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Paradigm shift in transfusion practices during early COVID-19 pandemic:A single center retrospective study

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World Journal of Virology 2024年第2期13卷 78-86页

作者： Sumukh Arun Kumar Sushmita Prabhu Ankushi Sanghvi Maya Gogtay Mithil Gowda Suresh Harshit Khosla yuvaraj Singh Ajay Kumar Mishra Susan George Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Hematology and Oncology University of Nebraska Medical CenterOmahaNE 68198United States Hospice and Palliative Care UTHSC and McGovern School of MedicineTexasTX 77030United States Department of Gastroenterology and Hepatology UMass Chan Medical SchoolWorcesterMA 01655United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND The advent of coronavirus disease 2019(COVID-19)unveiled the worst national blood crisis that the United States had witnessed in over a *** the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting,we aimed to explore the possible barriers contributing to the shortage of blood products within the medical *** COVID era and pre-COVID *** We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community *** was tabulated to include the number of red blood cell(RBC)transfusions and if transfusions met restrictive blood transfusion criteria as per institutional ***-square was applied to test the statistical association between qualitative *** t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative *** A total of 208 patients were included in the study,of which 108 were during COVID era and 100 were during pre-COVID *** leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath(53.7%and 36%P=0.001),followed by gastrointestinal bleeding(25.9%and 21%P=0.001).There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group(38.9%vs 22%,P=0.008).The restrictive transfusion criteria were met in 62%vs 79%in the COVID and pre-COVID eras,respectively(P=0.008).CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.

关键词： Blood transfusion Restrictive transfusion COVID-19 Pre-COVID-19 Blood shortage Pandemic

State of deceased donor transplantation in India:A model for developing countries around the world

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World Journal of Transplantation 2016年第2期6卷 331-335页

作者： Georgi Abraham Madhusudan Vijayan Natarajan Gopalakrishnan Sunil Shroff Joseph Amalorpavanathan anand yuvaraj Sanjeev Nair Saravanan Sundarrajan Madras Medical Mission Hospital Kilpauk Medical College Madras Medical College and Government General Hospital

Renal replacement therapy(RRT) resources are scarce in India, with wide urban-rural and interstate disparities. The burden of end-stage renal disease is expected to increase further due to increasing prevalence of risk factors like diabetes mellitus. Renal transplantation, the best RRT modality, is increasing in popularity, due to improvements made in public education, the deceased donor transplantation(DDT) programme and the availability of free and affordable transplant services in government hospitals and certain non-governmental philanthropic organizations. There are about 120000 haemodialysis patients and 10000 chronic peritoneal dialysis patients in India, the majority of them waiting for a donor kidney. Shortage of organs, lack of transplant facilities and high cost of transplant in private facilities are major barriers for renal transplantation in India. The DDT rate in India is now 0.34 per million population, among the lowest in the world. Infrastructural development in its infancy and road traffic rules not being strictly implemented by the authorities, have led to road traffic accidents being very common in urban and rural India. Many patients are declared brain dead on arrival and can serve as potential organ donors. The DDT programme in the state of Tamil Nadu has met with considerable success and has brought down the incidence of organ trade. Government hospitals in Tamil Nadu, with a population of 72 million, provide free transplantation facilities for the underprivileged. Public private partnership has played an important role in improving organ procurement rates, with the help of trained transplant coordinators in government hospitals. The DDT programmes in the southern states of India(Tamil Nadu, Kerala, Pondicherry) are advancing rapidly with mutual sharing due to public private partnership providing vital organs to needy patients. Various health insurance programmes rolled out by the governments in the southern states are effective in alleviatin

关键词： Deceased donor transplantation Kidney India Developing countries

Hybrid Active Contour Mammographic Mass Segmentation and Classification

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Computer Systems Science & Engineering 2022年第3期40卷 823-834页

作者： K.yuvaraj U.S.Ragupathy Department of Electronics and Instrumentation Engineering Kongu Engineering College PerunduraiErode638060India

