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3. Significant Mortality Associated With COVID-19 and Comorbid Cerebrovascular Disease: A Quantitative Systematic Review

Author

Sursal, Tolga, Gandhi, Chirag D., Clare, Kevin, Feldstein, Eric, Frid, Ilya, Kefina, Martin, Galluzzo, Daniela, Kamal, Haris, Nuoman, Rolla, Amuluru, Krishna, Muh, Carrie R., Pisapia, Jared M., Gulko, Edwin, Overby, Philip, Chandy, Dipak, Etienne, Mill, Kurian, Christeena, Kaur, Gurmeen, Dakay, Katarina, AlHamid, May, Al-Jehani, Hosam, Mayer, Stephan A., and Al-Mufti, Fawaz

Published
2023
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10. Significant Mortality Associated With COVID-19 and Comorbid Cerebrovascular Disease

Author

Sursal, Tolga, primary, Gandhi, Chirag D., additional, Clare, Kevin, additional, Feldstein, Eric, additional, Frid, Ilya, additional, Kefina, Martin, additional, Galluzzo, Daniela, additional, Kamal, Haris, additional, Nuoman, Rolla, additional, Amuluru, Krishna, additional, Muh, Carrie R., additional, Pisapia, Jared M., additional, Gulko, Edwin, additional, Overby, Philip, additional, Chandy, Dipak, additional, Etienne, Mill, additional, Kurian, Christeena, additional, Kaur, Gurmeen, additional, Dakay, Katarina, additional, AlHamid, May, additional, Al-Jehani, Hosam, additional, Mayer, Stephan A., additional, and Al-Mufti, Fawaz, additional

Published
2022
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11. Clinical and Laboratory Profile of COVID-19 Pneumonia Patients With a Complicated Post-Intensive Care Unit Hospital Course

Author

Yaqoob, Hamid, Vernik, David, Feustel, Paul J., Chandy, Dipak, and Epelbaum, Oleg

Subjects
Coronavirus, health care facilities, manpower, and services, Hospital course, COVID-19, Original Article, Intensive care unit, General Medicine, Complicated, Readmission
Abstract

Background Characteristics of intensive care unit (ICU) downgrades who experience a complicated post-ICU ward course (ICU return or floor death) and the incidence of this phenomenon have not been examined in ICU survivors of coronavirus disease 2019 (COVID-19) pneumonia. The aim of the present study was to establish the rate of a complicated post-ICU ward course among survivors of COVID-19 pneumonia and describe the associated patient, ICU management, and serum biomarker characteristics. An additional aim was to compare these parameters between those who experienced a complicated post-ICU course and those who did not. Methods This was a retrospective study of patients who were admitted to the ICU with COVID-19 pneumonia and were downgraded to a hospital floor at the end of their initial ICU stay. Patients were divided based on a complicated or uncomplicated post-ICU course. Groups were compared with respect to relevant clinical variables. Serum biomarker levels were compared on day of ICU exit and were trended in the days preceding the downgrade. Ward stay of patients who had a complicated course was examined for notable floor events surrounding their decompensation. Results Eighteen out of 99 downgraded patients (18%) experienced a complicated post-ICU course, among them there were 14 returns (14%) and four deaths (4%). They had higher Charlson Comorbidity Index, higher Acute Physiology and Chronic Health Evaluation (APACHE) IV score, as well as higher D-dimer and C-reactive protein (CRP) at ICU departure. They were less likely to have received therapeutic anticoagulation and convalescent plasma during their ICU stay. On multivariable analysis, these parameters except D-dimer remained independently associated with a complicated course. Review of biomarker trends preceding ICU exit demonstrated an upward trajectory of D-dimer, CRP, and lactate dehydrogenase (LDH) in the complicated course group not mirrored by the uncomplicated course group. Examination of notable floor events leading up to decompensation revealed that in 50% the ward course was characterized by new cardiac disturbances. Conclusions Our rate of ward death among ICU downgrades was similar to pre-COVID data, but the rate of ICU return was higher. Complicated post-ICU course patients were exhibiting upward biomarker trends at ICU exit, and their ward stay was punctuated by acute cardiac abnormalities.

Published
2021

28. Comparison of pulse-dose and high-dose corticosteroids with no corticosteroid treatment for COVID-19 pneumonia in the intensive care unit.

