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Full-Text Articles in Internal Medicine

Malignant Pleural Mesothelioma: A Comprehensive Review., Molly Jain Md, Morgan Crites Np-C, Patricia Rich Md, Bharat Bajantri Md Sep 2024

Malignant Pleural Mesothelioma: A Comprehensive Review., Molly Jain Md, Morgan Crites Np-C, Patricia Rich Md, Bharat Bajantri Md

Internal Medicine Residency

Mesotheliomas are hyperplastic tumors that envelop the serosal membranes that safeguard the body's external surfaces. Although certain instances may exhibit indolent characteristics, a significant number of tumors demonstrate rapid progression and a poor prognosis. Mesotheliomas are typically categorized as benign or malignant, with malignant mesothelioma being more frequently linked to asbestos exposure. Malignant pleural mesothelioma (MPM) predominantly impacts males and often emerges in the late 50 s or beyond, characterized by a median age of early 70 s among patients exposed to asbestos lasting from 2 to 4 decades. Respiratory exposure to asbestos particles leads to the development of malignant …


Unveiling The Influence Of Hyponatremia On Morbidity, Mortality, And Resource Utilization In Colorectal Carcinoma: Insights From A 5-Year Nationwide Study., Priya Hotwani Md, Vikash Kumar, Bhavyakumar Vachhani, Mrunanjali Gaddam, Jayalekshmi Jayakumar, Manasa Ginjupalli, Ankushi Sanghvi, Jincy Clement, Dhairya Nanavaty May 2024

Unveiling The Influence Of Hyponatremia On Morbidity, Mortality, And Resource Utilization In Colorectal Carcinoma: Insights From A 5-Year Nationwide Study., Priya Hotwani Md, Vikash Kumar, Bhavyakumar Vachhani, Mrunanjali Gaddam, Jayalekshmi Jayakumar, Manasa Ginjupalli, Ankushi Sanghvi, Jincy Clement, Dhairya Nanavaty

Internal Medicine Residency

Meeting Abstract: 2024 ASCO Annual Meeting

Background: Historically, Hyponatremia has been associated with higher mortality rates and longer hospital stays in patients with solid tumors. The existing literature contains limited information on the connection between hyponatremia and Colorectal cancer (CRC). Thus, our study aimed to assess the impact of hyponatremia on mortality, morbidity, and resource usage in patients with CRC.

Methods: A retrospective analysis using the National Inpatient Sample database and International Classification of Diseases, Tenth Revision codes was conducted to examine the impact of hyponatremia on mortality, morbidity, and resource utilization in patients with CRC. Categorical variables were compared …


Outcomes Of Mechanical Circulatory Support In Stemi Patients With Cardiogenic Shock: Insights From The National Inpatient Sample, Rahul Gupta, Chukwuemeka Umeh, Priya Hotwani Md, Gagan Kaur, Raghav Dhawan, Benson Eghreriniovo, Tamanna Mohta, Payaam Mahdavian, Eseosa Sanwo, Sabina Kumar, Mark A. Zainea, Jay Mohan May 2024

Outcomes Of Mechanical Circulatory Support In Stemi Patients With Cardiogenic Shock: Insights From The National Inpatient Sample, Rahul Gupta, Chukwuemeka Umeh, Priya Hotwani Md, Gagan Kaur, Raghav Dhawan, Benson Eghreriniovo, Tamanna Mohta, Payaam Mahdavian, Eseosa Sanwo, Sabina Kumar, Mark A. Zainea, Jay Mohan

Internal Medicine Residency

Background

Cardiogenic shock has been associated with a high mortality rate despite advances in mechanical circulatory support. Data is inconsistent as the majority of patients in the current trials are SCAI stage E, or data is combined with heart failure and STEMI cardiogenic shock.

Methods

Data was extracted from the 2020 United States National Inpatient data set. The diagnosis criteria were “STEMI” and “Cardiogenic shock”. The primary outcome of interest was comparing mortality in those patients who received mechanical circulatory support vs. those who did not in STEMI Cardiogenic shock.

