Sourabh Aggarwal

Obliterative Portal Venopathy: A Clinical and Histopathological Review

Non-cirrhotic portal hypertension (NCPH) is characterized by the elevation of the portal pressure in the absence of cirrhosis. Obliterative portal venopathy (OPV) as a cause of NCPH is being increasingly diagnosed, especially after recent reports of its occurrence in patients with HIV using didanosine. Patients usually present with episodes of variceal hemorrhage and other features of portal hypertension including jaundice, ascites, encephalopathy and hepatopulmonary syndrome. Hepatic synthetic function is typically well preserved and the laboratory evaluation in OPV patients typically reveals only mild nonspecific hematological abnormalities chiefly related to hypersplenism. Its diagnosis remains a challenge and patients are often mistakenly diagnosed as having cirrhosis. Despite the increasing recognition of OPV, its etiology and pathogenesis are still unclear. A number of etiologies have been proposed including genetic predisposition, recurrent bacterial infections, HIV infection and highly active antiretroviral therapy, an altered immune response, hypercoagulability, and exposure to chemicals and certain medications. Histopathological evaluation remains critical in excluding cirrhosis and other causes of portal hypertension, and is the only way of definitively establishing the diagnosis of OPV. Clinicians should have a high index of suspicion for OPV in patients who present with variceal bleeding and splenomegaly and who do not have other features of cirrhosis. The purpose of this review is to summarize the known etiologies for OPV and its associated clinical aspects and correlations, and to also provide ample histophotomicrographs of OPV to aid in the diagnosis. It will also help raise awareness of this entity amongst pathologists and clinicians alike.

Demographic parameters related to 30-day readmission of patients with acute myocardial infarction: Analysis of 2,371,867 hospitalizations☆

BACKGROUNDnAcute myocardial infarction (AMI) is the most common cause of mortality in the USA as per the data released by the CDC. Short term hospital readmissions account for a significant portion of health care budget and much of the focus recently has been on reducing 30day readmission rate aimed to identify the demographics associated with readmissions from AMI and major causes of readmissions.nnnMETHODSnWe queried the Nationwide Inpatient Sample which represents 20% of all the United States hospital data for our study. AMI was identified through ICD9 Clinical Classification Software Code 100 for readmissions secondary to AMI for years 2009-2013. Chi-square was used for statistical analysis.nnnRESULTSnA total of 2,371,867 admissions were identified with AMI and 15.87% of these readmitted within 30days after index hospitalizations due to any cause. Patients with age greater than 65years, female gender, Medicare and Medicaid insurances, low median income for zip code and metropolitan areas were associated with high 30day readmission rate. The most common identified cause of readmission from 2009-2011 was coronary atherosclerosis (15%) and from 2012-2013 the cause identified was congestive heart failure (13.5%) (p<0.001).nnnCONCLUSIONnAggressive medical management needs to be targeted at this demography of patients and prevent the most causes of readmissions to reduce the cost and morbidity of patients admitted with AMI.

Attitude and perception of junior resident doctors' regarding antibiotic resistance – A pilot study

Abstract Objective To analyze the attitude and perception of junior resident doctors regarding antibiotic resistance and prescribing. Methods This cross-sectional study was conducted in two tertiary care centres in the New Delhi during the months of May-June 2012. An email based questionnaire was emailed to all the junior residents (JRs) working in the clinical setting and all the responses obtained within 2 months were included in the study. Statistical analysis was done using SPSS v.17. Results This email based questionnaire was forwarded to 80 JRs. 53 responses were deemed appropriate for analysis with response rate of 66.25%. Forty-nine JRs (92.45%) believed that antibiotic resistance is a problem in India while 38 JRs (71.7%) believed it is a problem in their hospital. 28 JRs (52.83%) had received training regarding antibiotic prescription in last 6 months while 25 (47.17%) had not received any training. 47 JRs (88.7%) believed that Medical Council should take strict actions prohibiting irrational use of antibiotics. Only 18 JRs (33.96%) said that Government of India should go ahead with proposed plan of restricting junior doctors from prescribing third and fourth generation antibiotics without Head of Departments permission. Conclusions Most of the junior residents believe that antibiotic resistance is an emerging problem in their hospital as also nationally. There is a large unmet need of providing education to these residents.

