author: Neeraja Swaminathan, Akanksha Agrawal, and Pradhum Ram
Subjects: Pneumomediastinum, weightlifting, Medicine
Abstract: The presence of air in the mediastinal cavity (i.e., pneumomediastinum) is an uncommon condition. It is usually precipitated by an event such as penetrating trauma, barotrauma or increased intrathoracic pressure caused by severe vomiting or coughing. We present the case of a 32-year-old man who developed pneumomediastinum as a result of heavy weightlifting.
Published: 2019
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2. Successful Outcome with Transradial Primary Percutaneous Coronary Intervention During Cardiopulmonary Resuscitation

Author: Yashasvi Chugh, Pradhum Ram, Sunita Chugh, and Sanjay Kumar Chugh
Subjects: acute myocardial infarction, cardiac arrest, radial approach, Medicine
Abstract: Transradial access for ST Elevation Myocardial Infarction (STEMI) has been shown to reduce mortality, major adverse cardiac events and bleeding, when compared with femoral access. Often patients with STEMIs present in the setting of cardiogenic shock and cardiac arrest. Prior published work has established the mortality benefit with early percutaneous coronary intervention in patients presenting with out of hospital cardiac arrests. However, the utility of transradial intervention in such patients is still under study. We present a case of transradial primary intervention performed during cardiopulmonary resuscitation for a patient who presented with an antero-septal MI.
Published: 2017
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3. Echocardiographic Imaging of the Tricuspid Valve

Author: Nikoloz Shekiladze, Pradhum Ram, Joe Xie, and Patrick Gleason
Subjects: medicine.medical_specialty, Tricuspid valve, medicine.anatomical_structure, business.industry, Echo (computing), Psychological intervention, medicine, Significant part, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract: Transcatheter tricuspid valve (TV) interventions have increased dramatically in recent years. TV imaging is challenging in many respects. Given the TV's anatomic complexity, multimodality imaging, which is centered on echocardiography (echo), plays a significant part in planning and execution of these interventions. With the help of echo-guided imaging, pathophysiologic mechanisms for TV disease are better understood, and thus, appropriate valve intervention can be strategized. Novel devices for the TV continue to be developed, and thus, intraprocedural echo imaging will continue to evolve in the days ahead.
Published: 2022

4. Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Chi Linh Hoang, Christopher J L Murray, Faheem Hyder Pottoo, Feng Sha, Simon I. Hay, Jianrong Zhang, Nikita Otstavnov, Eman Abu-Gharbieh, Azeem Majeed, Lorenzo Monasta, Jasvinder A. Singh, Zhi-Jiang Zhang, Jalal Arabloo, Jonathan M. Kocarnik, Sadaf G. Sepanlou, Rahmatollah Moradzadeh, Freddy Sitas, Sanjeev Misra, Lisa M. Force, Irina Filip, Rafael Tabarés-Seisdedos, Shahabeddin Rezaei, Amir Radfar, Luca Ronfani, Iván Landires, Rovshan Khalilov, Brijesh Sathian, Bingyu Li, Farhad Pishgar, Mario Šekerija, Priya Rathi, Catalina Liliana Andrei, Michael T. Chung, Ali Bijani, Ritesh G. Menezes, Odgerel Chimed-Ochir, Ken Takahashi, Nobuyuki Horita, Supreet Kaur, Rakhi Dandona, Alan D. Lopez, Alireza Rafiei, Joana Morgado-da-Costa, Kelly Compton, Akram Pourshams, G Anil Kumar, Dinh-Toi Chu, Deniz Yuce, Huong Lan Thi Nguyen, Virginia Núñez-Samudio, Ahmad Ghashghaee, Cuong Tat Nguyen, Kazem Zendehdel, Maria Teresa Bustamante-Teixeira, Aaron Cohen, Mohsen Naghavi, Mukhammad David Naimzada, Lalit Dandona, Pradhum Ram, Ione Jayce Ceola Schneider, Thomas Roberts, Michael Brauer, Meseret Derbew Molla, Vesna Zadnik, Syed Mohamed Aljunid, Morteza Arab-Zozani, Lidia Morawska, Abebaw Alemayehu Desta, Qing Lan, Rajesh Sharma, Mahesh P A, David Laith Rawaf, Ali H. Mokdad, Tomasz Miazgowski, Zabihollah Yousefi, Seyed Sina Naghibi Irvani, Reza Malekzadeh, Paul J. Villeneuve, Masood Ali Shaikh, Muhammad Aziz Rahman, Sohail Ahmad, Abdollah Mohammadian-Hafshejani, Gholamreza Roshandel, Atalel Fentahun Awedew, Hassan Abolhassani, Hermann Brenner, Sara Sheikhbahaei, Elvynna Leong, Mohammad Rabiee, Abdallah M. Samy, Eyayou Girma Tadesse, Milena Santric-Milicevic, Silvano Gallus, Carlos A Castañeda-Orjuela, Mowafa Househ, Xiaochen Dai, Marco Vacante, Mihaela Hostiuc, Adrian Pana, Salman Rawaf, Sahar Saeedi Moghaddam, Francesco Saverio Violante, Weijia Fu, Paschalis Steiropoulos, Vahid Alipour, Tone Bjørge, Savita Lasrado, Burcu Kucuk Bicer, Farshad Farzadfar, Shafiu Mohammed, Fares Alahdab, Paolo Lauriola, Saeed Amini, Eugenio Traini, Maryam Zamanian, Samer Hamidi, Rajan Nikbakhsh, Pawan Faris, Birhan Gebresillassie Gebregiorgis, Emerito Jose A. Faraon, Stanislav S. Otstavnov, Shane D. Morrison, Marcel Ausloos, Aziz Sheikh, Eun-Kee Park, Antonio Biondi, Zahra Aryan, Claudiu Herteliu, Ivo Iavicoli, Hedyeh Ebrahimi, Nicholas L S Roberts, Navid Rabiee, Tudorel Andrei, Catherine Bisignano, Giulia Carreras, Andrew T Olagunju, Ejaz Ahmad Khan, Dejana Braithwaite, Alex Molassiotis, Kebebe Bekele Gonfa, Bárbara Niegia Garcia de Goulart, Javad Nazari, Giuseppe Gorini, Mahaveer Golechha, Bach Xuan Tran, Ravensara S. Travillian, Zahid A Butt, Baye Dagnew, Atif Amin Baig, Nima Rezaei, Nima Hafezi-Nejad, Khanh Bao Tran, Malke Asaad, Tim Driscoll, Navid Manafi, Frances E. Dean, Shailesh Advani, Stephen S Lim, Robert Ancuceanu, Milena Ilic, Maximiliano Ribeiro Guerra, Ashwin Kamath, Carlo La Vecchia, Farhad Islami, Sudeep K Siddappa Malleshappa, Irena Ilic, Emma Elizabeth Spurlock, Florian Fischer, GBD 2019 Respiratory Tract Cancer Collaborator, and Francesco S. Violante
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, CELL LUNG-CANCER, EGFR, Respiratory System, GBD 2019 Respiratory Tract Cancers Collaborators, Global Burden of Disease, 1117 Public Health and Health Services, Critical Care Medicine, Risk Factors, Neoplasms, General & Internal Medicine, Internal medicine, Tobacco Smoking, Humans, Medicine, Risk factor, Lung cancer, Bronchus, Science & Technology, SARS-CoV-2, MUTATIONS, business.industry, Risk Factor, MORTALITY, Incidence, Mortality rate, Incidence (epidemiology), cancer, GBD, respiratory tract, Smoking, COVID-19, Cancer, 1103 Clinical Sciences, Articles, AIR-POLLUTION, respiratory system, medicine.disease, Respiratory Tract Neoplasms, Respiratory Tract Neoplasm, medicine.anatomical_structure, Years of potential life lost, Socioeconomic Factors, Relative risk, CIGARETTE-SMOKING, business, Life Sciences & Biomedicine, Human, SMOKERS, 1199 Other Medical and Health Sciences
Abstract: Summary Background Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010–19 period. Findings Globally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (−16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (−10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (−8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (−8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9–66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3–69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019. Interpretation The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations—namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings. Funding Bill & Melinda Gates Foundation.
Published: 2021

5. Bicarbonate use and mortality outcome among critically ill patients with metabolic acidosis: A meta analysis

Author: Pradhum Ram, Veronica Garvia, Kevin Bryan Lo, Janani Rangaswami, and Jessica M. Stempel
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Illness, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Humans, Medicine, Randomized Controlled Trials as Topic, Sodium bicarbonate, business.industry, Metabolic acidosis, Odds ratio, medicine.disease, Intensive care unit, High anion gap metabolic acidosis, Intensive Care Units, Sodium Bicarbonate, 030228 respiratory system, chemistry, Lactic acidosis, Meta-analysis, Acidosis, Cardiology and Cardiovascular Medicine, business
Abstract: Background The use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of severe acidemia in critically ill patients, there is little data looking into the role of sodium bicarbonate in the treatment of severe metabolic acidosis in the intensive care unit (ICU) setting. Methods We conducted a comprehensive search of Pubmed and Cochrane Central Register of Controlled Trials addressing bicarbonate use in the metabolic acidosis in the intensive care unit (ICU) setting. We examined mortality as end point. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effect model. Results The final search yielded 202 articles of which all were screened individually. A total of 11 studies were identified but 6 studies were excluded due to irrelevance in mortality outcome and methodology. Analysis was done separately for observational studies and randomized controlled trials. The pooled OR [95% CI] for mortality with bicarbonate use in the observational studies was 1.5 [0.62–3.67] with heterogeneity of 67%, while pooled OR for mortality in the randomized trials was 0.72 [0.49–1.05] (figure 2). In combining all studies, the pooled odds ratio was 0.93 95% [0.69–1.25] but with heterogeneity of 63%. After sensitivity analysis with removing the study done by Kim et al. 2013, heterogeneity was 0% with OR 0.8 [0.59–1.10]. Conclusion There is no significant difference in mortality in the use of bicarbonate among critically ill patients with high anion gap metabolic acidosis predominantly driven by lactic acidosis.
Published: 2020

6. Readmissions Among Patients Admitted With Acute Decompensated Heart Failure Based on Income Quartiles

Author: Mahek Shah, Manyoo Agarwal, Brijesh Patel, Shantanu Patil, Venkata M. Alla, and Pradhum Ram
Subjects: Male, medicine.medical_specialty, Acute decompensated heart failure, Patient Readmission, Cohort Studies, Internal medicine, Humans, Medicine, Healthcare Cost and Utilization Project, Socioeconomic status, Reimbursement, Aged, Aged, 80 and over, Heart Failure, business.industry, General Medicine, Middle Aged, medicine.disease, Quartile, Acute Disease, Cohort, Income, Household income, Female, business, Cohort study
Abstract: To determine the impact of socioeconomic status using median household income within the patient's community on rate of readmission among patients with heart failure (HF).We derived a study cohort of patients who were admitted from January 1, 2013, through December 31, 2014, with congestive HF from the Healthcare Cost and Utilization Project National Readmission Database. Patients were stratified into quartiles according to the estimated median household income of residents in the patient's ZIP Code (quartile 1, lowest; quartile 4, highest). The primary outcome was 30-day readmission. We used univariate and multivariate models to compare patients with respect to baseline characteristics, income quartiles, and 30-day readmission.About 20% (110,152 of 546,841) of patients with an index HF admission were readmitted within the first 30 days. Patients in the lowest income quartile had a higher readmission rate compared with those in the highest income quartile (21.1% [35,422 of 167,625] vs 19.5% [20,771 of 106,353]; P.001). Patients within the lowest income group had higher odds of readmission for cardiovascular causes compared with the highest income group (50.6% [17,923 of 35,422] vs 48.8% [10,136 of 20,771; P.001). Readmissions within the lowest income group accounted for 30% of all rehospitalization-related costs at $715 million. Multivariate analysis confirmed a higher rate of 30-day readmission among patients in the lowest income group compared with those in the highest group (adjusted odds ratio, 1.11; 95% CI, 1.08-1.13).Our study shows that patients in communities with the lowest quartile of income have a higher rate of readmission following the index HF admission with high associated costs. Readmission reporting and reimbursement adjustments should account for these socioeconomic inequalities.
Published: 2019

7. Efficacy and Safety of Oral P2Y12 Inhibitors in Older Patients with Acute Coronary Syndrome: A Frequentist Network Meta-Analysis