This research implements a novel segmentation of mammographic *** methods are proposed,namely,segmentation of mass based on iterative active contour,automatic region growing,and fully automatic mask selectionbased active contour *** the first method,iterative threshold is performed for manual cropped preprocessed image,and active contour is applied *** overcome manual cropping in the second method,an automatic seed selection followed by region growing is *** that the result is only a few images owing to over segmentation,the third method uses a fully automatic active *** of the segmentation techniques are compared with the manual markup by experts,specifically by taking the difference in their mean ***,the difference in the mean value of the third method is 1.0853,which indicates the closeness of the ***,the proposed method is compared with the existing fuzzy C means and level set *** automatic mass segmentation based on active contour technique results in segmentation with high *** using adaptive neuro fuzzy inference system,classification is done and results in a sensitivity of 94.73%,accuracy of 93.93%,and Mathew’s correlation coefficient(MCC)of 0.876.

关键词： Feature optimization hybrid active contour segmentation mass classification mass feature extraction medical image analysis

Glycogen hepatopathy in type-1 diabetes mellitus: A case report

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World Journal of Hepatology 2022年第2期14卷 471-478页

作者： yuvaraj Singh Susant Gurung Maya Gogtay Internal Medicine Saint Vincent HospitalWorcesterMA 01604United States

BACKGROUND It has been studied that fluctuating glucose levels may superimpose glycated hemoglobin in determining the risk for diabetes mellitus(DM)*** non-alcoholic steatohepatitis(NASH)remains a predominant cause of elevated transaminases in Type 2 DM due to a strong underplay of metabolic syndrome,Type 1 DM can contrastingly affect the liver in a direct,benign,and reversible manner,causing Glycogen hepatopathy(GH)-with a good *** SUMMARY A 50-year-old female with history of poorly controlled type 1 DM,status post cholecystectomy several years ago,and obesity presented with nausea,vomiting,and abdominal *** vitals at the time of admission were *** physical examination,she had diffuse abdominal *** finger-stick glucose was 612 mg/dL with elevated ketones and low *** labs revealed abnormal liver studies:AST 1460 U/L,ALP:682 U/L,ALP:569 U/L,total bilirubin:0.3mg/dL,normal total protein,albumin,and prothrombin time/international normalized ratio(PT/INR).A magnetic resonance cholangiopancreatography(MRCP)demonstrated mild intra and extra-hepatic biliary ductal dilation without evidence of *** subsequently underwent a diagnostic ERCP which showed a moderately dilated CBD,for which a stent was *** for viral hepatitis,Wilson’s Disease,alpha-1-antitrypsin,and iron panel came back *** to waxing and waning transaminases during the hospital course,a liver biopsy was eventually done,revealing slightly enlarged hepatocytes that were PAS-positive,suggestive of glycogenic *** treatment of hyperglycemia and ensuing strict glycemic control,her transaminases improved,and she was *** With a negative hepatocellular and cholestatic work-up,our patient likely had GH,a close differential for NASH but a poorly recognized ***,first described in 1930 as a component of Mauriac syndrome,is believed to be due to glucose and insulin levels *** echo

关键词： Glycogen Mauriac Hepatic Steatosis Diabetes Type 1 Case report

New scoring system for acute chest pain risk stratification: Is it worth SVEAT-ing it?

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World Journal of Cardiology 2023年第4期15卷 200-204页

作者： Mahati Dasari Pramukh Arun Kumar yuvaraj Singh Eddison Ramsaran Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Cardiology Saint Vincent HospitalWorcesterMA 01608United States

The emergency room is a very potent environment in the *** the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at *** the spectrum of complaints,chest pain is the *** it being a daily ailment,chest pain brings concern to every physician at *** pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid *** often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical *** the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular ***,a new scoring system called SVEAT was developed and compared to the HEART *** have attempted to summarize how these scoring systems differ and their *** an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.

