The aim of the study was to investigate predictors of mortality in patients hospitalized with hyp... more The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia. Material and methods: Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded. Results: Of 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities. Acute kidney injury (AKI) and metabolic acidosis were common metabolic abnormalities, and 359 patients (88%) were on at least one drug associated with hyperkalemia. Mean duration to resolution of hyperkalemia was 12 ±9.9 h. Nonsteroidal anti-inflammatory drugs (HR = 1.59), highest potassium level (HR = 0.61), tissue necrosis (HR = 0.61), metabolic acidosis (HR = 0.77), and AKI (HR = 0.77) were significant independent determinants of duration prior to hyperkalemia resolution. Tissue necrosis (OR = 4.55), potassium supplementation (OR = 5.46), metabolic acidosis (OR = 4.84), use of calcium gluconate for treatment of hyperkalemia (OR = 4.62), AKI (OR = 3.89), and prolonged duration of hyperkalemia (OR = 1.06) were significant independent predictors of in-hospital mortality. Conclusions: Tissue necrosis, potassium supplementation, metabolic acidosis, calcium gluconate for treatment of hyperkalemia, AKI and prolonged duration of hyperkalemia are independent predictors of in-hospital mortality.
Acute coronary syndrome (ACS) represents an umbrella of ischemic myocardial disease and diagnoses... more Acute coronary syndrome (ACS) represents an umbrella of ischemic myocardial disease and diagnoses encompassing unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). UA and NSTEMI for all intents and purposes, share similar pathophysiology, but at increasing severity. This article focuses on the diagnosis, risk stratification, management, and strategies that impact outcomes in NSTEMI.
ABSTRACT Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of car... more ABSTRACT Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascular diseases, including acute myocardial infarction (AMI). However, whether SSc influences treatment choice and in-hospital outcomes in patients with AMI remains unknown. Methods: We used the 2002–2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with the principal diagnosis of AMI using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 410.xx. Secondary diagnosis of SSc was confirmed with ICD-9-CM code 710.1. Patients with rheumatoid arthritis (714.0–714.2), systemic lupus erythematosus (710.0), dermatomyositis (710.3) and polymyositis (710.4) were excluded. Multivariable logistic regression was used to compare treatment choice and outcomes between AMI patients with and without SSc. Results: From 2002–2010, among 5,966,599 patients with AMI, 3,890 (0.07%) had SSc. Patients with SSc were more likely to be younger, women, white and had a lower prevalence of smoking, dyslipidemia, obesity, hypertension, diabetes, known coronary artery diseases, carotid artery diseases, and a higher prevalence of congestive heart failure, peripheral vascular disease, chronic kidney disease, pulmonary circulation disorders, atrial fibrillation, atrioventricular block, deficiency anemia, chronic blood loss anemia, hypothyroidism and coagulopathy. SSc patients were more likely to receive medical therapy alone (OR 1.20, 95% CI 1.10–1.32, p<0.001) and thrombolysis (OR 1.47, 95% CI 1.12–1.92, p=0.005), and less likely to receive coronary artery bypass grafting (CABG) (OR 0.55, 95% CI 0.45–0.68, p<0.001), as compared to those without SSc. Utilization of percutaneous coronary intervention was similar in AMI patients with and without SSc (OR 0.97, 95% CI 0.88–1.06, p=0.486). Overall risk-adjusted in-hospital mortality was higher in patients with SSc (OR 1.60, 95% CI 1.40–1.84, p<0.001), as compared to those without SSc. Patients with SSc had less cardiogenic shock (OR 0.50, 95% CI 0.39–0.64, p<0.001), more gastrointestinal bleeding (OR 1.65 95% 1.38–1.97, p<0.001), and longer average length of stay (5.9±7.1 versus 5.1±6.1 days, p<0.001). Incidence of acute stroke was similar in AMI patients with and without SSc (OR 0.85, 95% CI 0.61–1.17, p=0.321). Conclusion: In patients with AMI, SSc is associated with an increased use of medical therapy alone and thrombolysis, and lesser use of CABG. Compared to patients without SSc, SSc patients with AMI have higher in-hospital mortality, more gastrointestinal bleeding, less cardiogenic shock and longer length of stay.