Author: Pradhum Ram, Fahd Makhdom, Vanita Motiani, Muhammad Abdullah Nizam, Muhammad Shariq Usman, Unaiza Naeem, Tehlil Rizwan, Izza Shahid, Ritesh G. Menezes, and Tariq Jamal Siddiqi
Subjects: Acute coronary syndrome, medicine.medical_specialty, Ticagrelor, Prasugrel, Network Meta-Analysis, law.invention, Percutaneous Coronary Intervention, Randomized controlled trial, law, Internal medicine, medicine, Humans, Pharmacology (medical), Acute Coronary Syndrome, Aged, business.industry, medicine.disease, Clopidogrel, Confidence interval, Treatment Outcome, Relative risk, Purinergic P2Y Receptor Antagonists, Geriatrics and Gerontology, business, Mace, Platelet Aggregation Inhibitors, medicine.drug
Abstract: BACKGROUND AND OBJECTIVE Previous studies and meta-analyses have assessed optimal P2Y12 inhibitors following acute coronary syndrome in overall trial cohorts. However, there are insufficient data for the elderly cohort who are prone to high bleeding and ischemic events. We aimed to assess the optimal P2Y12 inhibitor therapy for older patients. METHODS PubMed, CENTRAL, and ClinicalTrials.gov databases were searched from inception through July 2020 to identify randomized controlled trials and propensity-matched observational studies including older patients (aged ≥ 65 years) that reported study-defined major adverse cardiovascular events (MACE) or major bleeding events. Outcomes at the mid-term follow-up were pooled to conduct a frequentist network meta-analysis. RESULTS Fourteen studies involving 12,953 older patients were included in our analysis. No significant difference was observed with MACE when all three P2Y12 inhibitors were compared with each other. Compared with clopidogrel, ticagrelor significantly increased the risk of major bleeding (risk ratio 1.35, 95% confidence interval 1.10-1.67) while prasugrel did not (risk ratio 1.02, 95% confidence interval 0.67-1.57). A sensitivity analysis of only randomized controlled trials yielded similar results for both MACE and major bleeding. The P score displayed prasugrel (0.5871) as the best treatment for MACE, while clopidogrel (0.7701) was the best P2Y12 inhibitor to decrease the risk of major bleeding. Ticagrelor (0.0634) was ranked the lowest because of an increased bleeding risk. CONCLUSIONS No significant difference is observed between the three P2Y12 inhibitors in study-defined MACE. Ranking by p-score suggests prasugrel as the best P2Y12 inhibitor to reduce the risk of MACE while clopidogrel is a better alternative than ticagrelor in older patients with acute coronary syndrome to decrease the risk of major bleeding. Because of a lack of individual-patient data analysis and heterogeneity amongst studies, future studies representing older patients with acute coronary syndrome are required to strengthen evidence regarding optimal antithrombotic therapy in this cohort.
Published: 2021

8. Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization

Author: Byomesh Tripathi, Brijesh Patel, Purnima Sharma, Pradhum Ram, Varun Jain, Varunsiri Atti, Safi U. Khan, Abhishek Deshmukh, Varun Kumar, Sopan Lahewala, Mahek Shah, Vamsidhar Naraparaju, and Shilpkumar Arora
Subjects: medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, 030204 cardiovascular system & hematology, outcomes, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, atrial fibrillation, 030212 general & internal medicine, cardiovascular diseases, Secondary prevention, business.industry, Hypertrophic cardiomyopathy, cost trend, Atrial fibrillation, Original Articles, medicine.disease, hypertrophic cardiomyopathy, Comorbidity, lcsh:RC666-701, Ventricular fibrillation, Cardiology, cardiovascular system, Original Article, Cardiology and Cardiovascular Medicine, Cost of care, business, arrhythmias, Atrial flutter, Resource utilization
Abstract: Background Hypertrophic cardiomyopathy (HCM) accounts for significant morbidity and mortality worldwide. Arrhythmias are considered the main cause of mortality, however, there is paucity of data relating to trends of arrhythmia and associated outcomes in HCM patients. Methods Nationwide Inpatient Sample from 2003 to 2014 was analyzed. HCM related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9‐CM) code 425.1 and 425.11 in all diagnosis fields. Results Overall, there was an increase in number of hospitalizations related to arrhythmias among HCM patients from 7784 in 2003 to 8380 in 2014 (relative increase 10.5%, P
Published: 2019

9. Trends in the prevalence of malignancy among patients admitted with acute heart failure and associated outcomes: a nationwide population-based study

Author: Kevin Bryan Lo, Andrew Tiu, Mahek Shah, Pradhum Ram, and Kaushal Parikh
Subjects: Male, medicine.medical_specialty, Lung Neoplasms, Colorectal cancer, Breast Neoplasms, Comorbidity, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Breast cancer, Cancer Survivors, Risk Factors, Neoplasms, Internal medicine, Prevalence, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Lung cancer, Aged, Cause of death, Aged, 80 and over, Heart Failure, business.industry, Prostatic Neoplasms, Cancer, Odds ratio, Middle Aged, medicine.disease, Cardiotoxicity, Hospitalization, Acute Disease, Female, Colorectal Neoplasms, Cardiology and Cardiovascular Medicine, business
Abstract: Cancer is the second leading cause of death in the USA, and cardiovascular disease is the second leading cause of morbidity and mortality among cancer survivors. Cancer survivors share common risk factors for cardiovascular disease with non-cancer patients. With improved survival, cancer patients become susceptible to treatment-related toxicity often involving the heart. The impact of concurrent malignancy on outcomes particularly among heart failure patients is an area of active research. We studied the trends in the prevalence of a concurrent diagnosis of breast, prostate, colorectal, and lung cancer among admissions for acute heart failure and the associated trends for in-hospital mortality. Patients aged ≥ 18 years who were admitted with a primary diagnosis of “congestive heart failure” (CCS codes 99 and 108) from years 2003 to 2014 were included. We analyzed the rate of admission and in-hospital mortality among patients who had a concurrent diagnosis for either lung cancer, colorectal cancer, breast cancer (among females), or prostate cancer (among males). We performed a multivariate analysis to assess the role of a concurrent diagnosis of any cancer in predicting in-hospital mortality among HF admissions. From 2003 to 2014 across over 12 million HF admissions, ≈ 7% had a concurrent diagnosis of either lung, breast, colorectal, or prostate cancer. The prevalence was highest for breast cancer (2.3%) followed by prostate cancer (2.1%) and colorectal cancer (1.5%) and lowest with lung cancer (1.1%). The prevalence of cancer increased over the duration of study among all four cancer types with the largest increase in prevalence of breast cancer. Baseline comorbidities including hypertension, diabetes, smoking, chronic kidney disease, and coronary artery disease increased over time among patients with and without cancer. In-hospital mortality was higher among those with a diagnosis of lung cancer (5.9%) followed by colorectal cancer (4.0%), prostate cancer (3.5%), no diagnosis of cancer (3.3%), and breast cancer (3.2%). In-hospital mortality declined across HF admissions with and without a cancer diagnosis from 2003 to 2014. Decline in such mortality among heart failure was highest for patients with lung cancer (8.1 to 4.6% from 2003 to 2014; p
Published: 2019

10. Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

Author: Vincent M. Figueredo, Janani Rangaswami, Leandro Slipczuk, Pradhum Ram, Kevin Bryan Lo, Sandeep Dayanand, and Pradeep Dayanand
Subjects: Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, review, patient outcomes, 030204 cardiovascular system & hematology, urologic and male genital diseases, Article, 03 medical and health sciences, 0302 clinical medicine, Mitral valve, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Cardiac Surgical Procedures, Renal Insufficiency, Chronic, Heart Valve Prosthesis Implantation, Mitral regurgitation, Mitral valve repair, business.industry, MitraClip, renal function, Hemodynamics, Mitral valve replacement, General Medicine, medicine.disease, Treatment Outcome, medicine.anatomical_structure, cardiovascular system, Cardiology, Mitral Valve, Female, Percutaneous mitral repair, mitraclip, Cardiology and Cardiovascular Medicine, business, chronic kidney disease, Percutaneous Mitral Valve Repair, Kidney disease
Abstract: Percutaneous mitral valve repair is emerging as a reasonable alternative especially in those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral valve repair and the effects of this procedure itself on renal function is evolving, as more data emerges in this field. The current evidence suggests that the correction of mitral regurgitation via percutaneous mitral valve repair is associated with some degree of improvement in cardiac function, hemodynamics and renal function. The improvement in renal function was more significant for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease (CKD) in turn has been associated with poor long-term outcomes including increased mortality and hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD on long-term outcomes was consistent across all studies and was more prominent in those with GFR
Published: 2019

11. Acute Kidney Injury Post Cardiac Catheterization: Does Vascular Access Route Matter?

Author: Janani Rangaswami, Gregg S. Pressman, Kevin Bryan Lo, Pradhum Ram, and Benjamin Horn
Subjects: Male, Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, Vascular access, MEDLINE, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Humans, Medicine, In patient, 030212 general & internal medicine, Radial artery, catheterization, Cardiac catheterization, Transradial, business.industry, Acute kidney injury, transfemoral, vascular access, General Medicine, Acute Kidney Injury, medicine.disease, Treatment Outcome, anatomical challenges, Emergency medicine, kidney injury, Access site, Female, Cardiology and Cardiovascular Medicine, business, Complication
Abstract: Background: Acute Kidney Injury as a complication of cardiac catheterization is associated with increased length of hospital stay and mortality. In recent years, the use of the radial artery for cardiac catheterization is increasing in frequency. Objective: The objective of this concise review was to evaluate the method of cardiac access site and its impact on Acute Kidney Injury following cardiac catheterization. Methods: After a thorough search on Medline, Google Scholar and PubMed, we included all the literature relevant to Acute kidney injury following transradial and transfemoral cardiac catheterization. Results: While acute kidney injury was caused due to a variety of reasons, it was important to consider each case on an individual basis. We found a trend towards increased use of transradial approach in patients at high risk of developing kidney injury. However, limitations such as operator experience, anatomical challenges and so on do exist with this approach. Conclusion: Transradial access offers several advantages to a patient at high risk of acute kidney injury undergoing cardiac catheterization. Further large studies are needed to establish this trend in the years ahead.
Published: 2019

12. Carcinoid Heart Disease: Review of Current Knowledge

Author: Janani Rangaswami, Kevin Bryan Lo, Gregg S. Pressman, Pradhum Ram, and Jorge Penalver
Subjects: Diagnostic Imaging, medicine.medical_specialty, Carcinoid Heart Disease, Review, 030204 cardiovascular system & hematology, Global Health, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Correspondence, medicine, Humans, In patient, business.industry, Disease Management, Diagnostic test, medicine.disease, Serotonin metabolism, Combined Modality Therapy, Pathophysiology, 030220 oncology & carcinogenesis, Heart failure, Cardiology, Morbidity, Cardiology and Cardiovascular Medicine, Cardiac magnetic resonance, business, Carcinoid syndrome
Abstract: Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.
Published: 2019

13. Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction

Author: Kene Mezue, Janani Rangaswami, Parasuram Krishnamoorthy, Mahek Shah, Gregg S. Pressman, Pradhum Ram, Abhinav Goyal, Shuchita Gupta, and Kevin Bryan Lo
Subjects: Male, medicine.medical_specialty, Time Factors, Heart Ventricles, Urology, medicine.medical_treatment, 030232 urology & nephrology, Cardiorenal syndrome, 030204 cardiovascular system & hematology, Kidney, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Internal medicine, medicine, Humans, Renal Insufficiency, Myocardial infarction, Pulmonary wedge pressure, Retrospective Studies, Heart Failure, Ejection fraction, business.industry, Hemodynamics, Stroke Volume, Middle Aged, Prognosis, medicine.disease, Echocardiography, Ventricular assist device, Heart failure, Pulmonary artery, Ventricular Function, Right, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Heart failure with preserved ejection fraction, Follow-Up Studies, Glomerular Filtration Rate
Abstract: Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.
Published: 2018

14. Conventional Risk Factors, Telomere Length, and Ischemic Heart disease: Insights into the Mediation Analysis

Author: Nadezdha Niyarah Alemao, Sanjay Kumar Chugh, C Akash, Yashasvi Chugh, Shobhit Piplani, Sameer Ambar, Madhav Prabhu, Siba P Raychauduri, Pradhum Ram, and Vijay Kumbar
Subjects: serum uric acid, medicine.medical_specialty, real-time polymerase chain reaction, Disease, chemistry.chemical_compound, Internal medicine, telomere length, Genetics, medicine, cardiovascular diseases, Myocardial infarction, Molecular Biology, Blood urea nitrogen, Creatinine, business.industry, Vascular disease, Incidence (epidemiology), medicine.disease, ischemic heart disease, chemistry, Ageing, Cardiology, Original Article, business, Body mass index
Abstract: Telomere length is regarded as a potential biomarker of biological ageing and is associated with various age-related diseases, such as ischemic heart disease (IHD), myocardial infarction, peripheral vascular disease, and cancer. As there is a paucity of study that deals with this influence, this study aimed to assess how the cardiovascular risk factors influence the risk of IHD by performing mediation analysis. A total of 407 males were included in the study. IHD was diagnosed through echocardiography and coronary angiography by determining the number of coronary vessels involved. Demographic data, clinical history, and laboratory investigations such as random blood sugar (RBS), fasting lipid profile, serum creatinine, and serum urea levels of all the subjects were measured and recorded. Serum uric acid and blood urea nitrogen (BUN) levels were significantly higher in IHD subjects compared to non-IHD subjects (P < 0.05). Body mass index (BMI), glycosylated hemoglobin (HbA1c), RBS, serum uric acid, serum creatinine, BUN, total cholesterol, triglycerides, and telomere length significantly differed between subjects with and without IHD (P < 0.05). Further, telomere length (P < 0.001), BMI (P < 0.001), and total cholesterol level (P < 0.001) were risk factors that significantly affected the incidence of IHD, as proved by logistic regression. It indicates that shorter telomeres contribute to increased risk of IHD, influenced by BMI, HbA1c, BUN, total cholesterol levels, and RBS (P < 0.001). The study established a link between telomere shortening, conventional risk factors, and IHD; moreover, the study takes care in the role of mediation analysis which is a novel idea as little is done in this area of biostatistics with telomere length. Overall, this further establishes that telomeres length might serve as the promising biomarkers in predicting the risk of IHD.
Published: 2021

15. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019

Author: Mohsen Naghavi, Saman Esmaeilnejad, Irena Ilic, Chhabi Lal Ranabhat, Hubert Amu, Jalil Jaafari, Walter Mendoza, Yanzhong Wang, Atta Abbas Naqvi, Mahesh P A, Afshin Maleki, Songhomitra Panda-Jonas, Akila Prashant, Jessica Y Islam, Ali H. Mokdad, Rahmatollah Moradzadeh, Roman Shrestha, Muhammad Naveed, Andre M. N. Renzaho, Santi Martini, Reza Rawassizadeh, Chisom Joyqueenet Akunna, Tudorel Andrei, Jason A. Anderson, Martin McKee, Iffat Elbarazi, Golnaz Heidari, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Davood Anvari, Randah R. Hamadeh, G. K. Mini, Emerito Jose A. Faraon, Farhad Islami, Yasir Waheed, Fahad Alanezi, Maciej Banach, Sheikh Mohammed Shariful Islam, Ismaeel Yunusa, Suresh Mehata, Tarun Gupta, Mavra A Riaz, Derrick A Bennett, Nithin Kumar, Ali Soroush, Kurt Straif, Muhammad Aziz Rahman, Hasan Yusefzadeh, Avirup Guha, Catalina Liliana Andrei, Muhammed Shahriar Zaman, Arief Hargono, Sandhya Neupane Kandel, Adam E. Berman, Giulia Carreras, Ali Bijani, Christoph Nowak, Rafael Alves Guimarães, Aziz Sheikh, Kamal Hezam, Carlo Eduardo Medina-Solís, Simon I. Hay, Deborah Carvalho Malta, Rahman Shiri, Ashok Pandey, Ramesh Holla, Gyu Ri Kim, Aidin Abedi, Sharath Burugina Nagaraja, Andem Effiong, Samad Azari, Bhaskar Thakur, Mohsen Mazidi, Vahid Yazdi-Feyzabadi, Prashant Mathur, Bay Vo, Robert Ancuceanu, Eun-Kee Park, Mehdi Fazlzadeh, Thomas Hsiao, Richard G Pestell, Sindhura Lakshmi Koulmane Laxminarayana, Doo Woong Lee, Bayew Kelkay, Erkin M. Mirrakhimov, Hualiang Lin, Mohsen Bayati, Florian Fischer, Wei Liu, Stefan Stortecky, Javad Nazari, Fatemeh Pashazadeh Kan, Virginia Núñez-Samudio, Nitish Naik, Sreenivas Narasimha Swamy, Rajat Gupta, Rakhi Dandona, Hermann Brenner, Chandrashekhar T Sreeramareddy, Mohammad Ali Mansournia, Yuichiro Yano, Pankaj Bhardwaj, Samath D Dharmaratne, Constantine I. Vardavas, Gabriela Fernanda Gil, Azeem Majeed, Akram Pourshams, Nachimuthu Senthil Kumar, Florentino Luciano Caetano dos Santos, Juan Sanabria, Iván Landires, Parkes J Kendrick, Dinh-Toi Chu, Asma Tahir Awan, Khem Narayan Pokhrel, Siddharudha Shivalli, Omid Shafaat, Shankar Prasad Nagaraju, Manu Raj Mathur, Rachel L Updike, Mohammad Ebrahimi Kalan, Ryan David Kennedy, Alessandra Lugo, Olalekan A. Uthman, Tarek Tawfik Amin, Jiregna Darega Gela, Zhi-Jiang Zhang, Yeshambel T. Nigatu, Bedanta Roy, Arielle Wilder Eagan, Jalal Arabloo, Milena Ilic, Mehdi Hosseinzadeh, Jost B. Jonas, Dian Kusuma, Shahrzad Bazargan-Hejazi, Yo Han Lee, Mohammed Shannawaz, Mohammad Ali Moni, Valery L. Feigin, Himal Kandel, Lalit Dandona, Milena Santric-Milicevic, Jasvinder A. Singh, Till Bärnighausen, Neeraj Bhala, Sara Sheikhbahaei, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayana Manjunatha, Giuseppe Gorini, Saif Ullah, Sheikh M. Alif, Giang Thu Vu, Ai Koyanagi, Mahaveer Golechha, Ingan Ukur Tarigan, Sumaira Mubarik, Naohiro Yonemoto, Ahmad Ghashghaee, Yves Miel H Zuniga, Bach Xuan Tran, Sorin Hostiuc, Catherine P. Benziger, Ritesh G. Menezes, Leonardo Roever, Xiaochen Dai, Meghnath Dhimal, Medhat Farwati, Chenwen Zhong, Seyed Sina Naghibi Irvani, G Anil Kumar, Jaya Prasad Tripathy, Amirhossein Sahebkar, Simiao Chen, Zubair Kabir, Meseret Derbew Molla, Tilahun Ali, Animut Tagele Tamiru, Negussie Boti Sidemo, Monika Sawhney, Bright Opoku Ahinkorah, Ruxandra Irina Negoi, Segun Emmanuel Ibitoye, Vin Gupta, Mona Pathak, Lorenzo Monasta, Andrew T Olagunju, Nermin Ghith, Nuwan Darshana Wickramasinghe, Kazumasa Yamagishi, Virendra Singh, Takahiro Tabuchi, Gholamreza Roshandel, Andre R. Brunoni, Hayley D. Tymeson, Madhur Verma, Eyayou Girma Tadesse, Adrian Pana, Isabela M. Benseñor, Abdullah Al Mamun, Jianrong Zhang, Hai Quang Pham, Mihaela Hostiuc, Sung-In Jang, Vinay Nangia, Luca Ronfani, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Josip Car, Sohail Ahmad, Rekha Thapar, Salman Rawaf, Joanna L Whisnant, Sanjay Basu, Abdallah M. Samy, Michal Grivna, Zahid A Butt, Abera Getachew Obsa, Mahdi Nalini, Ted R. Miller, Sanjeev Misra, Utsav Parekh, Budi Aji, Saeed Amini, João Pedro Silva, Felix Akpojene Ogbo, Mihajlo Jakovljevic, Demosthenes B. Panagiotakos, Baye Dagnew, Yousef Khader, Atif Amin Baig, Habib Benzian, Keivan Ahmadi, Marco Vacante, Brijesh Sathian, Akshaya Srikanth Bhagavathula, Savita Lasrado, Maryam Khayamzadeh, Darshan B B, Mohammad Rifat Haider, Yonas Akalu, Irmina Maria Michalek, Simone Vidale, Getie Lake Aynalem, Rosa A. S. Couto, Yigizie Yeshaw, Syed Mohamed Aljunid, Pradhum Ram, Shrikant Pawar, Kevin Welding, Suzanne Barker-Collo, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Hiba Jawdat Barqawi, Marcos Roberto Tovani-Palone, K M Shivakumar, Gebiyaw Wudie Tsegaye, Fares Alahdab, Vafa Rahimi-Movaghar, Om P Kurmi, Nataliya Foigt, André Karch, Marina Pinheiro, Basema Saddik, Paschalis Steiropoulos, Chuanhua Yu, Graeme J. Hankey, Panniyammakal Jeemon, Abdul-Aziz Seidu, Ramaiah Itumalla, Befikadu Legesse Wubishet, Vera Marisa Costa, Shanshan Li, Ambrish Singh, Yuming Guo, Reza Malekzadeh, Nikha Bhardwaj, Mikhail Sergeevich Zastrozhin, Maryam Zamanian, Onyema greg Chido-Amajuoyi, Ibtihal Fadhil, Sabina O Nduaguba, Turki Alanzi, Eun-Cheol Park, Nicholas Arian, Salah Eddin Karimi, Parnaz Daneshpajouhnejad, Minale Tareke, Paramjit Gill, Chukwudi A Nnaji, Haroon Ahmed, Irina Filip, Juwel Rana, Aziz Rezapour, Huong Lan Thi Nguyen, Ashish Badiye, Kewal Krishan, Nima Hafezi-Nejad, Masood Ali Shaikh, Tanuj Kanchan, Shilpashree Madhava Kunjathur, Reza Ghanei Gheshlagh, Thomas R. Hird, Yousef Mohammad, Soraya Siabani, Falk Schwendicke, Ziyad Al-Aly, Desta Debalkie Atnafu, Krittika Bhattacharyya, Mika Kivimäki, Ayodipupo Sikiru Oguntade, Zabihollah Yousefi, Neeti Kapoor, Syed Mahboob Shah, Kavumpurathu Raman Thankappan, Mika Shigematsu, Ben Lacey, Ireneous N. Soyiri, Amir Radfar, Lemma Getacher, Sameer Vali Gopalani, David Laith Rawaf, Amir Masoud Rahmani, Birhan Gebresillassie Gebregiorgis, Morenike Oluwatoyin Folayan, Salime Goharinezhad, Ambuj Roy, Ruth W Kimokoti, Nuworza Kugbey, Getinet Ayano, Mohammad Hifz Ur Rahman, Benny Antony, Katrin Burkart, Christopher J L Murray, Khalid F. AlHabib, Mariam Molokhia, Mansour Ghafourifard, Abebaw Alemayehu Desta, Tariku Tesfaye Bekuma, Shailesh Advani, Kiomars Sharafi, Kurnia Dwi Artanti, E S Abhilash, Ejaz Ahmad Khan, Sana Salehi, Dan J. Stein, Pankaj Chaturvedi, Mahmoud A. Alomari, Kawkab Shishani, Dejana Braithwaite, Jung-Chen Chang, Rajeev Gupta, Giovanni Damiani, Maha El Tantawi, Maria Sofia Sofia Cattaruzza, Amir Abdoli, Narayanaswamy Venketasubramanian, Rakibul M Islam, Ibrahim Abdelmageed Ginawi, Victor Aboyans, Ganesh Kumar Saya, Silvano Gallus, João Mauricio Castaldelli-Maia, Vardhmaan Jain, Masoud Foroutan, Janni Leung, Mohammad Abdollahi, Mohammed Zewdu Yimmer, Vahid Alipour, Wondwossen Niguse Asmare, Ravi Prakash Jha, Gerhard Sulo, Brigid Unim, Sheng-Chia Chung, Sadaf G. Sepanlou, Hamed Mirzaei, Anna Aleksandrovna Skryabina, In-Hwan Oh, Rannveig Sigurvinsdottir, Oladimeji Adebayo, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Johan Sundström, Ali Kabir, Paolo Lauriola, Tilahun Belete Mossie, Sadia Bibi, Bartosz Miazgowski, Erin C Mullany, Keyvan Pakshir, Srikanta Banerjee, Mowafa Househ, Mohamed M. Gad, Leila R Kalankesh, Mikk Jürisson, Ismail Tareque, Albertino Damasceno, Musliu Adetola Tolani, Andrea Werdecker, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Monika Arora, Marissa B Reitsma, Filippos Filippidis, Biniyam Sahiledengle Geberemariyam, Bruno Piassi Sao Jose, Leeberk Raja Inbaraj, Antonio Biondi, Mohsen Abbasi-Kangevari, Junjie Huang, Mohammad Mahdi Zamani, Jean Jacques Noubiap, Emmanuela Gakidou, Valentin Yurievich Skryabin, Mayowa O. Owolabi, Shubha Jayaram, Hiroyasu Iso, Charles Ugochukwu Ibeneme, Molly R Nixon, Rachel Feldman, Liliana G Ciobanu, Kristina Edvardsson, Claudiu Herteliu, Andreea Mirica, Kindie Mitiku Kebede, Department of Public Health, Collaborators, GBD 2019 Chewing Tobacco, and Lacey, B
Subjects: Male, Health Status, Smoking Prevention, DETERMINANTS, Global Health, 01 natural sciences, Global Burden of Disease, SMOKELESS TOBACCO, 0302 clinical medicine, Risk Factors, Global health, Prevalence, 030212 general & internal medicine, 610 Medicine & health, RISK, High prevalence, WOMEN, Public Health, Global Health, Social Medicine and Epidemiology, Articles, Middle Aged, 3142 Public health care science, environmental and occupational health, Chewing tobacco, Smokeless tobacco, Population Surveillance, A990 Medicine and Dentistry not elsewhere classified, Female, Quality-Adjusted Life Years, Burden of disease, Adult, medicine.medical_specialty, Tobacco, Smokeless, Adolescent, WHO Framework Convention on Tobacco Control, VALIDATION, 03 medical and health sciences, Young Adult, Age Distribution, SDG 3 - Good Health and Well-being, Environmental health, medicine, Humans, 0101 mathematics, Sex Distribution, Chewing tobacco, Prevalence, Global Burden, Smokeless tobacco, business.industry, Public health, Smoking Tobacco, 010102 general mathematics, Public Health, Environmental and Occupational Health, Global Burden, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, STATES, Socioeconomic Factors, Smoking Cessation, business
Abstract: Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. For complete list of authors see http://dx.doi.org/10.1016/S2468-2667(21)00065-7
Published: 2021

16. Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection

Author: Anekwe Onwuanyi, Obiora Egbuche, Elizabeth Ofili, Bivek Wagle, Martin Luther Campbell, Pradhum Ram, Melvin R. Echols, Dolphurs Hayes, Rupak Desai, Temidayo Abe, Kenechukwu Mezue, Jayne Morgan, Jacques Kpodonu, Valery S. Effoe, Ky Huynh, Opeyemi Jegede, and Shirley I Nwokike
Subjects: Mechanical ventilation, ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Acute kidney injury, Retrospective cohort study, Disease, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Spotlight on Special Topics, Internal medicine, medicine, Original Article, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Cardiovascular outcomes
Abstract: BACKGROUND: The Corona Virus 19 (COVID-19) infection is associated with worse outcomes in blacks, although the mechanisms are unclear. We sought to determine the significance of black race, pre-existing cardiovascular disease (pCVD), and acute kidney injury (AKI) on cardiopulmonary outcomes and in-hospital mortality of COVID-19 patients. METHODS: We conducted a retrospective cohort study of blacks with/without pCVD and with/without in-hospital AKI, hospitalized within Grady Memorial Hospital in Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. The primary outcome was a composite of in-hospital cardiac events. RESULTS: Of the 293 patients hospitalized with COVID-19 in this study, 71 were excluded from the primary analysis (for race/ethnicity other than black non-Hispanic). Of the 222 hospitalized COVID-19 patients included in our analyses, 41.4% were female, 78.8% had pCVD, and 30.6% developed AKI during the admission. In multivariable analyses, pCVD (OR 4.7, 95% CI 1.5-14.8, P=0.008) and AKI (OR 2.7, 95% CI 1.3-5.5, P=0.006) were associated with increased odds of in-hospital cardiac events. AKI was associated with increased odds of in-hospital mortality (OR 8.9, 95% CI 3.3-23.9, P
Published: 2020

17. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study

Author: Gregory A. Roth, George A. Mensah, Catherine O. Johnson, Giovanni Addolorato, Enrico Ammirati, Larry M. Baddour, Noël C. Barengo, Andrea Z. Beaton, Emelia J. Benjamin, Catherine P. Benziger, Aimé Bonny, Michael Brauer, Marianne Brodmann, Thomas J. Cahill, Jonathan Carapetis, Alberico L. Catapano, Sumeet S. Chugh, Leslie T. Cooper, Josef Coresh, Michael Criqui, Nicole DeCleene, Kim A. Eagle, Sophia Emmons-Bell, Valery L. Feigin, Joaquim Fernández-Solà, Gerry Fowkes, Emmanuela Gakidou, Scott M. Grundy, Feng J. He, George Howard, Frank Hu, Lesley Inker, Ganesan Karthikeyan, Nicholas Kassebaum, Walter Koroshetz, Carl Lavie, Donald Lloyd-Jones, Hong S. Lu, Antonio Mirijello, Awoke Misganaw Temesgen, Ali Mokdad, Andrew E. Moran, Paul Muntner, Jagat Narula, Bruce Neal, Mpiko Ntsekhe, Glaucia Moraes de Oliveira, Catherine Otto, Mayowa Owolabi, Michael Pratt, Sanjay Rajagopalan, Marissa Reitsma, Antonio Luiz P. Ribeiro, Nancy Rigotti, Anthony Rodgers, Craig Sable, Saate Shakil, Karen Sliwa-Hahnle, Benjamin Stark, Johan Sundström, Patrick Timpel, Imad M. Tleyjeh, Marco Valgimigli, Theo Vos, Paul K. Whelton, Magdi Yacoub, Liesl Zuhlke, Christopher Murray, Valentin Fuster, Noel C. Barengo, Andrea Beaton, Aime Bonny, Jonathan R. Carapetis, Sumeet Chugh, Michael H. Criqui, Nicole K. DeCleene, Joaquim Fernández-Sola, F. Gerry R. Fowkes, Nicholas J. Kassebaum, Walter J. Koroshetz, Awoke T. Misganaw, Ali H. Mokdad, Gláucia M.M. Oliveira, Catherine M. Otto, Mayowa O. Owolabi, Marissa B. Reitsma, Nancy A. Rigotti, Craig A. Sable, Saate S. Shakil, Karen Sliwa, Benjamin A. Stark, Imad I. Tleyjeh, Liesl J. Zuhlke, Mohsen Abbasi-Kangevari, Alireza Abdi, Aidin Abedi, Victor Aboyans, Woldu A. Abrha, Eman Abu-Gharbieh, Abdelrahman I. Abushouk, Dilaram Acharya, Tim Adair, Oladimeji M. Adebayo, Zanfina Ademi, Shailesh M. Advani, Khashayar Afshari, Ashkan Afshin, Gina Agarwal, Pradyumna Agasthi, Sohail Ahmad, Sepideh Ahmadi, Muktar B. Ahmed, Budi Aji, Yonas Akalu, Wuraola Akande-Sholabi, Addis Aklilu, Chisom J. Akunna, Fares Alahdab, Ayman Al-Eyadhy, Khalid F. Alhabib, Sheikh M. Alif, Vahid Alipour, Syed M. Aljunid, François Alla, Amir Almasi-Hashiani, Sami Almustanyir, Rajaa M. Al-Raddadi, Adeladza K. Amegah, Saeed Amini, Arya Aminorroaya, Hubert Amu, Dickson A. Amugsi, Robert Ancuceanu, Deanna Anderlini, Tudorel Andrei, Catalina Liliana Andrei, Alireza Ansari-Moghaddam, Zelalem A. Anteneh, Ippazio Cosimo Antonazzo, Benny Antony, Razique Anwer, Lambert T. Appiah, Jalal Arabloo, Johan Ärnlöv, Kurnia D. Artanti, Zerihun Ataro, Marcel Ausloos, Leticia Avila-Burgos, Asma T. Awan, Mamaru A. Awoke, Henok T. Ayele, Muluken A. Ayza, Samad Azari, Darshan B. B, Nafiseh Baheiraei, Atif A. Baig, Ahad Bakhtiari, Maciej Banach, Palash C. Banik, Emerson A. Baptista, Miguel A. Barboza, Lingkan Barua, Sanjay Basu, Neeraj Bedi, Yannick Béjot, Derrick A. Bennett, Isabela M. Bensenor, Adam E. Berman, Yihienew M. Bezabih, Akshaya S. Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Ali Bijani, Boris Bikbov, Mulugeta M. Birhanu, Archith Boloor, Luisa C. Brant, Hermann Brenner, Nikolay I. Briko, Zahid A. Butt, Florentino Luciano Caetano dos Santos, Leah E. Cahill, Lucero Cahuana-Hurtado, Luis A. Cámera, Ismael R. Campos-Nonato, Carlos Cantu-Brito, Josip Car, Juan J. Carrero, Felix Carvalho, Carlos A. Castañeda-Orjuela, Ferrán Catalá-López, Ester Cerin, Jaykaran Charan, Vijay Kumar Chattu, Simiao Chen, Ken L. Chin, Jee-Young J. Choi, Dinh-Toi Chu, Sheng-Chia Chung, Massimo Cirillo, Sean Coffey, Sara Conti, Vera M. Costa, David K. Cundiff, Omid Dadras, Baye Dagnew, Xiaochen Dai, Albertino A.M. Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Vanessa De la Cruz-Góngora, Fernando P. De la Hoz, Jan-Walter De Neve, Edgar Denova-Gutiérrez, Meseret Derbew Molla, Behailu T. Derseh, Rupak Desai, Günther Deuschl, Samath D. Dharmaratne, Meghnath Dhimal, Raja Ram Dhungana, Mostafa Dianatinasab, Daniel Diaz, Shirin Djalalinia, Klara Dokova, Abdel Douiri, Bruce B. Duncan, Andre R. Duraes, Arielle W. Eagan, Sanam Ebtehaj, Aziz Eftekhari, Sahar Eftekharzadeh, Michael Ekholuenetale, Nevine El Nahas, Islam Y. Elgendy, Muhammed Elhadi, Shaimaa I. El-Jaafary, Sadaf Esteghamati, Atkilt E. Etisso, Oghenowede Eyawo, Ibtihal Fadhil, Emerito Jose A. Faraon, Pawan S. Faris, Medhat Farwati, Farshad Farzadfar, Eduarda Fernandes, Carlota Fernandez Prendes, Pietro Ferrara, Irina Filip, Florian Fischer, David Flood, Takeshi Fukumoto, Mohamed M. Gad, Shilpa Gaidhane, Morsaleh Ganji, Jalaj Garg, Abadi K. Gebre, Birhan G. Gebregiorgis, Kidane Z. Gebregzabiher, Gebreamlak G. Gebremeskel, Lemma Getacher, Abera Getachew Obsa, Alireza Ghajar, Ahmad Ghashghaee, Nermin Ghith, Simona Giampaoli, Syed Amir Gilani, Paramjit S. Gill, Richard F. Gillum, Ekaterina V. Glushkova, Elena V. Gnedovskaya, Mahaveer Golechha, Kebebe B. Gonfa, Amir Hossein Goudarzian, Alessandra C. Goulart, Jenny S. Guadamuz, Avirup Guha, Yuming Guo, Rajeev Gupta, Vladimir Hachinski, Nima Hafezi-Nejad, Teklehaimanot G. Haile, Randah R. Hamadeh, Samer Hamidi, Graeme J. Hankey, Arief Hargono, Risky K. Hartono, Maryam Hashemian, Abdiwahab Hashi, Shoaib Hassan, Hamid Y. Hassen, Rasmus J. Havmoeller, Simon I. Hay, Khezar Hayat, Golnaz Heidari, Claudiu Herteliu, Ramesh Holla, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Ayesha Humayun, Ivo Iavicoli, Charles U. Ibeneme, Segun E. Ibitoye, Olayinka S. Ilesanmi, Irena M. Ilic, Milena D. Ilic, Usman Iqbal, Seyed Sina N. Irvani, Sheikh Mohammed Shariful Islam, Rakibul M. Islam, Hiroyasu Iso, Masao Iwagami, Vardhmaan Jain, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Ranil Jayawardena, Panniyammakal Jeemon, Ravi P. Jha, Jost B. Jonas, Jitendra Jonnagaddala, Farahnaz Joukar, Jacek J. Jozwiak, Mikk Jürisson, Ali Kabir, Tanvir Kahlon, Rizwan Kalani, Rohollah Kalhor, Ashwin Kamath, Ibrahim Kamel, Himal Kandel, Amit Kandel, André Karch, Ayele Semachew Kasa, Patrick D.M.C. Katoto, Gbenga A. Kayode, Yousef S. Khader, Mohammad Khammarnia, Muhammad S. Khan, Md Nuruzzaman Khan, Maseer Khan, Ejaz A. Khan, Khaled Khatab, Gulam M.A. Kibria, Yun Jin Kim, Gyu Ri Kim, Ruth W. Kimokoti, Sezer Kisa, Adnan Kisa, Mika Kivimäki, Dhaval Kolte, Ali Koolivand, Vladimir A. Korshunov, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Vaman Kulkarni, G. Anil Kumar, Nithin Kumar, Om P. Kurmi, Dian Kusuma, Gene F. 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Tusa, Stefanos Tyrovolas, Krishna Kishore Umapathi, Brigid Unim, Bhaskaran Unnikrishnan, Muhammad S. Usman, Muthiah Vaduganathan, Pascual R. Valdez, Tommi J. Vasankari, Diana Z. Velazquez, Narayanaswamy Venketasubramanian, Giang T. Vu, Isidora S. Vujcic, Yasir Waheed, Yanzhong Wang, Fang Wang, Jingkai Wei, Robert G. Weintraub, Abrha H. Weldemariam, Ronny Westerman, Andrea S. Winkler, Charles S. Wiysonge, Charles D.A. Wolfe, Befikadu Legesse Wubishet, Gelin Xu, Ali Yadollahpour, Kazumasa Yamagishi, Lijing L. Yan, Srikanth Yandrapalli, Yuichiro Yano, Hiroshi Yatsuya, Tomas Y. Yeheyis, Yigizie Yeshaw, Christopher S. Yilgwan, Naohiro Yonemoto, Chuanhua Yu, Hasan Yusefzadeh, Geevar Zachariah, Sojib Bin Zaman, Muhammed S. Zaman, Maryam Zamanian, Ramin Zand, Alireza Zandifar, Afshin Zarghi, Mikhail S. Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Yunquan Zhang, Wangjian Zhang, Chenwen Zhong, Zhiyong Zou, Yves Miel H. Zuniga, and Christopher J.L. Murray
Subjects: BMI, body mass index, GBD, Global Burden of Diseases, Injuries, and Risk Factors Study, IS, ischemic stroke, 030204 cardiovascular system & hematology, MV, mitral valve, SDI, sociodemographic index, Global Health, UI, uncertainty interval, Global Burden of Disease, GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group, 0302 clinical medicine, Cost of Illness, LDL, low-density lipoprotein, Case fatality rate, Global health, 030212 general & internal medicine, IKF, impaired kidney function, 1102 Cardiorespiratory Medicine and Haematology, Incidence (epidemiology), Health Policy, IHD, ischemic heart disease, 1. No poverty, AC, alcoholic cardiomyopathy, 3. Good health, HICs, high-income countries, Cardiovascular Diseases, DALYs, disability-adjusted life years, TMREL, theoretical minimum risk exposure level, Public Health, HHD, hypertensive heart disease, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, AF, atrial fibrillation, Population health, CVD, cardiovascular disease, LMICs, low- and middle-income countries, PM, particulate matter, 1117 Public Health and Health Services, 03 medical and health sciences, JACC State-of-the-Art Review, RHD, rheumatic heart disease, Environmental health, medicine, Humans, LPA, low physical activity, YLLs, years of life lost, Health policy, Disease burden, PAD, peripheral artery disease, business.industry, SBP, systolic blood pressure, Public health, CKD, chronic kidney disease, The Present and Future, AFL, atrial flutter, Correction, HAP, household air pollution, ICD, International Classification of Diseases, CAVD, calcific aortic valve disease, YLDs, years lived with disability, Years of potential life lost, CHA, congenital heart anomalies, Cardiovascular System & Hematology, Heart Disease Risk Factors, business, population health
Abstract: Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases., Central Illustration, Highlights • The burden of CVD, in number of DALYs and deaths, continues to increase globally. • CVD burden attributable to modifiable risk factors continues to increase globally. • Countries should invest in existing cost-effective public health programs and clinical interventions to target modifiable risks, promote healthy aging across the lifespan, and reduce disability and premature death due to CVD.
Published: 2020

18. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. 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Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. 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Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. 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Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.
Subjects: Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract: Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020

19. Etiologies and predictors of readmission among obese and morbidly obese patients admitted with heart failure

Author: Brijesh Patel, Kevin Bryan Lo, Shilpkumar Arora, Nilay Patel, Manyoo Agarwal, Ulrich P. Jorde, Mahek Shah, Pradhum Ram, Byomesh Tripathi, and Sourin Banerji
Subjects: Male, medicine.medical_specialty, Post discharge, Aftercare, 030204 cardiovascular system & hematology, Morbidly obese, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Retrospective Studies, Heart Failure, business.industry, Odds ratio, medicine.disease, Obesity, Confidence interval, Patient Discharge, Obesity, Morbid, Hospitalization, Heart failure, Etiology, Female, Cardiology and Cardiovascular Medicine, Index hospitalization, business
Abstract: The relationship between severity of obesity and outcomes in heart failure (HF) has long been under debate. We studied index HF admissions from the 2013–14 National Readmission Database. Admissions were separated into three weight-based categories: non-obese (Non-Ob), obese (Ob), and morbidly obese (Morbid-Ob) to analyze hospital mortality and readmission at 30 days and 6 months. We investigated etiologies and predictors of 30-day readmission among these weight categories. We studied a total of 578,213 patients of whom 3.0% died during index hospitalization (Non-Ob 3.3% vs. Ob 1.9% vs. Morbid-Ob 1.9%; p
Published: 2020

20. Readmission-free period and in-hospital mortality at the time of first readmission in acute heart failure patients-NRD-based analysis of 40,000 heart failure readmissions

Author: Ahmed M Altibi, Brijesh Patel, Pradhum Ram, Byomesh Tripathi, George Prousi, Mahek Shah, and Manyoo Agarwal
Subjects: Heart Failure, medicine.medical_specialty, Time Factors, In hospital mortality, business.industry, Mistake, medicine.disease, Patient Readmission, Percutaneous Coronary Intervention, Treatment Outcome, Risk Factors, Heart failure, Emergency medicine, medicine, Humans, Hospital Mortality, Cardiology and Cardiovascular Medicine, business, Congestive heart failure chf
Abstract: The 30-day readmission rates, predictors, and outcomes for acute heart failure (AHF) patients are well published, but data beyond 30 days and the association between readmission-free period (RFP) and in-hospital readmission-related mortality remain unknown. We queried the National Readmission Database to analyze comparative outcomes of AHF. Patients were divided into three groups based on their RFP: group 1 (1-30 days), group 2 (31-90 days), and group 3 (91-275 days). AHF cases and clinical variables were identified using ICD-9 codes. The primary outcome was in-hospital mortality at the time of readmission. A total of 39,237 unplanned readmissions occurred within 275 days; 15,181 within group 1, 11,925 within group 2, and 12,131 within group 3. In-hospital mortality in groups 1, 2, and 3 were 7.4%, 5.1%, and 4.1% (p 0.001). Group 1 had higher percentages of patients with cardiogenic shock (1.3% vs. 0.9% vs. 0.9%; p 0.001), acute kidney injury (30.2% vs. 25.9% vs. 24.0%; p 0.001), dialysis use (8.6% vs. 7.5% vs. 6.9%; p 0.001), and non-ST elevation myocardial infarction (4.4% vs. 3.8% vs. 3.6%; p 0.001), but there was no statistical difference among the three groups for ST-elevation myocardial infarction, percutaneous coronary intervention (PCI), or ventricular assist device use at the time of index admission. However, group 3 had higher PCI (1.7%) compared with groups 1 and 2 (p 0.001). In multivariable logistic regression, groups 2 and 3 had odd ratio of 0.70 and 0.55, respectively, for in-hospital mortality compared with group 1. Longer RFP is associated with decreased risk of in-hospital mortality at the time of first readmission.
Published: 2020

21. Etiologies, Predictors, and Economic Impact of 30-Day Readmissions Among Patients With Peripartum Cardiomyopathy

Author: Vincent M. Figueredo, Brijesh Patel, Kevin Bryan Lo, Shantanu Patil, Pradhum Ram, Soumya Patnaik, Mahek Shah, Ulrich P. Jorde, Byomesh Tripathi, and Marvin Lu
Subjects: Adult, medicine.medical_specialty, Time Factors, Peripartum cardiomyopathy, 030204 cardiovascular system & hematology, Patient Readmission, Risk Assessment, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Peripartum Period, medicine, Humans, 030212 general & internal medicine, Hospital Costs, business.industry, Incidence, Incidence (epidemiology), Odds ratio, medicine.disease, United States, Confidence interval, Heart failure, Disease Progression, Cardiology, Etiology, Female, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cause of heart failure. Given the significant impact of heart failure on healthcare, we sought to identify etiologies and predictive factors for readmission in PPCM. We queried the 2013 to 2014 National Readmissions Database to identify patients admitted with a diagnosis of PPCM. Patients who were readmitted within 30 days were evaluated to identify etiologies and predictors of readmission. We identified 6,977 index admissions with PPCM. Of the 6,880 (98.6%) patients who survived the index hospitalization, 30-day readmission rate was 13%. Seventy-six percent of readmitted patients were admitted once, and the other 24% were readmitted at least twice within 30 days of discharge. Length of stay was ≥8 days (adjusted odds ratio [aOR] 2.80, 95% confidence interval [CI] 2.08 to 3.77), multiparity (aOR 2.07, 95% CI 1.09 to 3.92), coronary artery disease (aOR 2.28, 95% CI 1.42 to 3.67), and long-term anticoagulation use (aOR 2.51, 95% CI 1.73 to 3.64) were independently associated with increased risk of 30-day readmission. Among the readmissions, 48% were due to cardiac causes, where PPCM and related complications (24%) were the most common cardiac cause followed by heart failure (16%). The annual cost of stay for index admissions was $64.2 million (average cost for index admission was $16,892). The annual charges attributed to readmission within 30 days were ≈$9 million. Cardiac etiologies were the most common cause for 30-day readmissions in PPCM patients, with a readmission rate of 13%. Long-term anticoagulation use, multiparity, coronary disease and length of stay predicted higher 30-day readmission.
Published: 2018

22. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States

Author: Pradhum Ram, Sahil Agrawal, Ulrich P. Jorde, Manyoo Agarwal, Brijesh Patel, Shilpkumar Arora, Nilay Patel, Mahek Shah, Lohit Garg, Joyce Wald, and Soumya Patnaik
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Databases, Factual, Population, Shock, Cardiogenic, Infarction, 030204 cardiovascular system & hematology, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Risk Factors, Internal medicine, Odds Ratio, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Myocardial infarction, Practice Patterns, Physicians', education, Impella, Aged, Aged, 80 and over, education.field_of_study, Chi-Square Distribution, Intra-Aortic Balloon Pumping, business.industry, Incidence (epidemiology), Cardiogenic shock, Process Assessment, Health Care, Age Factors, General Medicine, Middle Aged, medicine.disease, United States, Logistic Models, Treatment Outcome, Shock (circulatory), Multivariate Analysis, Circulatory system, Cardiology, ST Elevation Myocardial Infarction, Female, Heart-Assist Devices, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Recent trends on outcomes in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) suggest improvements in early survival. However, with the ever-changing landscape in management of CS, we sought to identify age-based trends in these outcomes and mechanical circulatory support (MCS) use among patients with both AMI and non-AMI associated shock. We queried the 2005–2014 Nationwide Inpatient Sample databases to identify patients with a diagnosis of cardiogenic shock. Trends in the incidence of hospital-mortality, and use of MCS such as intra-aortic balloon pump (IABP), Impella/TandemHeart (IMP), and extra corporeal membrane oxygenation (ECMO) were analyzed within the overall population and among different age-categories (50 and under, 51–65, 66–80 and 81–99 years). We also made comparisons between patient groups admitted with CS complicating AMI and those with non-AMI associated CS. We studied 144,254 cases of CS, of which 55.4% cases were associated with an AMI. Between 2005 and 2014, an overall decline in IABP use (29.8–17.7%; ptrend < 0.01), and an uptrend in IMP use (0.1–2.6%; ptrend < 0.01), ECMO use (0.3–1.8%; ptrend < 0.01) and in-hospital mortality (44.1–52.5% AMI related, 49.6–53.5% non-AMI related; ptrend < 0.01) was seen. Patients aged 81–99 years had the lowest rate of MCS use (14.8%), whereas those aged 51–65 years had highest rate of MCS use (32.3%). Multivariable analysis revealed that patients aged 51-65 years (aOR 1.46, 95% CI 1.40–1.52; p
Published: 2017

23. Commotio cordis: A review

Author: Mohammed Madadin, Pankaj Singh, Saba Ahmed, Sushil Allen Luis, Syed Ather Hussain, Pradhum Ram, Ritesh G. Menezes, Magdy A. Kharoshah, Huda Fatima, and Sadip Pant
Subjects: Male, medicine.medical_specialty, Thoracic Injuries, Poison control, Autopsy, 030204 cardiovascular system & hematology, Wounds, Nonpenetrating, Sudden death, Commotio Cordis, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Commotio cordis, Injury prevention, medicine, Humans, 030216 legal & forensic medicine, Intensive care medicine, biology, Athletes, business.industry, Health Policy, medicine.disease, biology.organism_classification, Precordium, Issues, ethics and legal aspects, Death, Sudden, Cardiac, medicine.anatomical_structure, Athletic Injuries, Cardiology, Female, Crime, business, Law
Abstract: Commotio cordis is an increasingly reported fatal mechano-electric syndrome and is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium. By virtue of this impact, malignant arrhythmias consequently develop leading to the individual’s immediate demise, accompanied by a relatively normal post-mortem analysis. The importance of an autopsy remains paramount to exclude other causes of sudden death. With increasing awareness and reporting, survival rates are beginning to improve; however, prevention of the development of this condition remains the best approach for survival.
Published: 2017

24. Knowledge and Attitude Towards Cardiopulmonary Resuscitation Among Doctors of a Tertiary Care Hospital in Karachi

Author: Ritesh G. Menezes, Pankaj Singh, Pradhum Ram, Muhammad Mustafa Memon, Momal Jamali, Sushil Allen Luis, Muhammad Moinuddin Ashrafi, Jai Kumar, Muhammad Ahad Sher Khan, Fouzia Imtiaz, Zaiyn Ul Haq, Aiman Rehan, Savita Lasrado, Aamina Majid, and Rafia Irfan
Subjects: Medical curriculum, medicine.medical_specialty, Resuscitation, medicine.medical_treatment, education, resuscitation, Cardiology, 030204 cardiovascular system & hematology, acute coronary syndrome, 03 medical and health sciences, 0302 clinical medicine, medicine, Lack of knowledge, Cardiopulmonary resuscitation, Automated external defibrillator, health care economics and organizations, business.industry, Public health, public health, General Engineering, Basic life support, Tertiary care hospital, medicine.disease, Emergency Medicine, Medical emergency, business, 030217 neurology & neurosurgery, coronary artery disease
Abstract: Objective Cardiac arrest is an emergency, which can be managed effectively by sound knowledge and practice of basic life support (BLS) skills. However, it has been globally reported that the knowledge of doctors regarding cardiopulmonary resuscitation (CPR) and BLS is sub-standard. We conducted this study with the aim to assess the knowledge and attitude of doctors toward CPR in Dr. Ruth K.M. Pfau Civil Hospital, one of the largest tertiary care hospitals, in Pakistan. Methods We conducted a cross-sectional study, in Dr. Ruth K.M. Pfau Civil Hospital located in Karachi, Pakistan, using cluster sampling. A total of 285 doctors were interviewed. Results A majority of the doctors were unaware of the revised rate and depth of chest compressions (65.6% and 75.8% respectively). While many know the abbreviations of BLS and CPR (96.55% and 95.4%, respectively), 56.5% did not know what automated external defibrillator (AED) stood for. CPR was preferred over chest compression-only resuscitation (CCR) by 91.6% of the doctors. Half of the participants rated their knowledge as average. Most stated that they will not be reluctant to perform CPR in an emergency situation. The majority also agreed that BLS training should be an integral part of the medical curriculum. Conclusion There is an evident lack of knowledge of CPR among healthcare professionals, particularly regarding the updates made in the 2015 American Heart Association (AHA) guidelines. However, an overall positive attitude was observed.
Published: 2019

25. Trends in Incidence and Outcomes of Pregnancy-Related Acute Myocardial Infarction (From a Nationwide Inpatient Sample Database)