关键词： Chest pain Acute coronary syndrome SVEAT score HEART score TIMI score Risk stratification scores

Case-control analysis of venous thromboembolism risk in nonalcoholic steatohepatitis diagnosed by transient elastography

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World Journal of Clinical Cases 2023年第34期11卷 8126-8138页

作者： Mithil Gowda Suresh Maya Gogtay yuvaraj Singh Lekha Yadukumar Ajay Kumar Mishra George M Abraham Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Hematology and Oncology University of Nebraska Medical CenterOmahaNE 68198United States Department of Gastroenterology and Hepatology University of MassachusettsWorcesterMA 01605United States Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18505United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease *** have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein ***,there is paucity of data on the association of NASH and venous thromboembolism(VTE),with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized *** mechanism is believed to be a hepatocellular injury,which causes a chronic inflammatory state leading to the unregulated activation of procoagulant *** has been no prior analysis of the degree of steatosis and fibrosis(measured using transient elastography,commonly known as FibroScan)in NASH and its association with *** To examine the association between the degree of hepatic steatosis and fibrosis,quantified by transient elastography,and the incidence of VTE in patients with *** In our case-control study,we included patients with a documented diagnosis of *** excluded patients with inherited thrombophilia,hemoglobinopathy,malignancy,alcohol use disorder,autoimmune hepatitis,and primary biliary *** collected data included age,demographics,tobacco use,recreational drug use,medical history,and vibration controlled transient elastography ***-specific data included the location,type of anticoagulant,need for hospital stay,and history of VTE *** was categorized as S0-S1(mild)and S2-S3(moderate to severe)based on the controlled attenuation parameter *** was classified based on the kilopascal score and graded as F0-F1(Metavir stage),F2,F3,and F4(cirrhosis).χ^(2) and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses,***,we performed a logistic regression using VTE as the dependent *** A total of 415 patients were analyzed,and 386 met the inclusion criteria.51 and 335 patients were included

关键词： Nonalcoholic fatty liver disease Venous thromboembolism Non-alcoholic steatohepatitis Diabetes mellitus Liver fibrosis Steatosis Deep vein thrombosis Anticoagulation management

Hyperglycemia in COVID-19 infection without diabetes mellitus:Association with inflammatory markers

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World Journal of Clinical Cases 2023年第6期11卷 1287-1298页

作者： Harinivaas Shanmugavel Geetha Garima Singh Abinesh Sekar Maya Gogtay yuvaraj Singh George MAbraham Nitin Trivedi Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Hospice and Palliative Medicine University of Texas HealthSan AntonioTX 78229United States Department of Internal Medicine University of Massachusetts Chan Medical SchoolWorcesterMA 01655United States

BACKGROUND New onset hyperglycemia is common in patients with severe coronavirus disease 2019(COVID-19)*** storm due to COVID-19 infection is an essential etiology for new-onset hyperglycemia,but factors like direct severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-induced pancreaticβ-cell failure have also been postulated to play a *** We plan to investigate further the mechanisms underlying SARS-CoV-2 infection-induced hyperglycemia,particularly the rationale of the cytokine-induced hyperglycemia hypothesis,by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with COVID-19 *** We conducted a retrospective case-control study on adults without diabetes mellitus hospitalized for COVID-19 *** serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were *** was defined as glucose levels≥140 mg/dL.C-Reactive protein(CRP)≥100 mg/L,ferritin≥530 ng/mL,lactate dehydrogenase(LDH)≥590 U/L,and D-dimer≥0.5 mg/L were considered *** used theχ2 test for categorical variables and the Mann-Whitney U test for continuous variables and calculated the logistic regression for *** Of the 520 patients screened,248 met the inclusion *** demographics were equally distributed between patients with hyperglycemia and those who were *** inflammatory markers in patients with or without new-onset hyperglycemia were elevated as follows:CRP(58.1%vs 65.6%,P=0.29),ferritin(48.4%vs 34.9%,P=0.14),D-dimer(37.1%vs 37.1%,P=0.76)and LDH(19.4%vs 11.8%,P=0.02).Logistic regression analysis showed LDH odds ratio(OR)=1.623(P=0.256).We observed significantly higher mortality(24.2%vs 9.1%,P=0.001;OR=2.528,P=0.024)and length of stay(8.89 vs 6.69,P=0.026)in patients with *** Our study showed no association between CRP,ferritin,LDH,D-dimer levels,and new-onset hyperg