Pericardial synovial sarcoma is an extremely rare tumor with Introduction poor prognosis. Timely ... more Pericardial synovial sarcoma is an extremely rare tumor with Introduction poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. : A 27-year-old man presented with dyspnea and cough of three weeks Case duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE) noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT) of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the tumor to be a monophasic synovial sarcoma. Fluorescent in-situ hybridization (FISH) was positive for SS18 (SYT) gene rearrangement on chromosome 18q11, substantiating the diagnosis. Work-up for metastases was negative. Neo-adjuvant chemotherapy with high dose ifosfamide led to substantial reduction in the size of the tumor. The patient underwent surgical resection and external beam radiation therapy (EBRT) post surgery. He had symptom-free survival for 8 months prior to local recurrence. This was managed with left lung upper lobectomy and follow-up chemotherapy with docetaxel. The patient is currently stable with an acceptable functional status. In patients with pericardial effusions of unknown etiology, multiple Conclusion: modalities of cardiac imaging must be employed if there is suspicion of a pericardial mass. CT and magnetic resonance imaging (MRI) are useful to evaluate for pericardial thickening or masses in addition to TTE. Treatment of synovial sarcoma is not well established. Surgery is the cornerstone of treatment. In non-resectable tumors, aggressive neo-adjuvant chemotherapy with ifosfamide followed by surgical resection and EBRT may lead to improved outcome. Referees v1
Indian Journal of Pediatrics, Volume 75June, 2008 ... Correspondence and Reprint requests : Dr. ... more Indian Journal of Pediatrics, Volume 75June, 2008 ... Correspondence and Reprint requests : Dr. MR Savitha, No. 79/ A, 4th Main, Maruthi Temple Road, Saraswathipuram, Mysore-570 009; Phone-0821-2341891, Mobile: +919740506690 [Received January 29, 2007; ...
Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascul... more Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascular diseases, including acute myocardial infarction (AMI). However, whether SSc influences treatment choice and in-hospital outcomes in patients with AMI remains unknown. Methods: We used the 2002–2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with the principal diagnosis of AMI using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 410.xx. Secondary diagnosis of SSc was confirmed with ICD-9-CM code 710.1. Patients with rheumatoid arthritis (714.0–714.2), systemic lupus erythematosus (710.0), dermatomyositis (710.3) and polymyositis (710.4) were excluded. Multivariable logistic regression was used to compare treatment choice and outcomes between AMI patients with and without SSc. Results: From 2002–2010, among 5,966,599 patients with AMI, 3,890 (0.07%) had SSc. Patients with SSc were more likely to be younge...
A b s t r a c t Introduction: The aim of the study was to investigate predictors of mortality in ... more A b s t r a c t Introduction: The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia. Material and methods: Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded. Results: Of 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities. Acute kidney injury (AKI) and metabolic acidosis were common metabolic abnormalities, and 359 patients (88%) were on at least one drug associated with hyperkalemia. Mean duration to resolution of hyperkalemia was 12 ±9.9 h. Nonsteroidal anti-inflammatory drugs (HR = 1.59), highest potassium level (HR = 0.61), tissue necrosis (HR = 0.61), metabolic acidosis (HR = 0.77), and AKI (HR = 0.77) were significant independent determinants of duration prior to hyperkalemia resolution. Tissue necrosis (OR = 4.55), potassium supplementation (OR = 5.46), metabolic acidosis (OR = 4.84), use of calcium gluconate for treatment of hyperkalemia (OR = 4.62), AKI (OR = 3.89), and prolonged duration of hyperkalemia (OR = 1.06) were significant independent predictors of in-hospital mortality. Conclusions: Tissue necrosis, potassium supplementation, metabolic acidosis, calcium gluconate for treatment of hyperkalemia, AKI and prolonged duration of hyperkalemia are independent predictors of in-hospital mortality.
Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and... more Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. A 27-year-old man presented with dyspnea and cough of three weeks duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE) noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT) of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the t...
