Mohinder Vindhyal

A Living Systematic Review of Nebulized Hypertonic Saline for Acute Bronchiolitis in Infants

Results | The LTL (expressed in the telomere repeat copy number to the single gene copy number ratio) remained unchanged during and after the OC intake. In contrast, the LTL doubled while taking PioFluMet and returned to baseline after the PioFluMet intake was stopped (Figure). The LTL changes across treatment groups during 18 months related inversely to fasting insulinemia, body fat fraction by dual energy x-ray absorptiometry, and visceral and hepatic adiposity by magnetic resonance imaging (all r values were between −0.53 and −0.57; all P values were between 0.002 and 0.007). The ratio of circulating neutrophils to lymphocytes was first similar in treatment groups and remained similar in and between groups across 24 months. Noteworthy adverse effects were not encountered in either treatment group.4

Heart Failure Secondary to Left Ventricular Non-compaction Cardiomyopathy in a 26-Year-Old Male

Left ventricular non-compaction (LVNC) is a genetic anomaly where the ventricular wall is replaced by thick ventricular trabeculations with deep intertrabecular recesses held together by a thin compacted layer. We present a case of a 26-year-old male who presented with dyspnea on exertion and edema in his legs for the last one week.

Decreased Renal Function is Associated with Heart Failure Readmissions

Introduction Heart failure (HF) is one of the most common causes of hospitalization and readmissions. Approximately six million Americans are living with HF. Among patients with HF, hospitalization rate in the United States is higher for those over age 65, making it one of the leading causes of hospitalization in this age group. Furthermore, about 15% of those who were hospitalized with HF were readmitted within 30 days and 30% within 60 days. HF and chronic kidney disease (CKD) share many risk factors; therefore, it is expected that CKD is more prevalent in HF. About 50% of patients with HF also have concomitant CKD. Those patients have been found to have an increased risk of mortality and morbidity. This risk increases as glomerular filtration rate (GFR) decreases. Strategies to reduce the hospitalization rate in patients with HF include optimizing evidence-based drug and device therapies, addressing the causes of HF, treating comorbidities, and improving management of care. In our study, we aim to find an association between HF and the patient’s renal function as well as the GFR level. This study investigates the effect of renal function on HF morbidity and readmission rate. Methods We performed a retrospective study looking at 132 patients who were admitted to the hospital with HF and compared their measured GFR at three key time periods: admissions, discharges, and readmissions at 30 days. A Pearson product-moment correlation coefficient was calculated to determine the association between the GFR and readmission in HF admission cases. Results There is a statistically significant difference in the readmission rate based on the change in GFR between admission and discharge (Admit GFR – Discharge GFR; t = 2.28; p < 0.05). We found that patients who were readmitted in 30 days had an average decrease in GFR by 2.46 ml/min/1.73 m2, whereas patients with a lower readmission rate had an average increase in GFR by 1.92 ml/min/1.73 m2. Conclusion A decline in renal function due to hospitalization in patients with renal failure is associated with an increase in readmission for HF. Providers should be cognizant of the need to optimize renal function as well as cardiac function during hospitalization.

Cardiac Mass: A Case of Cardiac Papillary Fibroelastoma

Cardiac papillary fibroelastoma (CPF) is one of the most common neoplasms of the cardiac valvular structures that are associated with complications such as systemic stroke, embolism, and arrhythmias. We present a case of an incidentally discovered left ventricular mass in a 75-year-old Caucasian woman.

Case 5: Abdominal Pain, Nausea, and Vomiting in a 14-year-old Boy

1. Mohinder R. Vindhyal, MD, MEd* 2. Stephanie Kuhlmann, DO* 3. Shravani Vindhyal, MD* 4. Jeff Kao, MD* 5. Ragneel Bijjula, MD* 6. K. James Kallail, PhD* 1. *KU School of Medicine, The University of Kansas Medical Center, Wichita, KS A 14-year-old boy presents with nausea, vomiting (3–4 times per day), and abdominal pain lasting 7 days. The abdominal pain is sharp and rated 6 of 10 without radiation. The patient and his mother deny fever and weight loss. He had a bowel movement 4 days before presentation and has had decreased urination for the past 3 days. His medical history includes kidney disease, and his surgical history is unremarkable. He plays basketball at school and has no history of recent travel or excessive exercise. His Patient Health Questionnaire-9 score reveals no evidence of depression, and his psychiatric history rules out an eating disorder. His temperature is 96.1°F (35.6°C), heart rate is 92 beats/min, respiratory rate is 20 breaths/min, blood pressure is 134/90 mm Hg, and oxygen saturation is 98% on room air. His weight is 117.7 lb (53.4 kg), height is 70.0 in (177.8 cm), and BMI is 16.8, which is at the 9th percentile, with no significant change from his previous visits to his primary care physician. On physical examination, he is alert and oriented with no distress but reports some abdominal discomfort. His mucous membranes are dry, with delayed capillary refill and poor skin turgor. His abdomen is distended, with diffuse tenderness …

Decreased Renal Function Is Associated with Elevated CHA2DS2VASC and R2CHADS2 Scores in Non-Valvular Atrial Fibrillation Patients Presenting with Stroke

Introduction Atrial fibrillation (AF), the most common cardiac arrhythmia, affects approximately 2.3 million patients in the United States, costing around

TCT-641 Transcatheter Aortic Valve Replacement Outcomes In Patients With End-Stage Renal Disease: Systematic Review and Meta-analysis

26 billion. Atrial fibrillation is associated with a two- to seven-fold increased risk of stroke, one of the most serious complications. Chronic kidney disease affects approximately 13% of the US population and has been associated with higher rates of AF than the general population. In patients with chronic kidney disease (CKD), the risk of stroke increases as the glomerular filtration rate (GFR) decreases, especially in CKD stages three and four. Several risks stratification scores such as CHADS2 (congestive heart failure, hypertension, age, diabetes mellitus, stroke), CHA2DS2VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex), and R2CHADS2 (renal failure, congestive heart failure, age, diabetes, stroke) scores are used for stroke risk assessment in patients with non-valvular atrial fibrillation (NVAF). This study investigates the association between renal functions and risk stratification scoring systems in patients with non-valvular AF presenting with stroke. Methods Using the convenience sampling method, 171 subjects were selected from the eligible population (n = 386). A Pearson product-moment correlation coefficient was calculated to determine the association between the GFR and each of the CHA2DS2VASc and R2CHADS2 scores. In addition, a Pearson product-moment correlation coefficient was calculated to determine the association between the CHA2DS2VASc and R2CHADS2 scores. Results The selected population represented 44.3% of the eligible subjects. Of these, 88% were Caucasian, 60% were female, and the mean age was 78 years. The mean CHA2DS2VASc score was six (range 2-9). The mean eGFR was 69.77 (range 6-108). Both the mode and the median CHA2DS2VASc score was four (range 2-8). A weak, but significant, negative correlation was found between renal function (eGFR) and the CHA2DS2VASc score (r = -0.263; p = 0.0005). There was a stronger negative correlation between the eGFR and R2CHADS2score (r = -0.70; p < 0.00001). The CHA2DS2VASc and R2CHADS2scoring schemes were significantly and positively correlated (r = 0.627; p < 0.00001). Discussion In NVAF patients presenting with stroke, renal failure is associated with higher CHA2DS2VASc and R2CHADS2 scores. One must consider renal failure (end-stage or non-end stage renal failure) as an additional potential risk factor for stroke when recommending anticoagulation in non-valvular atrial fibrillation.