Author: Purnima Sharma, Ewelina Wojtaszek, Byomesh Tripathi, Nileshkumar J. Patel, Pradhum Ram, Varunsiri Atti, Sejal Savani, Avnish Tripathi, Toralben Patel, Brijesh Patel, Abhishek Deshmukh, Anmol Pitiliya, Varun Kumar, Shilpkumar Arora, Vincent M. Figueredo, Radha Gopalan, and Mahek Shah
Subjects: Adult, Databases, Factual, Pregnancy Complications, Cardiovascular, Myocardial Infarction, 030204 cardiovascular system & hematology, Logistic regression, Thrombophilia, computer.software_genre, Risk Assessment, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pregnancy, Risk Factors, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Young adult, Retrospective Studies, Inpatients, Database, business.industry, Incidence (epidemiology), Incidence, Retrospective cohort study, medicine.disease, United States, Hospitalization, Survival Rate, Concomitant, Female, Cardiology and Cardiovascular Medicine, business, computer
Abstract: Acute myocardial infarction (AMI) during pregnancy is rare but fatal complication. Recent incidence of pregnancy related AMI and trends in the related outcomes are unknown. The Nationwide Inpatient Sample database was utilized from years 2005 to 2014. International Classification of Disease-Ninth Revision were used to identify pregnancy related admissions and AMI. Primary outcome was incidence and trend of AMI related to pregnancy and Secondary outcomes were trends in mortality, resource utilization, and predictors of AMI during pregnancy. Simple logistic regression model was used to calculate predictors of AMI during pregnancy. p Values for trends were generated by Cochrane-Armitage test for categorical variables and simple linear regression for continuous variables. A total of 43,437,621 pregnancy related hospitalization and 3,786 cases of AMI (86% ante-partum and 14% postpartum) were noted during study period. The incidence of AMI during the study period was 8.7 per 100,000 pregnancies with an overall increase in incidence during the study period (relative increase of 18.9%, p
Published: 2018

26. A large mass in the right ventricle: Tumor or thrombus?

Author: Mahek Shah, Harish Raj Seetha Rammohan, Soumya Patnaik, Pradhum Ram, Alexander Rubin, and Saurabh Sharma
Subjects: medicine.medical_specialty, Heart Ventricles, 030204 cardiovascular system & hematology, Diagnosis, Differential, Heart Neoplasms, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Edema, medicine, Humans, 030212 general & internal medicine, Thrombus, Aged, Neoplasm Staging, Ovarian Neoplasms, business.industry, Poorly differentiated, Disease Management, Thrombosis, General Medicine, medicine.disease, medicine.anatomical_structure, Echocardiography, Ventricle, Female, Neoplasm staging, Radiology, Sarcoma, medicine.symptom, Tomography, X-Ray Computed, business, Kidney disease
Abstract: A 69-year-old woman with hypertension, diabetes mellitus, and chronic kidney disease presented with a 1-month history of worsening episodic dyspnea, lower-extremity edema, and dizziness. Two months earlier, she had been diagnosed with poorly differentiated pelvic adnexal sarcoma associated with a
Published: 2017

27. Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis

Author: Vincent M. Figueredo, Kevin Bryan Lo, Pradhum Ram, Carlos Gongora, Hafeez Ul Hassan Virk, Vladimir Lakhter, and Gregg S. Pressman
Subjects: Acute coronary syndrome, medicine.medical_specialty, Chest Pain, business.industry, Adrenergic beta-Antagonists, Cocaine induced chest pain, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Chest pain, Confidence interval, 03 medical and health sciences, Cocaine-Related Disorders, 0302 clinical medicine, Treatment Outcome, Relative risk, Internal medicine, Meta-analysis, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, medicine.symptom, business, After treatment
Abstract: Background Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes. Methods Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model. Results Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate. Conclusion This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.
Published: 2018

28. Etiologies, predictors, and economic impact of readmission within 1 month among patients with takotsubo cardiomyopathy

Author: Byomesh Tripathi, Shantanu Patil, Pradhum Ram, Natee Sirinvaravong, Brijesh Patel, Kevin Bryan Lo, Mahek Shah, and Vincent M. Figueredo
Subjects: Male, medicine.medical_specialty, Time Factors, Databases, Factual, Cardiomyopathy, Clinical Investigations, 030204 cardiovascular system & hematology, Patient Readmission, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Takotsubo Cardiomyopathy, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Private insurance, Aged, Retrospective Studies, Heart Failure, business.industry, Cost impact, General Medicine, After discharge, Middle Aged, medicine.disease, Obesity, United States, Survival Rate, Heart failure, Etiology, Disease Progression, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: BACKGROUND: Limited data exist on readmission among patients with takotsubo cardiomyopathy (TC), a commonly reversible cause of heart failure. HYPOTHESIS: We sought to identify etiologies and predictors for readmission among TC patients. METHODS: We queried the National Readmissions Database for 2013–2014 to identify patients with primary admission for TC using ICD‐9‐CM code 429.83. Patients readmitted to hospital within 1 month after discharge were further evaluated to identify etiologies, predictors, and resultant economic burden of readmission. Additionally, we analyzed readmission for TC at 6 months. RESULTS: We studied 5997 patients admitted with TC, of whom 1.2% experienced in‐hospital mortality. Median age was 67 years, with 91.5% being female. Among survivors, 10.3% were readmitted within 1 month; 25% of the initial 1‐month readmissions occurred within 4 days, 50% within 10 days, and 75% within 20 days from discharge. The most common etiologies for readmission were cardiac (26%), respiratory (16%), and gastrointestinal (11%) causes. Heart failure was the most common cardiac etiology. Significant predictors of increased 1‐month readmission included systemic thromboembolic events, length of stay ≥3 days, and underlying psychoses. Obesity and private insurance predicted lower 1‐month readmission. The annual national cost impact for index admission and 1‐month readmissions was ≈$112 million. Recurrent TC was seen among 1.9% of patients readmitted within 6 months. CONCLUSIONS: Though the overall rate of 1‐month readmission following TC is low, associated economic burden from readmission is still significant. Patients are readmitted mostly for noncardiac causes. Readmission for another episode of TC within 6 months was uncommon.
Published: 2018

29. National trends in hospitalizations and outcomes in patients with alcoholic cardiomyopathy

Author: Kevin Bryan Lo, Janani Rangaswami, Pradhum Ram, Brijesh Patel, Mahek Shah, and Vincent M. Figueredo
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Databases, Factual, Substance-Related Disorders, Cardiomyopathy, Clinical Investigations, Disease, Comorbidity, 030204 cardiovascular system & hematology, Alcoholic cardiomyopathy, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Age Distribution, Patient Admission, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Sex Distribution, Depression (differential diagnoses), Aged, business.industry, Cardiomyopathy, Alcoholic, Smoking, General Medicine, Middle Aged, medicine.disease, United States, Natural history, Substance abuse, Treatment Outcome, Heart failure, Etiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background Numerous studies have shown conflicting results regarding the natural history and outcomes with alcoholic cardiomyopathy (AC). Hypothesis Determining the trends in hospitalization among patients with AC and associated outcomes will facilitate a better understanding of this disease. Methods We conducted our analysis on discharge data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2002 through 2014. We obtained data from patients aged ≥18 years with diagnosis of "Alcoholic Cardiomyopathy." Death was defined within the NIS as in-hospital mortality. By using International Classification of Disease-9th edition-Clinical Modification (ICD-9CM) diagnoses and diagnosis-related groups different comorbidities were identified. Results We studied a total of 45 365 admissions among patients with AC. The absolute number of admissions decreased from 2002 to 2014 (3866-2834 admissions). In-hospital mortality was variable throughout study duration without a clinically relevant trend (Mean 4.5%, range 3.6%-5.6%). The patients were mostly male (87%) and Caucasian (50.5%). Commonest age groups involved were 45-59 years (46.7%) followed by 60-74 years (29.2%). Trends in associated comorbidities such as smoking, drug abuse, depression, and hypertension increased over the same time period. Among all admissions, almost half were for cardiovascular etiologies (48.9%) and heart failure (≈24%) was the commonest reason for hospital admission. Conclusion While the overall admissions among patients with AC decreased over time, the proportion of patients with high-risk characteristics such as smoking, depression, and drug abuse increased. Patients aged 45 and older were largely affected and cardiovascular etiologies predominated among causes for admission.
Published: 2018

30. Left ventricular thrombosis in acute anterior myocardial infarction: Evaluation of hospital mortality, thromboembolism, and bleeding

Author: Lohit Garg, Shantanu Patil, Natee Sirinvaravong, Pradhum Ram, Byomesh Tripathi, Vincent M. Figueredo, Kevin Bryan Lo, Mahek Shah, and Brijesh Patel
Subjects: Male, medicine.medical_specialty, Time Factors, Heart Diseases, Heart Ventricles, Anterior wall, Clinical Investigations, Hemorrhage, Hospital mortality, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Fibrinolytic Agents, Internal medicine, Thromboembolism, medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Ventricular thrombosis, Propensity Score, Letters to the Editor, Anterior Wall Myocardial Infarction, Retrospective Studies, business.industry, Incidence, Thrombosis, General Medicine, Left ventricular thrombus, Acute anterior myocardial infarction, Middle Aged, medicine.disease, United States, Survival Rate, Echocardiography, Propensity score matching, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Complication, Follow-Up Studies
Abstract: Background Left ventricular thrombosis (LVT) is a well-known complication of acute myocardial infarction, most commonly seen in anterior wall ST-segment elevation myocardial infarction (STEMI). It is associated with systemic thromboembolism. Hypothesis Our aim was to evaluate the impact of LVT on in-hospital mortality, thromboembolism, and bleeding in patients with anterior STEMI. Methods Data was collected from the Nationwide Inpatient Sample where patients with a primary diagnosis of "Anterior STEMI" [ICD9-CM code 410.1] were included. Comparisons were made between patients with LVT [ICD9-CM code 429.79] vs those without using propensity score matching (PSM). Results From 2002 to 2014, there were 157 891 cases of anterior STEMI. Among these, 649 (0.4%) had LVT. Post-PSM, there was no difference in in-hospital mortality between the groups with LVT and without (7.3% vs 8.6%). Thromboembolic event rate was higher with LVT compared to those without LVT (7.3% vs 2.1%). There was no difference in bleeding events between patients with LVT and those without (2.9% vs 3.2%). The baseline average length of stay in the group with LVT was longer than the group without LVT (7.9 ± 6.7 days vs 5.1 ± 6.0 days). The average hospitalization-related costs were also significantly higher among patients with LVT compared to those without (95 598 USD vs 66 641 USD per stay) at baseline. Conclusion Among patients hospitalized with anterior STEMI, presence of LVT is associated with increased thromboembolic events, average length of hospital stay and average cost of hospitalization. However, it is not associated with increased in-hospital mortality or bleeding events.
Published: 2018

31. Validation of digital ankle-brachial index as a screening tool in symptomatic patients with peripheral arterial disease

Author: Manisha Ganapathi Raikar, Jon C. George, Deepakraj Gajanana, Sean Janzer, Pradhum Ram, Vincent M. Figueredo, and Vikas Bhalla
Subjects: Male, medicine.medical_specialty, Multivariate analysis, Arterial disease, Point-of-Care Systems, 030204 cardiovascular system & hematology, 03 medical and health sciences, Peripheral Arterial Disease, 0302 clinical medicine, Predictive Value of Tests, Medicine, Humans, Ankle Brachial Index, cardiovascular diseases, 030212 general & internal medicine, Aged, Retrospective Studies, Philadelphia, Receiver operating characteristic, business.industry, Angiography, Reproducibility of Results, General Medicine, Gold standard (test), Odds ratio, Middle Aged, Prognosis, Peripheral, body regions, medicine.anatomical_structure, Point-of-Care Testing, Cohort, Female, Radiology, Ankle, Cardiology and Cardiovascular Medicine, business
Abstract: Introduction There is scarcity of data validating portable digital ankle-brachial index (ABI) with contrast angiography in peripheral arterial disease (PAD). Our aim was to provide an objective analysis of the relationship between digital ABI (dABI) and peripheral angiographic data. Methods Consecutive patients with symptoms of PAD between May 2014 to May 2015 at Einstein Medical Center, Philadelphia, who were undergoing simultaneous dABI and peripheral angiography, were evaluated. Measurements were made using the FloChec™ Digital ABI system (Bard) prior to the scheduled peripheral angiogram. Results The final cohort consisted of 51 patients. Mean age was 68.8 ± 9.5 years with 55% being male. Aorto-iliac disease accounted for 13% of the total lesions, while femoro-popliteal lesions comprised 55%. The FloChec™ digital ABI had a sensitivity of 84% and a positive predictive value of 84%. The area under the receiver operating characteristic curve was 0.74 (p = 0.007). On multivariate analysis, FloChec™ digital ABI was still an independent predictor of PAD, Odds ratio 6.8 (2.3–20.6, p = 0.001). Conclusion A portable, point-of-care digital ABI system can be used as a valuable, simple, cost-effective and reliable screening tool with high sensitivity and accuracy. To date, ours is the first study validating FloChec™ digital ABI with the gold standard angiographic data.
Published: 2018