All that looks like “Brugada” is not “Brugada”: Case series of Brugada phenocopy caused by hyponatremia

Brugada syndrome (BS), a life-threatening channelopathy associated with reduced inward sodium current due to dysfunctional sodium channels, is characterized by ST-segment elevation with downsloping “coved type” (type 1) or “saddle back” (type 2) pattern in V1–V3 precordial chest leads (1, 2). Brugada phenocopy, a term describing conditions inducing Brugada-like pattern of electrocardiogram (EKG) manifestations in patients without true BS, is an emerging condition (3). We describe a case series of Brugada phenocopy with hyponatremia.

Demographic Patterns Associated With Compliance in Pain Contract Patients: A Residency Clinic Experience

Age (y) <.001 Mean SD 56.3 13.5 56.8 14.7 49.5 11.2 Range 20-93 24-87 18-88 Sex .032 Male 52 (49.1) 15 (31.9) 92 (53.5) Female 54 (50.9) 32 (68.1) 80 (46.5) Ethnicity .13 African American 26 (24.5) 5 (10.6) 23 (13.4) White 73 (68.87) 37 (78.7) 62 (36.0) Unknown 5 (4.72) 0 85 (49.4) Other 2 (1.89) 5 (10.6) 2 (1.2) Relationship status .56 Single 43 (40.6) 23 (48.9) 76 (44.2) Married 35 (33.0) 11 (23.4) 43 (25.0) Other (divorced, widowed, legally separated) 28 (26.4) 12 (25.5) 33 (19.2)

IMPACT OF VITAMIN D DEFICIENCY ON PATIENTS UNDERGOING CORONARY ARTERY DISEASE BETWEEN THE YEARS 2008 THROUGH 2012: NATIONWIDE INPATIENT SAMPLE DATA ANALYSIS

Background: Vitamin D deficiency (VDD) is a universal disorder, involved in the pathogenesis of coronary artery disease (CAD). The atherosclerotic character of vitamin D deficiency is known to increase cardiovascular events. This study was done to review the impact of VDD on CAD in the US for years

IMPACT OF HEREDITARY CAUSES OF THROMBOSIS ON ISCHEMIC STROKE BETWEEN THE YEARS 2008 THROUGH 2012: NATIONWIDE INPATIENT SAMPLE DATA ANALYSIS

Background: Ischemic Stroke (IS) is associated with traditional risk factors of diabetes, hypertension, hyperlipidemia and smoking. However, impact of hereditary causes of thrombosis (HT) on IS is largely unknown. HT includes primary hypercoagulable state, activated protein C resistance,

Sushruta: Father of plastic surgery in Benares:

Sushruta has been regarded as one of the pioneers of surgery. He performed procedures with crude surgical instruments that paved the path for todays operations. However, his existence is shrouded in myth and mystery. Sushruta belonged to a rich heritage of learned scholars and practiced and taught surgery at Benares University around 600BC. His work is assembled into a monumental thesis, possibly the first text book on surgery, the ‘Sushruta Samhita’ where he describes surgical instruments, procedures, illnesses, medicinal plants and preparation, dissection and the study of human anatomy, embryology and fractures. Sushruta is perhaps best known for the nasal reconstruction flap which is still used in different versions. For all his contributions, he has been aptly titled ‘Father of Plastic Surgery’.

FACTORS ASSOCIATED WITH 30-DAY READMISSIONS IN CONGESTIVE HEART FAILURE PATIENTS: ANALYSIS OF 2,536,439 ADMISSIONS

Congestive heart failure (CHF) is a major cause of morbidity and is associated with a high 30-day re-admission rate (RR) and economic burden on health care. This study was done to determine parameters associated with high 30-day RR secondary to CHF.nnNationwide Inpatient Sample data was used to

IMPACT OF SMOKING BAN ON CARDIOVASCULAR MORBIDITY AND MORTALITY: LESSONS TO LEARN FROM MICHIGAN

Cigarette smoking is well known to increase mortality and morbidity. Smoking bans/smoke-free laws are public policies prohibiting tobacco smoking in workplaces and/or public spaces. Michigan States “Smoke Free Air Law” restricting indoor public smoking came into effect in May 2010. However, its