Nishi Shah

U.S. Trends in Inpatient Utilization of Fractional Flow Reserve and Percutaneous Coronary Intervention.

Fractional flow reserve (FFR) of intermediate coronary stenosis is a highly accurate, reproducible, and cost-effective modality with powerful prognostic value. Results of the FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) [(1)][1] and FAME-2 trials [(2)][2] have shown a

Utilization and Predictors of Electrical Cardioversion in Patients Hospitalized for Atrial Fibrillation

Atrial fibrillation (AF) is a common arrhythmia in adults associated with thromboembolic complications. External electrical cardioversion (DCCV) is a safe procedure used to convert AF to normal sinus rhythm. We sought to study factors that affect utilization of DCCV in hospitalized patients with AF. The study sample was drawn from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project in the United States. Patients with a primary discharge diagnosis of AF that received DCCV during hospitalization in the years 2000–2010 were included. An estimated 2,810,530 patients with a primary diagnosis of AF were hospitalized between 2001 and 2010, of which 1,19,840 (4.26%) received DCCV. The likelihood of receiving DCCV was higher in patients who were males, whites, privately insured, and aged < 40 years and those with fewer comorbid conditions. Higher CHADS2 score was found to have an inverse association with DCCV use. In-hospital stroke, in-hospital mortality, length of stay, and cost for hospitalization were significantly lower for patients undergoing DCCV during AF related hospitalization. Further research is required to study the contribution of other disease and patient related factors affecting the use of this procedure as well as postprocedure outcomes.

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.

PARP1 Is Up-Regulated in Non-small Cell Lung Cancer Tissues in the Presence of the Cyanobacterial Toxin Microcystin

Non-small cell lung cancer (NSCLC) is the major form of lung cancer, with adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) being its major subtypes. Smoking alone cannot completely explain the lung cancer etiology. We hypothesize that altered lung microbiome and chronic inflammatory insults in lung tissues contribute to carcinogenesis. Here we explore the microbiome composition of LUAD samples, compared to LUSC and normal samples. Extraction of microbiome DNA in formalin-fixed, paraffin-embedded (FFPE) lung tumor and normal adjacent tissues was meticulously performed. The 16S rRNA product from extracted microbiota was subjected to microbiome amplicon sequencing. To assess the contribution of the host genome, CD36 expression levels were analyzed then integrated with altered NSCLC subtype-specific microbe sequence data. Surprisingly phylum Cyanobacteria was consistently observed in LUAD samples. Across the NSCLC subtypes, differential abundance across four phyla (Proteobacteria, Bacteroidetes, Actinobacteria, and Firmicutes) was identified based on the univariate analysis (p-value < 6.4e-4 to 3.2e-2). In silico metagenomic and pathway analyses show that presence of microcystin correlates with reduced CD36 and increased PARP1 levels. This was confirmed in microcystin challenged NSCLC (A427) cell lines and Cyanobacteria positive LUAD tissues. Controlling the influx of Cyanobacteria-like particles or microcystin and the inhibition of PARP1 can provide a potential targeted therapy and prevention of inflammation-associated lung carcinogenesis.

Is cirrhosis associated with lower odds of ischemic stroke: A nationwide analysis?

AIM To determine the association between cirrhosis and ischemic stroke in a large nationally representative sample. METHODS A retrospective cross-sectional study of all hospitalized patients during 2012 and 2013 in the United States was performed using the National Inpatient Sample database. Hospitalizations with acute stroke, cirrhosis and other risk factors were identified using ICD-9-CM codes. RESULTS There were a total of 72082638 hospitalizations in the United States during the years 2012 and 2013. After excluding hospitalizations with missing demographic variables, that there were a total of 1175210 (1.6%) out of these were for acute ischemic stroke. Cirrhosis was present among 5605 (0.4%) cases of ischemic stroke. Mean age among the cirrhotic and non-cirrhotic groups with ischemic stroke were 66.4 and 70.5 years, respectively. Prevalence of risk factors among the two groups was also calculated. After adjusting for various known risk factors the odds of having an ischemic stroke (OR = 0.28, P < 0.001) were 72% lower in cirrhotics compared to non-cirrhotics. CONCLUSION Our study suggests that in a large, nationally representative sample of the United States population, cirrhosis is associated with a lower likelihood of stroke.

ACUTE PROSTHETIC MECHANICAL MITRAL VALVE THROMBOSIS: NEEDLE OR SCALPEL?

Surgery is the treatment of choice for prosthetic mechanical mitral valve thrombosis (PMVT) with heart failure. We present a case where two-dose thrombolysis was successful in PMVT. A 35-year-old woman with history of mechanical mitral valve for rheumatic mitral stenosis presented with dyspnea,

BURDEN OF ARRHYTHMIAS IN PATIENTS WITH MULTIPLE MYELOMA

Multiple myeloma (MM) is associated with development of cardiac amyloidosis. Data on arrhythmic burden in this population is lacking. We sought to assess the burden of arrhythmias in patients with MM. Patients with a diagnosis of MM and various cardiac arrhythmias (CA) at discharge were identified

UTILIZATION AND PREDICTORS OF ELECTRICAL CARDIOVERSION FOR ATRIAL FIBRILLATION

Atrial fibrillation (AF) poses a huge healthcare burden. Electrical cardioversion (DCCV) has been an effective rhythm control therapy for AF. We sought to examine the use of DCCV in patients with AF and to identify predictors for undergoing DCCV. We identified patients with a primary discharge