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14. Case report

Author

Charokopos, Antonios, Muhammad, Tariq, Surbhi, Sidana, and Brateanu, Andrei

Subjects
Simvastatin -- Complications and side effects, Rhabdomyolysis -- Case studies, Fluconazole -- Complications and side effects, Drug interactions -- Case studies, Health
Abstract

THE PATIENT 76-year-old woman SIGNS & SYMPTOMS --Weakness and pain in arms and legs --Dark urine --History of vertebral osteomyelitis THE CASE A 76-year-old Caucasian woman presented to the emergency [...]

Published
2017

18. Association of antibiotic use and acute kidney injury in patients hospitalized with community-acquired pneumonia

Author

Le, Phuc, Navaneethan, Sankar Dass, Yu, Pei-Chun, Pallotta, Andrea M., Rastogi, Radhika, Patel, Preethi, Brateanu, Andrei, Imrey, Peter B., and Rothberg, Michael B.

Subjects
urologic and male genital diseases
Abstract

Acute kidney injury (AKI) is common among hospitalized patients with community-acquired pneumonia (CAP). We aimed to estimate and compare the risk of AKI for various antibiotic combinations in adults hospitalized for CAP. We conducted a retrospective cohort study of the Premier Healthcare Database containing all admissions for 660 US hospitals from 2010 to 2015. We included adults aged ���18 years hospitalized with CAP and considered 6 different antibiotic combinations based on continuous use in the first 3 hospital days. The primary outcome was incident AKI, defined by ICD-9 codes 584.5-584-9. We evaluated associations of AKI with in-hospital mortality and length-of-stay. We excluded patients who were admitted directly to the intensive care unit, had AKI codes present on admission or had dialysis in the first 2 days. We used generalized linear mixed models with the hospital as a random effect and covariate adjustment for patient demographics, comorbidities, other treatments on day 0/1, and hospital characteristics. The total sample included 449,535 patients, 3.15% of whom developed AKI. All other regimens but fluoroquinolones exhibited higher AKI odds than 3rd generation cephalosporin with or without macrolide. The combination of piperacillin/tazobactam and vancomycin with or without other antibiotics was associated with the highest AKI odds (OR = 1.89; 95% CI: 1.73���2.06). Patients with incident AKI had an increased odds of hospital mortality (OR = 6.37; 95% CI: 6.07���6.69) and longer length-of-stay (mean multiplier = 1.84; 95% CI: 1.82, 1.86). Compared to 3rd generation cephalosporin with or without macrolide, piperacillin/tazobactam, vancomycin, and their combination were associated with higher odds of developing AKI, which in turn were associated with worse clinical outcomes.

Published
2021
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19. An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S.

Author

Colbert, Colleen Y., primary, French, Judith C., additional, Brateanu, Andrei, additional, Pacheco, Susan E., additional, Khatri, Sumita B., additional, Sapatnekar, Suneeti, additional, Vacharathit, Voranaddha, additional, Pien, Lily C., additional, Prelosky-Leeson, Allison, additional, LaRocque, Regina, additional, Mark, Bryan, additional, and Salas, Renee N., additional

Published
2021
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22. An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S.

Author

Colbert, Colleen Y., French, Judith C., Brateanu, Andrei, Pacheco, Susan E., Khatri, Sumita B., Sapatnekar, Suneeti, Vacharathit, Voranaddha, Pien, Lily C., Prelosky-Leeson, Allison, LaRocque, Regina, Mark, Bryan, and Salas, Renee N.

Subjects
HOSPITAL medical staff, CURRICULUM, HUMAN services programs, INTERNSHIP programs, EMERGENCY management, GRADUATE education, PHYSICIANS, CURRICULUM planning, CLIMATE change, MEDICAL education
Abstract

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change. [ABSTRACT FROM AUTHOR]

Published
2022
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24. Association of antibiotic use and acute kidney injury in patients hospitalized with community-acquired pneumonia.

Author

Le, Phuc, Navaneethan, Sankar Dass, Yu, Pei-Chun, Pallotta, Andrea M., Rastogi, Radhika, Patel, Preethi, Brateanu, Andrei, Imrey, Peter B., and Rothberg, Michael B.