The aim of the study was to investigate predictors of mortality in patients hospitalized with hyp... more The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia. Material and methods: Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded. Results: Of 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities. Acute kidney injury (AKI) and metabolic acidosis were common metabolic abnormalities, and 359 patients (88%) were on at least one drug associated with hyperkalemia. Mean duration to resolution of hyperkalemia was 12 ±9.9 h. Nonsteroidal anti-inflammatory drugs (HR = 1.59), highest potassium level (HR = 0.61), tissue necrosis (HR = 0.61), metabolic acidosis (HR = 0.77), and AKI (HR = 0.77) were significant independent determinants of duration prior to hyperkalemia resolution. Tissue necrosis (OR = 4.55), potassium supplementation (OR = 5.46), metabolic acidosis (OR = 4.84), use of calcium gluconate for treatment of hyperkalemia (OR = 4.62), AKI (OR = 3.89), and prolonged duration of hyperkalemia (OR = 1.06) were significant independent predictors of in-hospital mortality. Conclusions: Tissue necrosis, potassium supplementation, metabolic acidosis, calcium gluconate for treatment of hyperkalemia, AKI and prolonged duration of hyperkalemia are independent predictors of in-hospital mortality.
Acute coronary syndrome (ACS) represents an umbrella of ischemic myocardial disease and diagnoses... more Acute coronary syndrome (ACS) represents an umbrella of ischemic myocardial disease and diagnoses encompassing unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). UA and NSTEMI for all intents and purposes, share similar pathophysiology, but at increasing severity. This article focuses on the diagnosis, risk stratification, management, and strategies that impact outcomes in NSTEMI.
ABSTRACT Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of car... more ABSTRACT Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascular diseases, including acute myocardial infarction (AMI). However, whether SSc influences treatment choice and in-hospital outcomes in patients with AMI remains unknown. Methods: We used the 2002–2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with the principal diagnosis of AMI using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 410.xx. Secondary diagnosis of SSc was confirmed with ICD-9-CM code 710.1. Patients with rheumatoid arthritis (714.0–714.2), systemic lupus erythematosus (710.0), dermatomyositis (710.3) and polymyositis (710.4) were excluded. Multivariable logistic regression was used to compare treatment choice and outcomes between AMI patients with and without SSc. Results: From 2002–2010, among 5,966,599 patients with AMI, 3,890 (0.07%) had SSc. Patients with SSc were more likely to be younger, women, white and had a lower prevalence of smoking, dyslipidemia, obesity, hypertension, diabetes, known coronary artery diseases, carotid artery diseases, and a higher prevalence of congestive heart failure, peripheral vascular disease, chronic kidney disease, pulmonary circulation disorders, atrial fibrillation, atrioventricular block, deficiency anemia, chronic blood loss anemia, hypothyroidism and coagulopathy. SSc patients were more likely to receive medical therapy alone (OR 1.20, 95% CI 1.10–1.32, p<0.001) and thrombolysis (OR 1.47, 95% CI 1.12–1.92, p=0.005), and less likely to receive coronary artery bypass grafting (CABG) (OR 0.55, 95% CI 0.45–0.68, p<0.001), as compared to those without SSc. Utilization of percutaneous coronary intervention was similar in AMI patients with and without SSc (OR 0.97, 95% CI 0.88–1.06, p=0.486). Overall risk-adjusted in-hospital mortality was higher in patients with SSc (OR 1.60, 95% CI 1.40–1.84, p<0.001), as compared to those without SSc. Patients with SSc had less cardiogenic shock (OR 0.50, 95% CI 0.39–0.64, p<0.001), more gastrointestinal bleeding (OR 1.65 95% 1.38–1.97, p<0.001), and longer average length of stay (5.9±7.1 versus 5.1±6.1 days, p<0.001). Incidence of acute stroke was similar in AMI patients with and without SSc (OR 0.85, 95% CI 0.61–1.17, p=0.321). Conclusion: In patients with AMI, SSc is associated with an increased use of medical therapy alone and thrombolysis, and lesser use of CABG. Compared to patients without SSc, SSc patients with AMI have higher in-hospital mortality, more gastrointestinal bleeding, less cardiogenic shock and longer length of stay.