Author

Yaqoob, Hamid, Greenberg, Daniel, Hwang, Frank, Lee, Curtis, Vernik, David, Manglani, Ravi, Zhen Wang, Murad, M. Hassan, Chandy, Dipak, and Epelbaum, Oleg

Subjects
COVID-19, ACUTE kidney failure, COVID-19 treatment, INTENSIVE care units, CORTICOSTEROIDS
Abstract

Corticosteroid dosing in the range of 0.5-2 mg/kg/day of methylprednisolone equivalents has become a standard part of the management of intensive care unit (ICU) patients with COVID-19 pneumonia based on positive results of randomized trials and a meta-analysis. Alongside such conventional dosing, administration of 1 gm of methylprednisolone daily (pulse dosing) has also been reported in the literature with claims of favorable outcomes. Comparisons between such disparate approaches to corticosteroids for Coronavirus disease 2019 (COVID-19) pneumonia are lacking. In this retrospective study of patients admitted to the ICU with COVID-19 pneumonia, we compared patients treated with 0.5-2 mg/kg/day in methylprednisolone equivalents (high-dose corticosteroids) and patients treated with 1 gm of methylprednisolone (pulse-dose corticosteroids) to those who did not receive any corticosteroids. The endpoints of interest were hospital mortality, ICUfree days at Day 28, and complications potentially attributable to corticosteroids. Pulse-dose corticosteroid therapy was associated with a significant increase in ICUfree days at Day 28 compared to no receipt: adjusted relative risk (aRR): 1.45 (95% confidence interval [CI]: 1.05-2.02; p = 0.03) and compared with high-dose corticosteroid administration (p = 0.003). Nonetheless, receipt of high-dose corticosteroids--but not of pulse-dose corticosteroids--significantly reduced the odds of hospital mortality compared to no receipt: adjusted Odds ratio (aOR) 0.31 (95% CI: 0.12-0.77; p = 0.01). High-dose corticosteroids reduced mortality compared to pulse-dose corticosteroids (p = 0.04). Pulse-dose corticosteroids--but not high-dose corticosteroids--significantly increased the odds of acute kidney injury requiring renal replacement therapy compared to no receipt: aOR 3.53 (95% CI: 1.27-9.82; p = 0.02). The odds of this complication were also significantly higher in the pulse-dose group when compared to the high-dose group (p = 0.05 for the comparison). In this single-center study, pulse-dose corticosteroid therapy for COVID-19 pneumonia in the ICU was associated with an increase in ICU-free days but failed to impact hospital mortality, perhaps because of its association with development of severe renal failure. In line with existing trial data, the effect of high-dose corticosteroids on mortality was favorable. [ABSTRACT FROM AUTHOR]

Published
2022
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29. Obstructive sleep apnoea and cardiovascular disease: a literature review.

Author

Assallum, Hussein, Tian Yue Song, Aronow, Wilbert S., Chandy, Dipak, and Song, Tian Yue

Subjects
SLEEP apnea syndromes, CARDIOVASCULAR diseases, ATHEROSCLEROSIS, CAUSES of death, DISEASE risk factors, LITERATURE reviews
Abstract

As obesity becomes more common worldwide, the prevalence of obstructive sleep apnoea (OSA) continues to rise. Obstructive sleep apnoea is a well-known disorder that causes chronic intermittent hypoxia (CIH), which is considered a risk factor for atherosclerosis directly and indirectly. Ischaemic heart disease remains the leading cause of death. Most risk factors for atherosclerosis are well understood. However, other factors such as CIH are less well understood. Several studies have investigated the pathophysiology of CIH, attempting to uncover its link to atherosclerosis and to determine whether OSA treatment can be a therapeutic modality to modify the risk for atherosclerosis. In this article, we will review the pathophysiology of OSA as an independent risk factor for cardiovascular disease and discuss the most common markers that have been studied. We will also examine the potential impact of OSA management as a risk factor modifier on the reversibility of atherosclerosis. [ABSTRACT FROM AUTHOR]

Published
2021
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33. Intracranial Administration of Nicardipine After Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature

Author

Dodson, Vincent, primary, Majmundar, Neil, additional, El-Ghanem, Mohammad, additional, Amuluru, Krishna, additional, Gupta, Gaurav, additional, Nuoman, Rolla, additional, Wainwright, John, additional, Kaur, Gurmeen, additional, Cole, Chad, additional, Santarelli, Justin, additional, Chandy, Dipak, additional, Bowers, Christian, additional, Gandhi, Chirag, additional, and Al-Mufti, Fawaz, additional

Published
2019
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37. Therapeutic options for severe asthma

Author

Mathew, Jilcy, Aronow, Wilbert S., and Chandy, Dipak

Subjects
severe asthma, treatment, State of the Art Paper
Abstract

As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidities like gastro-esophageal reflux disease and obstructive sleep apnea. Current treatment options include conventional agents such as inhalational corticosteroids, long acting β(2) agonists, leukotriene antagonists, and oral corticosteroids. Less conventional treatment options include immunotherapy with methotrexate, cyclosporine and tacrolimus, biological drugs like monoclonal antibodies, tumor necrosis factor-α blockers and oligonucleotides, phosphodiesterase inhibitors, antimicrobials and bronchial thermoplasty.