Results

There were 4,302 patients with STEMI and cardiogenic shock, …


Nationwide Outcomes In Intermediate To High-Risk Pulmonary Embolism Treated With Catheter-Based Therapies, Chukwuemeka Umeh, Rahul Gupta, Priya Hotwani Md, Sabina Kumar, Mark A. Zainea, Jay Mohan May 2024

Nationwide Outcomes In Intermediate To High-Risk Pulmonary Embolism Treated With Catheter-Based Therapies, Chukwuemeka Umeh, Rahul Gupta, Priya Hotwani Md, Sabina Kumar, Mark A. Zainea, Jay Mohan

Internal Medicine Residency

Background

The mortality rate of pulmonary embolism is as high as 30% and affects 900,000 individuals in the United States per year. Catheter-based therapies (CBT), including catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT), have been developed to treat patients with intermediate- and high-risk pulmonary embolisms. This study aims to characterize the outcomes in patients admitted with intermediate or high-risk pulmonary embolism treated with MT compared with CDT.

Methods

The 2020 National Inpatient Sample data was used to analyze outcomes in hospitalized pulmonary embolism patients who received CDT and MT. The primary and secondary outcomes were in-hospital mortality, length of hospital …


In-Hospital Outcomes Of Patients With Lung Cancer With And Without Superior Vena Cava Thrombosis: A Nationwide Analysis., Ankushi Sanghvi, Dhairya Nanavaty, Sagar Patel, Bhavyakumar Vachhani, Mrunanjali Gaddam, Manasa Ginjupalli, Jayalekshmi Jayakumar, Nawaraj Adhikari, Rishav Sinha, Vikash Kumar, Priya Hotwani Md, Ahmed Nadeem May 2024

In-Hospital Outcomes Of Patients With Lung Cancer With And Without Superior Vena Cava Thrombosis: A Nationwide Analysis., Ankushi Sanghvi, Dhairya Nanavaty, Sagar Patel, Bhavyakumar Vachhani, Mrunanjali Gaddam, Manasa Ginjupalli, Jayalekshmi Jayakumar, Nawaraj Adhikari, Rishav Sinha, Vikash Kumar, Priya Hotwani Md, Ahmed Nadeem

Internal Medicine Residency

Meeting Abstract: 2024 ASCO Annual Meeting

Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. …


Intravascular Ultrasound In Percutaneous Coronary Interventions: A Nationwide Overview Of Its Use And Outcomes, Priya Hotwani Md, Chukwuemeka Umeh Md, Rahul Gupta, Gagan Kaur Md, Raghav Dhawan, Benson Eghreriniovo, Tamanna Mohta, Payaam Mahdavian Md, Jessica Ekomerei Obi, Eseosa Sanwo, Sabina Kumar Do, Mark A. Zainea Md Fscai, Jay Mohan Do Fscai May 2024

Intravascular Ultrasound In Percutaneous Coronary Interventions: A Nationwide Overview Of Its Use And Outcomes, Priya Hotwani Md, Chukwuemeka Umeh Md, Rahul Gupta, Gagan Kaur Md, Raghav Dhawan, Benson Eghreriniovo, Tamanna Mohta, Payaam Mahdavian Md, Jessica Ekomerei Obi, Eseosa Sanwo, Sabina Kumar Do, Mark A. Zainea Md Fscai, Jay Mohan Do Fscai

Internal Medicine Residency

Background

Intravascular ultrasound (IVUS) is a valuable adjunct to angiography, aiding interventionists in evaluating lesion severity, plaque morphology, stent apposition, stent expansion, and edge dissection. IVUS-guided PCI may increase procedure time but can lead to increased stent patency rates. This study aims to provide insights into the comparative outcomes of IVUS and non-IVUS-guided PCI in real-world clinical settings.

Methods

We compared outcome measures with the 2020 United States National Inpatient Sample in patients who received IVUS-guided PCI and those who did not. The primary outcome was the mortality rate between the two groups.