Subjects
ACUTE kidney failure, COMMUNITY-acquired pneumonia, ANTIBIOTICS, RANDOM effects model, CEPHALOSPORINS, INTENSIVE care units
Abstract

Acute kidney injury (AKI) is common among hospitalized patients with community-acquired pneumonia (CAP). We aimed to estimate and compare the risk of AKI for various antibiotic combinations in adults hospitalized for CAP. We conducted a retrospective cohort study of the Premier Healthcare Database containing all admissions for 660 US hospitals from 2010 to 2015. We included adults aged ≥18 years hospitalized with CAP and considered 6 different antibiotic combinations based on continuous use in the first 3 hospital days. The primary outcome was incident AKI, defined by ICD-9 codes 584.5-584-9. We evaluated associations of AKI with in-hospital mortality and length-of-stay. We excluded patients who were admitted directly to the intensive care unit, had AKI codes present on admission or had dialysis in the first 2 days. We used generalized linear mixed models with the hospital as a random effect and covariate adjustment for patient demographics, comorbidities, other treatments on day 0/1, and hospital characteristics. The total sample included 449,535 patients, 3.15% of whom developed AKI. All other regimens but fluoroquinolones exhibited higher AKI odds than 3rd generation cephalosporin with or without macrolide. The combination of piperacillin/tazobactam and vancomycin with or without other antibiotics was associated with the highest AKI odds (OR = 1.89; 95% CI: 1.73–2.06). Patients with incident AKI had an increased odds of hospital mortality (OR = 6.37; 95% CI: 6.07–6.69) and longer length-of-stay (mean multiplier = 1.84; 95% CI: 1.82, 1.86). Compared to 3rd generation cephalosporin with or without macrolide, piperacillin/tazobactam, vancomycin, and their combination were associated with higher odds of developing AKI, which in turn were associated with worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Published
2022
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29. Residents’ Perception of the Nephrology Specialty

Author

Nakhoul, Georges N., primary, Mehdi, Ali, additional, Taliercio, Jonathan J., additional, Brateanu, Andrei, additional, Diwakar, Amit, additional, Daou, Remy, additional, Foshee, Cecile M., additional, Sedor, John R., additional, Nally, Joseph V., additional, O’Toole, John F., additional, and Bierer, S. Beth, additional

Published
2020
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35. Adult Onset Still’s Disease Associated with Mycoplasma pneumoniae Infection and Hemophagocytic Lymphohistiocytosis

Author

Agnihotri, Abhishek, Ruff, Allison, Gotterer, Lauren, Walker, Addie, McKenney, Amy H., and Brateanu, Andrei

Subjects
Article Subject
Abstract

Adult Onset Still’s Disease (AOSD) is a systemic inflammatory disorder that can be associated with hemophagocytic lymphohistiocytosis (HLH), a rare but potentially fatal disease of overactive histiocytes and lymphocytes. We present a unique case of AOSD complicated by Mycoplasma pneumonia infection and HLH. A 28-year-old female developed joint pains followed by a diffuse, erythematous, pruritic skin rash that quickly spread throughout the body. The patient deteriorated and developed fever, chills, cough, and dyspnea and had to be intubated. She had hypoalbuminemia, elevated liver enzymes, a very high serum ferritin level, positive anti-Mycoplasma pneumonia IgG and IgM antibodies, and normal rheumatoid factor and anti-nuclear antibodies. The chest X-ray showed diffuse bilateral infiltrates. Bone marrow biopsy revealed hemophagocytosis. The patient was treated with azithromycin, methylprednisolone, and anakinra and was discharged home on cyclosporine and prednisone. This case highlights that patients can develop features of both AOSD and HLH at the beginning of the disease and early diagnosis and treatment increase the likelihood of recovery.

Published
2016
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42. Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis

Author

Patel, Krishna, primary, Chagin, Kevin, primary, Tunsupon, Pichapong, primary, Yampikulsakul, Pojchawan, primary, Shah, Gautam V., primary, Wangsiricharoen, Sintawat, primary, Amah, Linda, primary, Allen, Joshua, primary, Shapiro, Aryeh, primary, Gupta, Neha, primary, Morgan, Lillie, primary, Kumar, Rahul, primary, Nielsen, Craig, primary, Rothberg, Michael B., primary, and Brateanu, Andrei, additional

Published
2016
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