Published
2012

38. Hyponatremia and cerebrovascular spasm in aneurysmal subarachnoid hemorrhage

Author

Chandy, Dipak, Sy, Roger, Aronow, Wilbert, Lee, Wei-Nchih, Maguire, George, and Murali, Raj

Subjects
Subarachnoid hemorrhage -- Complications and side effects -- Research -- Diagnosis, Cerebrovascular spasm -- Causes of -- Diagnosis -- Research -- Complications and side effects, Hyponatremia -- Causes of -- Complications and side effects -- Research -- Diagnosis, Health, Diagnosis, Complications and side effects, Research, Causes of
Abstract

Byline: Dipak. Chandy, Roger. Sy, Wilbert. Aronow, Wei-Nchih. Lee, George. Maguire, Raj. Murali Background: Hyponatremia develops in approximately a third of patients with aneurysmal subarachnoid hemorrhage (SAH). Studies have been [...]

Published
2006

40. Milestones: a rapid assessment method for the Clinical Competency Committee

Author

Nabors, Christopher, primary, Forman, Leanne, additional, Peterson, Stephen J., additional, Gennarelli, Melissa, additional, Aronow, Wilbert S., additional, DeLorenzo, Lawrence, additional, Chandy, Dipak, additional, Ahn, Chul, additional, Sule, Sachin, additional, Stallings, Gary W., additional, Khera, Sahil, additional, Palaniswamy, Chandrasekar, additional, and Frishman, William H., additional

Published
2017
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44. Lung cancer: Early intervention is key

Author

CHANDY, DIPAK, LESSER, MARVIN, and RASHID, AMBER

Subjects
Mortality -- United States, Prevalence studies (Epidemiology) -- Analysis, Lung cancer -- Care and treatment -- Patient outcomes, Cancer -- Patient outcomes -- Care and treatment, Health, Care and treatment, Analysis, Patient outcomes
Abstract

The leading cause of cancer deaths in this country, lung cancer is usually silent until the disease is advanced. Studies have failed to show benefits from screening, but early detection [...]

Published
2001

45. Pulmonary sarcoidosis: an update.

Author

Ramachandraiah, Vidya, Aronow, Wilbert, and Chandy, Dipak

Subjects
SARCOIDOSIS, SARCOIDOSIS treatment, GRANULOMA, ADRENOCORTICAL hormones, LUNG transplantation, DIAGNOSIS, THERAPEUTICS, DISEASE risk factors
Abstract

Sarcoidosis is a multisystem disease characterized by the presence of noncaseating granulomas, the exact etiology of which is yet to be determined. Pulmonary involvement occurs in the majority of patients and its severity ranges from asymptomatic involvement of mediastinal lymph nodes to progressive pulmonary fibrosis and chronic respiratory failure that is insensitive to treatment. Diagnosis of pulmonary sarcoidosis requires a compatible clinical picture supported by radiologic and pathologic data. A recent development in establishing the diagnosis of pulmonary sarcoidosis is endobronchial ultrasound that increases the yield of transbronchial needle aspiration of hilar and/or mediastinal lymph nodes. Fluorodeoxyglucose positron emission tomography (FDG-PET) is highly sensitive in detecting occult sites of disease and is of value in guiding biopsies of these sites. A combined imaging modality using both FDG-PET and CT scan is more sensitive than PET alone and is now the standard of care in patients requiring biopsies of active lesions. Biologic agents like anti-tumor necrosis factor antibodies are being used as second line treatment in those patients dependent on steroids or in cases of refractory sarcoidosis. Lung transplantation is the final option in suitable patients with end-stage pulmonary sarcoidosis. [ABSTRACT FROM PUBLISHER]

Published
2017
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47. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease

Author

Chandy,Dipak, Aronow,Wilbert S, Banach,Maciej, Chandy,Dipak, Aronow,Wilbert S, and Banach,Maciej

Abstract

Dipak Chandy,1 Wilbert S Aronow,2 Maciej Banach3 1Division of Pulmonary, Critical Care and Sleep, 2Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, NY, USA; 3Department of Hypertension, Medical University of Lodz, Lodz, Poland Abstract: Systemic hypertension and chronic obstructive pulmonary disease (COPD) frequently coexist in the same patient, especially in the elderly. Today, a wide variety of antihypertensive drugs with different mechanisms of action are available to the prescribing physician. In addition, combination drugs for hypertension are becoming increasingly popular. Certain antihypertensive drugs can affect pulmonary function. Therefore the management of such patients can present therapeutic challenges. We have examined the literature pertaining to the use of antihypertensive drugs in patients with systemic hypertension and coexisting COPD. Although data are often limited or of poor quality, we have attempted to review and then provide recommendations regarding the use of all the specific classes of antihypertensive drug therapies including combination drugs in patients with COPD. The antihypertensive agents reviewed include diuretics, aldosterone receptor blockers, beta blockers, combined alpha and beta blockers, angiotensin-converting enzyme inhibitors, angiotensin II antagonists, calcium channel blockers, alpha-1 blockers, centrally acting drugs, direct vasodilators, and combinations of these drugs. Of these classes, calcium channel blockers and angiotensin II antagonists appear to be the best initial choices if hypertension is the only indication for treatment. However, the limited data available on many of these drugs suggest that additional studies are needed to more precisely determine the best treatment choices in this widely prevalent patient group. Keywords: blood pressure, hypertension, COPD, treatment, antihypertensive drugs

Published
2013

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