Results

IVUS was used in 10,757 of …


Gender Disparities In Outcomes Of Left Atrial Appendage Occlusion Device Placement, Manoj Kumar, Shafaqat Ali, Faryal Farooq, Priya Hotwani Md, Sanjay Kumar May 2024

Gender Disparities In Outcomes Of Left Atrial Appendage Occlusion Device Placement, Manoj Kumar, Shafaqat Ali, Faryal Farooq, Priya Hotwani Md, Sanjay Kumar

Internal Medicine Residency

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with profound morbidity & mortality, including a fivefold increase in stroke risk. Due to side effects & compliance issues associated with anticoagulation, left atrial appendage occlusion (LAAO) devices have emerged as an alternative approach. However, women have been underrepresented in both the PROTECT & PREVAIL trials, landmark trials supporting LAAO use.

Objective

We aim to compare gender disparities in outcomes of LAAO occlusive devices.

Methods

The national readmission database (2016-2020) was utilized to identify hospitalizations for LAAO placement. Cohorts were stratified by gender. A propensity score matching …


Propensity Matched In-Hospital Outcomes Of Acute St Elevation Myocardial Infarction Of Left Anterior Descending (Lad) Coronary Artery In Patients With & Without Chronic Total Occlusion Of Coronaries, Manoj Kumar, Shafaqat Ali, Faryal Farroq, Sanchit Duhan, Priya Hotwani Md, Bijeta Keisham, Sanjay Kumar, Mahin R. Khan May 2024

Propensity Matched In-Hospital Outcomes Of Acute St Elevation Myocardial Infarction Of Left Anterior Descending (Lad) Coronary Artery In Patients With & Without Chronic Total Occlusion Of Coronaries, Manoj Kumar, Shafaqat Ali, Faryal Farroq, Sanchit Duhan, Priya Hotwani Md, Bijeta Keisham, Sanjay Kumar, Mahin R. Khan

Internal Medicine Residency

Background

Chronic total occlusion (CTO) is a near-total blockage of a coronary artery often seen during percutaneous coronary intervention for acute coronary syndrome but not directly responsible for the event.

Methods

The national readmission database (2016-2020) was utilized to identify hospitalizations for STEMI, with LAD as the culprit. Cohorts were stratified based on the presence of the CTO. A Propensity Score Matching (PSM) model matched CTO and non-CTO cases. Pearson’s x2 test was applied to PSM-2 matched cohorts to compare outcomes.

Results

Among 98,213 hospitalizations for LAD-STEMI, About 5.53% (N: 5,704) had CTO. After propensity matching (N=3,197), patients with CTO …


Early Vs Late Extracorporeal Membrane Oxygenation (Ecmo) For Mechanical Circulatory Support, Manoj Kumar, Shafaqat Ali, Sanchit Duhan, Nomesh Kumar, Priya Hotwani Md, Sanjay Kumar, Fnu Bawna, Faryal Farooq, Muhammad Sultan, Muhammad Sohaib Afzal, M Chadi Alraies May 2024

Early Vs Late Extracorporeal Membrane Oxygenation (Ecmo) For Mechanical Circulatory Support, Manoj Kumar, Shafaqat Ali, Sanchit Duhan, Nomesh Kumar, Priya Hotwani Md, Sanjay Kumar, Fnu Bawna, Faryal Farooq, Muhammad Sultan, Muhammad Sohaib Afzal, M Chadi Alraies

Internal Medicine Residency

Background

Use of Extracorporeal membrane oxygenation (ECMO) for hemodynamic (HD) support is becoming increasingly prevalent. While potentially life-saving, ECMO use is associated with complications of its own due to widespread immune activation. We aim to compare early (≤1 day) vs late (>1 day) ECMO use for hemodynamic support.

Methods

The national readmission database (2016-2020) was utilized to identify hospitalizations requiring ECMO. Cohorts were stratified based on ECMO initiation. A Propensity Score Matching (PSM) model matched patients with early vs late ECMO use. Pearson’s x2 test was applied to PSM-2 matched cohorts to compare outcomes.