32. Cerbera odollam toxicity: A review

Author: Tariq Jamal Siddiqi, Ritesh G. Menezes, Syed Bilal Pasha, Tooba Qadir Fatima, S. Senthilkumaran, Syed Ather Hussain, Mohammed Madadin, Muhammad Usman, Sushil Allen Luis, Huda Fatima, and Pradhum Ram
Subjects: Atropine, Pacemaker, Artificial, Digoxin, medicine.medical_treatment, 030204 cardiovascular system & hematology, Cardiotoxins, Pathology and Forensic Medicine, 03 medical and health sciences, chemistry.chemical_compound, Forensic Toxicology, Immunoglobulin Fab Fragments, 0302 clinical medicine, Cardenolide, medicine, Humans, Immunologic Factors, 030212 general & internal medicine, Cerbera odollam, Cardiac glycoside, biology, Traditional medicine, Digoxin immune fab, business.industry, Poisoning, food and beverages, General Medicine, Plant poison, biology.organism_classification, Apocynaceae, Cardenolides, chemistry, Toxicity, Cerberin, business, Law, Anti-Arrhythmia Agents, medicine.drug
Abstract: Cerbera odollam is a plant species of the Apocynaceae family. It is often dubbed the 'suicide tree' due to its strong cardiotoxic effects, which make it a suitable means to attempt suicide. The plant grows in wet areas in South India, Madagascar, and Southeast Asia; and its common names include Pong-Pong and Othalanga. The poison rich part of the plant is the kernel which is present at the core of its fruit. The bioactive toxin in the plant is cerberin, which is a cardiac glycoside of the cardenolide class. Cerberin has a mechanism of action similar to digoxin; hence, Cerbera odollam toxicity manifests similar to acute digoxin poisoning. Ingestion of its kernel causes nausea, vomiting, hyperkalemia, thrombocytopenia, and ECG abnormalities. Exposure to high doses of Cerbera odollam carries the highest risk of mortality. Initial management includes supportive therapy and administration of atropine followed by temporary pacemaker insertion. Administration of digoxin immune Fab may be considered in severe cases, although efficacy is variable and data limited to isolated case reports.
Published: 2017

33. Right Ventricular Free Wall Strain Is Associated With Long-Term Renal Function in Heart Failure With Preserved Ejection Fraction

Author: Napatt Kanjanahattakij, Janani Rangaswami, Pradhum Ram, Gregg S. Pressman, Kevin Bryan Lo, and Shuchita Gupta
Subjects: Male, medicine.medical_specialty, Time Factors, Heart Ventricles, Renal function, Strain (injury), 030204 cardiovascular system & hematology, Kidney, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, medicine, Humans, Retrospective Studies, Heart Failure, business.industry, Stroke Volume, Middle Aged, Prognosis, medicine.disease, Term (time), 030228 respiratory system, Ventricular Function, Right, Cardiology, Female, Right Ventricular Free Wall, Cardiology and Cardiovascular Medicine, business, Heart failure with preserved ejection fraction, Follow-Up Studies, Glomerular Filtration Rate
Published: 2018

34. Reply: Surprisingly low incidence of left ventricular thrombosis in anterior ST-segment elevation myocardial infarction

Author: Vincent M. Figueredo, Kevin Bryan Lo, Pradhum Ram, and Mahek Shah
Subjects: medicine.medical_specialty, business.industry, Incidence (epidemiology), General Medicine, Hospital mortality, 030204 cardiovascular system & hematology, medicine.disease, Anterior ST segment elevation, Thrombosis, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, Cardiology, Medicine, Anterior Wall Myocardial Infarction, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Ventricular thrombosis
Published: 2018

35. Fat infiltration of left ventricle – a rare cause of sudden cardiac death

Author: Urmila N Khadilkar, Jenash Acharya, Tanuj Kanchan, Pradhum Ram, and Talvinder Rana
Subjects: Adult, medicine.medical_specialty, Heart Ventricles, Fat infiltration, India, Embolism, Fat, Autopsy, Sudden cardiac death, Internal medicine, medicine, Humans, Pericardium, Fat embolism, Normal heart, business.industry, General Medicine, Forensic Medicine, medicine.disease, Death, Sudden, Cardiac, medicine.anatomical_structure, Ventricle, cardiovascular system, Cardiology, Female, Histopathology, business
Abstract: Cor adiposum is a rare disorder of the heart, where the normal heart tissue is replaced by fibro-fatty infiltrates. We report one such case of a middle-aged female who was declared dead shortly after a syncopal episode. At autopsy, the pericardium was intact and firmly adhered to the heart. Histopathology revealed fatty infiltrates extending into the left ventricle of the heart. A post-mortem diagnosis of Cor adiposum was made which is an uncommonly reported cause of sudden cardiac death.
Published: 2016

36. Use of Aldosterone Antagonist to Treat Diarrhea and Hypokalemia of Ogilvie’s Syndrome

Author: Joshua Sloan, William McElhaugh, Marvin Lu, Pradhum Ram, and Abhinav Goyal
Subjects: History, medicine.medical_specialty, endocrine system diseases, Polymers and Plastics, 030232 urology & nephrology, Case Report, 030204 cardiovascular system & hematology, urologic and male genital diseases, Gastroenterology, Industrial and Manufacturing Engineering, 03 medical and health sciences, chemistry.chemical_compound, Therapeutic approach, 0302 clinical medicine, Internal medicine, medicine, lcsh:RC799-869, Business and International Management, Femoral neck, Aldosterone, business.industry, Antagonist, nutritional and metabolic diseases, Abdominal distension, Hypokalemia, Surgery, Diarrhea, medicine.anatomical_structure, chemistry, Spironolactone, lcsh:Diseases of the digestive system. Gastroenterology, medicine.symptom, business
Abstract: Ogilvie’s syndrome (OS) is a functional obstruction of the bowel due to an autonomic imbalance. It often presents with diarrhea and is associated with hypokalemia. We present a case of a 70-year-old male who developed severe abdominal distension, watery diarrhea, and persistent hypokalemia status after left hip arthroplasty after suffering from a femoral neck fracture due to a fall and was diagnosed with OS. The persistent hypokalemia was slow to improve despite aggressive repletion because of the high potassium losses in the stool. This is most likely mediated through the increased expression of BK channels in the colonic mucosa. Aldosterone is theorized to have a role in the regulation of BK channels. Spironolactone was subsequently given and resulted in marked improvement of the diarrhea and hypokalemia. Thus, this case suggests a novel therapeutic approach for the treatment of Ogilvie’s syndrome-associated diarrhea and hypokalemia.
Published: 2016

37. Hospital mortality and thirty day readmission among patients with non-acute myocardial infarction related cardiogenic shock

Author: Pradhum Ram, Jooyoung J. Shin, Byomesh Tripathi, Shantanu Patil, Manyoo Agarwal, Ulrich P. Jorde, Brijesh Patel, Soumya Patnaik, and Mahek Shah
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Population, Myocardial Infarction, Shock, Cardiogenic, 030204 cardiovascular system & hematology, Patient Readmission, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, medicine, Extracorporeal membrane oxygenation, Humans, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, education, Impella, Aged, Aged, 80 and over, education.field_of_study, business.industry, Cardiogenic shock, Odds ratio, Middle Aged, medicine.disease, Heart failure, Emergency medicine, Etiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background Cardiogenic shock (CS) in absence of acute myocardial infarction (AMI) has significant morbidity and mortality. This population of patients has been excluded from prior major randomized trials and observational studies. Methods We included patients with CS in absence of AMI from the 2013–14 HCUP's National Readmission Database. 30-day readmissions were studied and etiology for readmission was identified by using ICD-9CM codes in primary diagnosis field. Multivariable mixed effect logistic regression models were created to identify predictors of 30-day readmission and in-hospital mortality, respectively. Results We studied 38,198 index admissions with non-AMI CS, with an in-hospital mortality of 35.4%. Mean age, length and cost of stay were 63.6 years, 16.9 days and 69,947$, respectively among survivors of index admission. Among those discharged, 22.6% were readmitted within 30 days with >50% readmissions occurring within 11-days. Cardiovascular etiologies (42.3%), especially heart failure (24.0%) comprised the commonest reason for readmission. Among non-cardiac causes were infectious (11.7%) and respiratory (9.2%) etiologies. Older age (50–64 years odds ratio:1.29, 65–79 years, OR:1.59, ≥80 years OR:2.69), ventilator use (OR:4.25), sepsis (OR:1.12), use of short term devices (intra-aortic balloon pump OR:2.67, Impella/TandemHeart OR:4.84, extracorporeal membrane oxygenation OR:3.68) and non-ischemic cardiomyopathy(OR:0.65) were among the predictors of in-hospital mortality. Older age (65–79 years, OR:1.25, ≥80 years OR:1.41), male sex (OR:1.08), and ventilator use (OR:1.21) predicted higher 30-day readmission. Conclusion Both, in-hospital mortality and 30-day readmission among those admitted for non-AMI CS were significantly elevated. The majority of readmissions were due to non-cardiovascular causes. Identifying high-risk factors may help devise strategies to improve quality of care and reduce adverse outcome rates.
Published: 2017

38. Breaking your heart-A review on CPR-related injuries

Author: Ritesh G. Menezes, Syed Ather Hussain, Mohammed Madadin, Sushil Allen Luis, Savita Lasrado, Natee Sirinvaravong, Glenn Eiger, and Pradhum Ram
Subjects: Male, medicine.medical_specialty, Time Factors, Thoracic Injuries, medicine.medical_treatment, Abdominal Injuries, Heart Massage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Risk Factors, medicine, Humans, Cardiopulmonary resuscitation, Facial Injuries, business.industry, Age Factors, 030208 emergency & critical care medicine, General Medicine, Cardiopulmonary Resuscitation, Heart Arrest, Emergency medicine, Emergency Medicine, Female, business, Airway
Abstract: Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra-abdominal injuries. This review discusses the risk factors and prevalence of CPR-related injuries.
Published: 2017

39. Acute kidney injury post-transcatheter aortic valve replacement

Author: Janani Rangaswami, Kenechukwu Mezue, Gregg S. Pressman, and Pradhum Ram
Subjects: medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Reviews, 030204 cardiovascular system & hematology, Global Health, Risk Assessment, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Risk Factors, Prevalence, Medicine, Humans, 030212 general & internal medicine, Embolization, Intensive care medicine, business.industry, valvular heart disease, Acute kidney injury, General Medicine, Aortic Valve Stenosis, Acute Kidney Injury, medicine.disease, Stenosis, Aortic valve stenosis, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract: Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.
Published: 2017

40. Clinical utility of the HEART score in patients admitted with chest pain to an inner-city hospital in the USA

Author: Obiora Maludum, Marvin Lu, Mahek Shah, Vincent M. Figueredo, Ritika Puri, Percy Balderia, Pradhum Ram, Soumya Patnaik, John Brady Imms, and Yaser Alhamshari
Subjects: Male, medicine.medical_specialty, Chest Pain, medicine.medical_treatment, 030204 cardiovascular system & hematology, Revascularization, Chest pain, Coronary Angiography, Risk Assessment, Severity of Illness Index, Diagnosis, Differential, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Hospitals, Urban, Patient Admission, Risk Factors, Severity of illness, medicine, Odds Ratio, Humans, Telemetry, Myocardial infarction, Acute Coronary Syndrome, Diagnostic Errors, Prospective cohort study, Non-ST Elevated Myocardial Infarction, Retrospective Studies, Philadelphia, business.industry, Incidence, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Odds ratio, Middle Aged, medicine.disease, United States, Emergency medicine, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Emergency Service, Hospital, Mace, Follow-Up Studies
Abstract: Background Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA. Patients and methods We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia. After applying inclusion and exclusion criteria, 299 patients were included in the analysis. Patients were divided into low-risk (0-3) and intermediate-high (≥4)-risk HEART score groups. Baseline characteristics, thrombolysis in myocardial infarction score, need for revascularization during index hospitalization, and major adverse cardiovascular events (MACE) at 6 weeks and 12 months were recorded. Results There were 98 and 201 patients in the low-score group and intermediate-high-score group, respectively. Compared with the low-score group, patients in the intermediate-high-risk group had a higher incidence of revascularization during the index hospital stay (16.4 vs. 0%; P=0.001), longer hospital stay, higher MACE at 6 weeks (9.5 vs. 0%) and 12 months (20.4 vs. 3.1%), and higher cardiac readmissions. HEART score of at least 4 independently predicted MACE at 12 months (odds ratio 7.456, 95% confidence interval: 2.175-25.56; P=0.001) after adjusting for other risk factors in regression analysis. Conclusion HEART score of at least 4 was predictive of worse outcomes in patients with chest pain in an inner-city USA hospital. If validated in multicenter prospective studies, the HEART score could potentially be useful in risk-stratifying patients presenting with chest pain in the USA and could impact clinical decision-making.
Published: 2017

41. Haemophilus influenzae Pyomyositis in a Patient with Diabetic Ketoacidosis: A Unique Case and Review of Literature

Author: Pradhum Ram, Kamolyut Lapumnuaypol, Sanna Fatima, Gemlyn George, and Antoinette Climaco
Subjects: 0301 basic medicine, medicine.medical_specialty, Debridement, Diabetic ketoacidosis, Pyomyositis, Respiratory tract infections, business.industry, medicine.medical_treatment, 030106 microbiology, Case Report, General Medicine, medicine.disease_cause, medicine.disease, Dermatology, Haemophilus influenzae, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Diabetes mellitus, medicine, lcsh:RC109-216, business, Fasciitis, Intensive care medicine
Abstract: Haemophilus influenzae is a Gram-negative bacillus commonly known to cause upper respiratory tract infections. Skin and soft tissue infections are very uncommon. Of these, the majority were associated with necrotizing fasciitis requiring emergent debridement. We report a case of pyomyositis caused by Haemophilus influenzae in an adult with diabetes.
Published: 2017