关键词： COVID-19 Inflammatory markers Hyperglycemia C-reactive protein Mortality Severity Mechanisms Diabetes mellitus

Virtual patient education for hypertension: The truth about behavioral change

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World Journal of Cardiology 2023年第6期15卷 324-327页

作者： Zeynep Yukselen yuvaraj Singh Sarat Malempati Mahati Dasari Pramukh Arun Kumar Eddison Ramsaran Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States School of Public Health and Health Sciences University of MassachusettsAmherstMA 01003United States Department of Cardiovascular Medicine Saint Vincent HospitalWorcesterMA 01608United States

Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the *** digital technologies for education as a part of preventive measures for hypertension is a cost-effective approach and helps low-income communities and vulnerable populations overcome barriers to healthcare *** coronavirus disease 19 pandemic further highlighted the need of new health interventions to address health *** education is helpful to improve awareness,knowledge,and attitude toward ***,given the complexity of behavioral change,educational approaches do not always provide a change in *** of the obstacles in online hypertensive education could be time limitations,not being tailored to individual needs and not including the different elements of behavioral models to enhance behavior *** regarding virtual education should be encouraged and involve lifestyle modifications emphasizing the importance of Dietary Approaches to Stop Hypertension diet,salt restriction,and exercise and should be used adjunct to in-person visits for the management of ***,to stratify patients according to hypertension type(essential or secondary)would be useful to create specific educational *** hypertension education is promising to increase awareness regarding risk factors and most importantly motivate patients to be more compliant with management helping to decrease hypertension related complications and hospitalizations.

关键词： Hypertension Virtual education Health promotion Public health Patient education Patient adherence Dietary approaches to stop hypertension diet

Influence of non-alcoholic fatty liver disease on non-variceal upper gastrointestinal bleeding:A nationwide analysis

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World Journal of Hepatology 2023年第1期15卷 79-88页

作者： Aakriti Soni Anuroop Yekula yuvaraj Singh Nitish Sood Dushyant Singh Dahiya Kannu Bansal GM Abraham Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Internal Medicine Medical College of GeorgiaAugusta UniversityAugustaGA 30912United States Department of Internal Medicine Central Michigan UniversitySaginawMI 48602United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of liver disease globally with an estimated prevalence of 25%,with the clinical and economic burden expected to continue to *** the United States,non-variceal upper gastrointestinal bleeding(NVUGIB)has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15%based on co-morbidity *** To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United *** We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United *** population was divided based on the presence and absence of *** characteristics,outcomes and complications were *** The total number of hospitalizations for NVUGIB was 799785,of which 6%were found to have *** and GIB was,on average,more common in younger patients,females,and Hispanics than GIB without ***,GIB was less common amongst blacks with *** logistic regression analysis was conducted,controlling for the multiple *** primary outcome of interest,mortality,was found to be significantly higher in patients with NAFLD and GIB[adjusted odds ratio(aOR)=1.018(1.013-1.022)].Secondary outcomes of interest,shock[aOR=1.015(1.008-1.022)],acute respiratory failure[aOR=1.01(1.005-1.015)]and acute liver failure[aOR=1.016(1.013-1.019)]were all more likely to occur in this *** with NAFLD were also more likely to incur higher total hospital charges(THC)[$2148($1677-$2618)];however,were less likely to have a longer length of stay[0.27 d(0.17-0.38)].Interestingly,in our study,the patients with NAFLD were less likely to suffer from acute myocardial infarction[aOR=0.992(0.989-0.995)].Patients with NAFLD were not more likely to suffer acute kidney injury,sepsis,blood transfusion,intubation,or *** NVUGIB in NAFLD hospitalizations had higher inpatient mortality,THC,and compli

关键词： Non-alcoholic fatty liver disease Non-variceal gastrointestinal bleeding Outcomes Mortality Complications