Kshitij Chatterjee

Is vaping a gateway to smoking: a review of the longitudinal studies

Abstract Background: The use of e-cigarettes (ECs) is rising globally. There is concern that e-cigarette may actually lead to smoking, especially amongst adolescents. Objective: To perform a comprehensive review of literature reporting the longitudinal effects of e-cigarette use on onset of smoking among adolescents and young adults. Methods: A search was conducted using PubMed, Google Scholar, Scopus, and Web of Science in February 2016 to identify the studies containing data on EC use among adolescents and young adults (age<30 years). We then narrowed our search to only include longitudinal studies with data on EC and conventional cigarette smoking among this population. Results: Four longitudinal studies were identified that analyzed the use of ECs and smoking at both baseline and follow-ups in the target population. These studies demonstrated that EC use is associated with an increase in combustible cigarette smoking, even amongst the adolescents who were not susceptible to smoking. Conclusion: This review highlights the strong evidence that not only are ECs are not an effective tool for smoking cessation among adolescents, they actually are associated with higher incidence of combustible cigarette smoking. Policy makers need to recognize of the insidious nature of this campaign by the tobacco industry and design policies to regulate it.

Impact of Targeted Educational Interventions on Clostridium difficile Infection Treatment in Critically Ill Adults

Background Clostridium diffcile infection (CDI) is a growing clinical and economic burden throughout the world. Pharmacists often are members of the primary care team in the intensive care unit (ICU) setting; however, the impact of pharmacists educating other health care providers on appropriateness of CDI treatment has not been previously examined. Objective This study was performed to determine the impact of structured educational interventions on CDI treatment on appropriateness of CDI treatment and clinical outcomes. Methods This was a single-center, retrospective, cohort study of patients with CDI in the medical ICU at an academic medical center between January and June 2014 (pre-period) and 2015 (post-period). All patients were evaluated for appropriate CDI treatment before and after implementing pharmacist-provided educational interventions on CDI treatment. Results Patients in the post-period were prescribed appropriate CDI treatment more frequently than patients in the pre-period (91.7% vs 41.7%; p = .03) and received fewer inappropriate doses of a CDI treatment agent (14 doses vs 30 doses). Patients in the pre-period had a shorter ICU length of stay [1.5 days (range, 1–19) vs 3.5 days (range, 2–36); p = .01] and a similar hospital length of stay [9.5 days (range, 4–24) vs 11.5 days (range, 3–56); p = .30]. Total time spent providing interventions was 4 hours. Conclusion Patients had appropriate CDI treatment initiated more frequently in the post-period. This low-cost intervention strategy should be easy to implement in institutions where pharmacists interact with physicians during clinical rounds and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

Rasmussen's aneurysm: A forgotten scourge

Rasmussens aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary artery adjacent to a tuberculous cavity. Life threatening massive hemoptysis from the rupture of a Rasmussens aneurysm is an uncommon yet life threatening complication of cavitary tuberculosis (TB). We present a case of a young woman who presented with low-grade fever and hemoptysis. Computed tomographic (CT) angiography showed biapical cavitary lesions and actively bleeding aneurysms involving pulmonary artery, which successfully underwent glue embolization.

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population

Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated. Conclusions Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures.

Maximizing the Tweet Engagement Rate in Academia: Analysis of the AJNR Twitter Feed

SUMMARY: The use of social media by medical professionals and organizations is increasing, with Twitter receiving the most attention. User engagement is an important goal of social media activity, and engagement metrics represent a viable gauge of value in social media. No thorough analysis of tweet characteristics that increase academic user engagement has yet been published. In this study, the authors analyzed the American Journal of Neuroradiology Twitter feed to determine the tweet characteristics that were associated with higher engagement rates.

A bronchoscopic approach to benign subglottic stenosis

Objectives: Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. Methods: We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing. Results: We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications. Conclusion: Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.