Pericardial synovial sarcoma is an extremely rare tumor with Introduction poor prognosis. Timely ... more Pericardial synovial sarcoma is an extremely rare tumor with Introduction poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. : A 27-year-old man presented with dyspnea and cough of three weeks Case duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE) noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT) of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the tumor to be a monophasic synovial sarcoma. Fluorescent in-situ hybridization (FISH) was positive for SS18 (SYT) gene rearrangement on chromosome 18q11, substantiating the diagnosis. Work-up for metastases was negative. Neo-adjuvant chemotherapy with high dose ifosfamide led to substantial reduction in the size of the tumor. The patient underwent surgical resection and external beam radiation therapy (EBRT) post surgery. He had symptom-free survival for 8 months prior to local recurrence. This was managed with left lung upper lobectomy and follow-up chemotherapy with docetaxel. The patient is currently stable with an acceptable functional status. In patients with pericardial effusions of unknown etiology, multiple Conclusion: modalities of cardiac imaging must be employed if there is suspicion of a pericardial mass. CT and magnetic resonance imaging (MRI) are useful to evaluate for pericardial thickening or masses in addition to TTE. Treatment of synovial sarcoma is not well established. Surgery is the cornerstone of treatment. In non-resectable tumors, aggressive neo-adjuvant chemotherapy with ifosfamide followed by surgical resection and EBRT may lead to improved outcome. Referees v1
Indian Journal of Pediatrics, Volume 75June, 2008 ... Correspondence and Reprint requests : Dr. ... more Indian Journal of Pediatrics, Volume 75June, 2008 ... Correspondence and Reprint requests : Dr. MR Savitha, No. 79/ A, 4th Main, Maruthi Temple Road, Saraswathipuram, Mysore-570 009; Phone-0821-2341891, Mobile: +919740506690 [Received January 29, 2007; ...
Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascul... more Background/Purpose: Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascular diseases, including acute myocardial infarction (AMI). However, whether SSc influences treatment choice and in-hospital outcomes in patients with AMI remains unknown. Methods: We used the 2002–2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with the principal diagnosis of AMI using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 410.xx. Secondary diagnosis of SSc was confirmed with ICD-9-CM code 710.1. Patients with rheumatoid arthritis (714.0–714.2), systemic lupus erythematosus (710.0), dermatomyositis (710.3) and polymyositis (710.4) were excluded. Multivariable logistic regression was used to compare treatment choice and outcomes between AMI patients with and without SSc. Results: From 2002–2010, among 5,966,599 patients with AMI, 3,890 (0.07%) had SSc. Patients with SSc were more likely to be younge...
A b s t r a c t Introduction: The aim of the study was to investigate predictors of mortality in ... more A b s t r a c t Introduction: The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia. Material and methods: Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded. Results: Of 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities. Acute kidney injury (AKI) and metabolic acidosis were common metabolic abnormalities, and 359 patients (88%) were on at least one drug associated with hyperkalemia. Mean duration to resolution of hyperkalemia was 12 ±9.9 h. Nonsteroidal anti-inflammatory drugs (HR = 1.59), highest potassium level (HR = 0.61), tissue necrosis (HR = 0.61), metabolic acidosis (HR = 0.77), and AKI (HR = 0.77) were significant independent determinants of duration prior to hyperkalemia resolution. Tissue necrosis (OR = 4.55), potassium supplementation (OR = 5.46), metabolic acidosis (OR = 4.84), use of calcium gluconate for treatment of hyperkalemia (OR = 4.62), AKI (OR = 3.89), and prolonged duration of hyperkalemia (OR = 1.06) were significant independent predictors of in-hospital mortality. Conclusions: Tissue necrosis, potassium supplementation, metabolic acidosis, calcium gluconate for treatment of hyperkalemia, AKI and prolonged duration of hyperkalemia are independent predictors of in-hospital mortality.
Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and... more Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. A 27-year-old man presented with dyspnea and cough of three weeks duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE) noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT) of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the t...
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