42. Diverticular Pylephlebitis and Polymicrobial Septicemia

Author: Chitra Punjabi, Kamolyut Lapumnuaypol, and Pradhum Ram
Subjects: medicine.medical_specialty, Pylephlebitis, business.industry, Sigmoid colon, Case Report, General Medicine, 030204 cardiovascular system & hematology, Diverticulitis, medicine.disease, Optimal management, digestive system diseases, Surgery, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Mesenteric Venous Thrombosis, 0302 clinical medicine, medicine.anatomical_structure, medicine, lcsh:RC109-216, 030212 general & internal medicine, Polymicrobial sepsis, business
Abstract: Diverticulitis primarily affects the sigmoid colon and is often complicated by intra-abdominal abscesses and fistulas. Rarely, however, mesenteric venous thrombosis has been known to occur. Optimal management is still unclear. We report the first case of polymicrobial sepsis resulting from diverticular pylephlebitis, managed successfully with bowel rest, antibiotics, and anticoagulation.
Published: 2017

43. The mystery of a deadly recurrent constrictive pericarditis: TB or not TB?

Author: Pradhum Ram, Majorie Stanek, Seyedhesamaldin Mostafavitoroghi, Ernest C. Madu, ParasuramKrishnamoorthy, Edwin Tulloch-Reid, and Kenechukwu Mezue
Subjects: Constrictive pericarditis, medicine.medical_specialty, Tuberculosis, business.industry, Signs and symptoms, 030204 cardiovascular system & hematology, medicine.disease, Dermatology, Cardiac surgery, Surgery, 03 medical and health sciences, Pericarditis, 0302 clinical medicine, medicine.anatomical_structure, Right heart failure, 030228 respiratory system, cardiovascular system, medicine, Etiology, Pericardium, business
Abstract: Constrictive pericarditis is characterized by scarring and loss of elasticity of the Pericardium, and subsequently, this leads to signs and symptoms of right heart failure. Common etiologies include previous cardiac surgery, repeated pericarditis, and Radiation therapy. However, less common causes include tuberculosis, neoplasms, and autoimmune disorders. Here we present a rare case of constrictive pericarditis of possible tuberculous etiology and review the diagnosis and management of the condition.
Published: 2017

44. Pattern of acute poisonings in children below 15 years – A study from Mangalore, South India

Author: Tanuj Kanchan, Bhaskaran Unnikrishnan, and Pradhum Ram
Subjects: Male, Insecticides, Pediatrics, medicine.medical_specialty, Adolescent, India, Tertiary care, Time-to-Treatment, Pathology and Forensic Medicine, Kerosene, Forensic Toxicology, Age Distribution, Age groups, Humans, Medicine, Registries, Sex Distribution, Child, Retrospective Studies, business.industry, Poisoning, Medical record, Infant, Against medical advice, Mean age, General Medicine, Length of Stay, Suicide, Accidents, Child, Preschool, Female, Seasons, Homicide, business, Law, Gasoline, Paediatric emergency, Male predominance
Abstract: Acute poisoning in children is a problem ubiquitous in distribution and is an important paediatric emergency. The present research was aimed to study the pattern and outcome of childhood poisoning under the age of 15 years at a tertiary care centre in South India to characterize the problem of acute paediatric poisoning among the children in different age group in the region. Medical records of all poisoning patients admitted during 2010 and 2011 were reviewed, and the information relating to the sociodemographic and clinical profile of the patients was recorded. Acute poisoning was reported in 81 children aged below 15 years during the study period. 50.6% were boys (n = 41) and 49.4% girls (n = 40). The mean age of the study sample was 6.8 years. Mean age was observed to be higher in females than males. The maximum number of cases were observed in the below 5 years age group (n = 45). A male predominance was evident in the below 5 years age group, while a female predominance in the age group between 10 and 15 years. Kerosene (n = 23, 28.4%) and organophosphate compounds (n = 16, 19.8%) were the most common agents responsible for poisoning in children. The majority of the poisoning cases were reported to the hospital within 12 h of the incident (n = 65, 83.3%). The mortality in paediatric poisoning was observed to be 7.4%. The majority of the children (n = 68, 84.0%) recovered, while seven patients had left the hospital against medical advice (8.6%). The study reports agrochemicals and hydrocarbons to be the most commonly implicated agents in paediatric poisoning. The cause of paediatric poisonings varies in different age groups and hence, preventive strategies should be planned accordingly.
Published: 2014

45. Knowledge, attitude and perceptions of mothers with children under five years of age about vaccination in Mangalore, India

Author: Pradhum Ram, Mukta N Chowta, Soundarya Mahalingam, Abhijna Soori, Basavaprabhu Achappa, and Deepak Madi
Subjects: knowledge, geography, geography.geographical_feature_category, Under-five, business.industry, media_common.quotation_subject, lcsh:R, lcsh:Medicine, perception, medicine.disease, Urban area, Poliomyelitis, Child mortality, Vaccination, Nursing, attitude, vaccine, Perception, Environmental health, medicine, Rural area, Descriptive research, General Agricultural and Biological Sciences, business, media_common
Abstract: Objective: Vaccination is a cost-effective intervention to prevent major illnesses that contribute to child mortality in the country. Increase in parental knowledge about vaccination will lead to increase in vaccination rates of children The main aim of our study was to assess the Knowledge (K), attitudes (A) and perceptions (KAP) of mothers with children under five years of age about vaccination. We also compared the KAP data between urban and rural setup. Methodology: This cross sectional descriptive study was conducted on mothers attending the Urban Health Centre (in Mangalore city) and on mothers attending a Peripheral Health Centre (Bengre, outskirts of Mangalore) having children under five years of age. A semi structured pre validated questionnaire designed to assess the Knowledge, Attitudes and Perceptions about vaccination was administered to mothers attending the Urban Health Centre and on mothers attending a Peripheral Health Centre having children under five years of age. Results: Among the study participants, 74 were from urban setup and 126 from rural set up. Around 8 (10.8%) from urban area and 78(61.9%) from rural area were illiterate. Mothers were the main decision makers regarding vaccination of the child in both urban and rural setup. The main source of information regarding vaccination differed among urban and rural setup, being the hospital and the anganwadi worker respectively. There was a statistically significant difference between urban and rural mothers when it was asked whether they knew why vaccination was important. A majority of the mothers both in the urban and rural areas believed that vaccines were safe. Among the urban mothers 90.5% and 62.7% of mother from rural were able to identify polio as a vaccine preventable disease. On a net analysis, 64(86.5%) mothers in the urban area and only 64 (50.8%) mothers in the rural area mothers found to have favourable knowledge, attitudes, perceptions and practices towards vaccination. Conclusion: A significant number of mothers in rural areas were unaware about the vaccination and its implications. Even in the urban areas we found significant lacunae in the KAP of mothers towards childhood vaccination. DOI: http://dx.doi.org/10.3126/ajms.v5i4.10306 Asian Journal of Medical Sciences 2014 Vol.5(4); 52-57
Published: 2014

46. Osborn waves of hypothermia

Author: Pradhum Ram and Gemlyn George
Subjects: medicine.medical_specialty, Paranoid schizophrenia, business.industry, Crisis response, Rectal temperature, General Medicine, Emergency department, Hypothermia, medicine.disease, mental disorders, Emergency medicine, medicine, Medical emergency, medicine.symptom, business
Abstract: A 38-year-old patient with paranoid schizophrenia presented to our institution from the crisis response centre for unusual behaviour over the last 24 hours. Rectal temperature measured in the emergency department was 28.9°C (84.2°F) with an ECG (figure 1) showing Osborn waves in leads V1–V5 …
Published: 2016

47. Late presentation of Pneumocystis jirovecii pneumonia after renal transplant: A case report

Author: Pradhum Ram, Prithiv Prasad, and Kevin Bryan Lo
Subjects: 0301 basic medicine, medicine.medical_specialty, Opportunistic infection, medicine.medical_treatment, 030106 microbiology, Case Report, Microbiology, Late presentation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, parasitic diseases, medicine, Pneumocystis jirovecii, 030212 general & internal medicine, lcsh:QH301-705.5, lcsh:R5-920, Graft rejection, biology, business.industry, Pneumocystis jirovecii Pneumonia, Immunosuppression, medicine.disease, biology.organism_classification, Solid organ transplant, Infectious Diseases, surgical procedures, operative, lcsh:Biology (General), Renal transplant, Concomitant, Opportunistic infection prophylaxis, business, lcsh:Medicine (General)
Abstract: The highest risk of opportunistic infections is from 1 to 6 months post-transplant. We report a rare case of Pneumocystis jirovecii pneumonia in a renal transplant recipient only on maintenance immunosuppression eleven years after transplant without concomitant CMV infection or recent episodes of graft rejection. Keywords: Pneumocystis jirovecii, Immunosuppression, Opportunistic infection, Solid organ transplant, Opportunistic infection prophylaxis
Published: 2018

48. Anticoagulation for intra-cardiac thrombi in peripartum cardiomyopathy: A review of the literature

Author: Janani Rangaswami, Jorge Luis Penalver Leon, Pradhum Ram, Deepanshu Jain, and Akanksha Agrawal
Subjects: Adult, medicine.medical_specialty, Future studies, Peripartum cardiomyopathy, Pregnancy Complications, Cardiovascular, Cardiomyopathy, Intracardiac injection, Young Adult, Pregnancy, Internal medicine, Peripartum Period, medicine, Humans, In patient, Thrombus, Blood Coagulation, reproductive and urinary physiology, Ejection fraction, business.industry, Anticoagulants, Thrombosis, General Medicine, medicine.disease, female genital diseases and pregnancy complications, Treatment Outcome, Cardiology, Female, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business
Abstract: Peripartum cardiomyopathy is a type of non-ischemic cardiomyopathy with a high rate of thromboembolic events. Guiding strategies for anticoagulation in patients with peripartum cardiomyopathy and thromboembolic events are limited. Literature for all cases of peripartum cardiomyopathy with intracardiac thrombi were reviewed and summarized from twelve case reports. Based on the available literature, we conclude that patients with peripartum cardiomyopathy with ejection fraction of less than 30% should strongly consider anticoagulation therapy to avoid thromboembolic events. Future studies may be able to further elucidate the optimal indication and duration of anticoagulation.
Published: 2019

49. Development of a teaching module for parenteral drug administration and objective structured practical examination stations in pharmacology

Author: Ritesh G. Menezes, Pradhum Ram, Prachitee Upadhye, and Vasudha Devi
Subjects: medicine.medical_specialty, Students, Medical, Intraclass correlation, Concurrent validity, Teaching module, education, objective structured practical examination, feedback, Drug preparation skills, Surveys and Questionnaires, Pedagogy, module, Medicine, Humans, Pharmacology (medical), Medical physics, Infusions, Parenteral, Response rate (survey), Pharmacology, business.industry, Drug administration, Checklist, Test (assessment), Inter-rater reliability, medical student, Clinical Competence, business, Research Article, Education, Medical, Undergraduate
Abstract: Objectives: Safe parenteral drug administration includes preparation of safe medication for administration. Training medical students is crucial to minimize medication administration errors. The study aims to develop a module to teach drug preparation skills and to develop objective structured practical examination (OSPE) stations to assess these skills. Students’ perceptions regarding the module were also assessed. Materials and Methods: A module was developed to teach following skills to 2nd year medical students: Aspiration of a drug from the ampule, aspiration of the drug from the vial, aspiration of the drug in powdered form from vial (reconstitution), and setting up an intravenous (IV) infusion. A randomized case control study design was used to establish the validity of OSPE stations. Student volunteers were grouped into case (n = 20) and control groups (n = 20) by simple randomization. The test group watched videos of skills and received demonstration of skills and a practice session before OSPE, whereas the control group watched videos before the OSPE and received demonstration and a practice session only after the OSPE. Each student was assessed by two faculty members during OSPE using a validated checklist. Mean OSPE scores of control and test groups were compared using independent samples t-test. Interrater reliability and concurrent validity of stations were analyzed using interclass correlation coefficient (ICC) and Pearson correlation, respectively. Students’ responses were expressed as median and interquartile range. Results: The response rate in the questionnaire was 100%. Significant difference between mean scores (P < 0.05) of test and control groups revealed fulfillment of construct validity of OSPE stations. Interrater reliability (ICC > 0.7) and concurrent validity (r value > 7) of all the stations was high. Perceptions revealed acceptability of module and OSPE stations by students (median 4, scale 1-5). Conclusions: A module to teach drug preparation skills was developed and along with valid and reliable OSPE stations that were acceptable to students. The study demonstrated that students acquire better skills through teaching than merely watching these skills in videos.
Published: 2013

50. Honesty is the best policy: A brief overview of retraction notices

Author: Huda Fatima, Brijesh Sathian, Ritesh G. Menezes, and Pradhum Ram
Subjects: Virtue, Epidemiology, business.industry, media_common.quotation_subject, MEDLINE, Perfection, 06 humanities and the arts, 0603 philosophy, ethics and religion, 03 medical and health sciences, Misconduct, 0302 clinical medicine, Editorial, Honesty, Medicine, Engineering ethics, 060301 applied ethics, 030212 general & internal medicine, business, media_common
Abstract: It has been said that practice makes progress and progress leads to perfection, and we have made immense progress by the formation and revision of retraction policies and this has understandably led to the publication of more authentic literature in recent times. However, multiple hurdles still do exist and by virtue of authentic studies we hope to overcome them with the eventual goal of a world of publication free of misconduct.
Published: 2016

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