National Trends (2007-2013) of Clostridium difficile Infection in Patients with Septic Shock: Impact on Outcome

BACKGROUND: Clostridium difficile is the most common infectious cause of healthcare‐associated diarrhea and is associated with worse outcomes and higher cost. Patients with septic shock (SS) are at increased risk of acquiring C. difficile infections (CDIs) during hospitalization, but little data are available on CDI complicating SS. OBJECTIVE: Prevalence of CDI in SS between 2007‐2013 and impact of CDI on outcomes in SS. DESIGN: We used the National Inpatient Sample to identify hospitalizations (2007‐2013) of adults with SS and CDI and the Nationwide Readmissions Database 2013 to calculate 30‐day readmissions. MAIN MEASUREMENTS: Outcomes were prevalence of CDI in SS, effect on mortality, length of stay (LOS), and 30‐day readmission. RESULTS: There were 2,031,739 hospitalizations with SS (2007‐2013). CDI was present in 8.2% of SS. The in‐hospital mortality of SS with and without CDI were comparable (37.1% vs 37.0%; P = 0.48). Median LOS was longer for SS with CDI (13 days vs 9 days; P < 0.001). LOS >75th percentile (>17 days) was 36.9% in SS with CDI vs 22.7% without CDI (P < 0.001). Similarly, LOS > 90th percentile (> 29 days) was 17.5% vs 9.1%, P < 0.001. Odds of LOS >75% and >90% in SS were greater with CDI (odds ratio [OR] 2.11; 95% confidence interval [CI], 2.06‐2.15; P < 0.001 and OR 2.25; 95% CI, 2.22‐2.28; P < 0.001, respectively). Hospital readmission of SS with CDI was increased, adjusted OR 1.26 (95% CI, 1.22‐1.31; P < 0.001). CONCLUSIONS: CDI complicating SS is common and is associated with increased hospital LOS and 30‐day hospital readmission. This represents a population in which a focus on prevention and treatment may improve clinical outcomes.

Thirty-Day Readmissions After Hospitalization for Clostridium difficile Enteritis Measures and Predictors: A Nationwide Analysis

Clostridium difficile infection (CDI) is the most common cause of healthcare-associated diarrhea and an emerging cause of enteritis in individuals even without significant risk factors or healthcare exposure. CDI frequently requires hospitalizations including 30-day readmissions, contributing to significant healthcare utilization and cost. Limited data are available on demographic characteristics and predictors of readmissions after an index hospitalization for CDI. We determined the national level 30-day readmission measures and predictors after hospitalization for CDI.

A case of DIPNECH presenting as usual interstitial pneumonia

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disease that is classically described as presenting with cough, dyspnea, and wheezing in non-smoker middle aged females. Pulmonary function tests commonly demonstrate an obstructive pattern and CT of chest usually reveals diffuse air trapping with mosaic pattern. We present a case of patient with DIPNECH manifesting with restrictive pattern and as usual interstitial pneumonia on imaging.

Contemporary national trends of cystic fibrosis hospitalizations and co-morbidities in the United States.

INTRODUCTION Cystic fibrosis (CF) is a life-limiting multisystemic genetic disease. Patients with CF have a high rate of hospitalization. We attempt to ascertain national trends of inpatient stays, prevalence of various co-morbidities during hospitalizations, outcomes and discharge disposition among CF patients. MATERIAL AND METHODS Data from the National Inpatient Sample (NIS) was used to identify all hospitalizations of patients with CF and their demographic characteristics from 2003 to 2013. Prevalence and effects of various co-morbidities like acute kidney injury (AKI) were determined. Detailed sub-group analysis was performed for individuals with lung transplant. RESULTS The annual rate of hospitalization per 1,000 CF patients in the U.S. increased from 994 in 2003 to 1,072 in 2013. The overall in-hospital mortality was 1.5%; median age at death was 27 years. In-hospital mortality trended down from 1.9% to 1.2% from 2003 to 2013 (p-value for trend: 0.002). The median length of stay was 7 days. The prevalence of chronic liver disease and AKI was 3.7% and 3.8% respectively. Multivariate adjusted odds of mortality for AKI was 1.74 (95% CI 1.57-1.93, p < 0.001). Patients with prior lung transplantation accounted for 6.5% of hospitalizations. These patients had a significantly higher prevalence of AKI. CONCLUSIONS The annual hospitalization rates of CF patients is increasing over the years. Females with CF constitute a higher proportion of hospitalized patients despite a higher male preponderance of males with CF in the community. AKI is associated with a significantly higher in-hospital mortality. Lung transplant recipients have a higher prevalence of AKI and mortality.