Results

Among 40,984 hospitalizations requiring …


Transcatheter Aortic Valve Implantation Vs Surgical Aortic Valve Replacement In Solid Organ Transplant Recipients: Readmission Rates And Health-Care Burden, Manoj Kumar, Shafaqat Ali, Sanchit Duhan, Faryal Farooq, Bijeta Keisham, Yahya Khlidj, Malalai Manan, Yasar Sattar, Mahin R. Khan, Rohan Gajjar, Priya Hotwani Md, Sanjay Kumar, Hameem U. Changezi, Ahmad Munir, Kalgi A. Modi, Tarek Helmy Apr 2024

Transcatheter Aortic Valve Implantation Vs Surgical Aortic Valve Replacement In Solid Organ Transplant Recipients: Readmission Rates And Health-Care Burden, Manoj Kumar, Shafaqat Ali, Sanchit Duhan, Faryal Farooq, Bijeta Keisham, Yahya Khlidj, Malalai Manan, Yasar Sattar, Mahin R. Khan, Rohan Gajjar, Priya Hotwani Md, Sanjay Kumar, Hameem U. Changezi, Ahmad Munir, Kalgi A. Modi, Tarek Helmy

Internal Medicine Residency

Background Transcatheter Aortic Valve Implantation (TAVI) outnumbers Surgical Aortic Valve Replacement (SAVR) for Aortic Stenosis in the US. Readmission rates and the healthcare burden of these procedures in Solid Organ Transplant (SOT) recipients are poorly studied.

Methods National Readmission Database (2016-2020) was used to identify SOT recipients (Renal, Heart, Kidney, Lung & Pancreas) undergoing TAVI or SAVR. Propensity score matching (PSM) was used to remove confounding factors from outcomes. Descriptive and regression based analysis was performed.

Results Among 3,394 hospitalizations for Aortic Valve Replacement, 2,181 underwent TAVI & 1,213 underwent SAVR. SAVR was associated with higher median LOS (10 vs …


From Biliary Dilatation To Meningitis: Finding Listeria In A Patient With Advanced Cholangiocarcinoma, Molly Jain Md, Mallika Gyawali Md, Sophia Lubrin Md Jan 2024

From Biliary Dilatation To Meningitis: Finding Listeria In A Patient With Advanced Cholangiocarcinoma, Molly Jain Md, Mallika Gyawali Md, Sophia Lubrin Md

Internal Medicine Residency

This presentation won 1st prize for the 2024 ACP Indiana conference in the oral clinical vignette. Case Presentation.



Systemic Amyloidosis Presenting As Adrenal Insufficiency And Multi-Nodular Goiter, Aqsa Khan Md, Emily B. Schroeder Md Oct 2022

Systemic Amyloidosis Presenting As Adrenal Insufficiency And Multi-Nodular Goiter, Aqsa Khan Md, Emily B. Schroeder Md

Internal Medicine Residency

Poster Presented at ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation: A 69-year-old male presented to the Endocrinology clinic after multiple hospital admissions for severe orthostatic hypotension, weight loss, edema and generalized weakness. On physical exam, he was found to have orthostatic hypotension and large goiter.


Papillary Thyroid Cancer In A Patient With Germline Ttn Mutation, Payal Shukla Md, Ms, Emily B. Schroeder Md Oct 2022

Papillary Thyroid Cancer In A Patient With Germline Ttn Mutation, Payal Shukla Md, Ms, Emily B. Schroeder Md

Internal Medicine Residency

Poster Presented at the ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation:

• A 60-year-old male presented with new onset atrial fibrillation and hyperthyroidism.

• His past medical history was significant for germline TTN mutation and recurrent ventricular tachycardia status post implantable cardiac defibrillator placement.

• He had been treated with amiodarone for two and a half years and had stopped the medication eight months prior to presentation.

• Laboratory workup was done (table 1) and an ultrasound of the thyroid gland showed a multinodular goiter with subcentimeter cysts and a right lower lobe nodule.

• A …


"Crypto Syphilis" Cryptogenic Stroke As The Presentation Of Neurosyphilis In Young Adults, Priya Hotwani Md, Matthew Bartock Do, Emily B. Schroeder Md, Munyaradzi Chakabva Md Oct 2022

"Crypto Syphilis" Cryptogenic Stroke As The Presentation Of Neurosyphilis In Young Adults, Priya Hotwani Md, Matthew Bartock Do, Emily B. Schroeder Md, Munyaradzi Chakabva Md

Internal Medicine Residency

Poster Presented at the ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation: A young adult man in his 30s with a history of tobacco and methamphetamine use presented to the emergency department with a three day history fo aphasia, right sided facial droop and confusion.