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Trends of alcoholic liver cirrhosis readmissions from 2010 to 2018:Rates and healthcare burden associated with readmissions

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World Journal of Hepatology 2021年第12期13卷 2128-2136页

作者： Asim Kichloo Zain El-Amir Dushyant Singh Dahiya farah wani Jagmeet Singh Dhanshree Solanki Ehizogie Edigin Precious Eseaton Asad Mehboob Hafeez Shaka Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48602United States Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Department of Internal Medicine Rutgers UniversityNew BrunswickNJ 07103United States Department of Internal Medicine John H Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine University of Benin School of MedicineEdo 300213Nigeria Division of Gastroenterology Department of Internal MedicineCovenant HealthcareSaginawMI 48602United States

BACKGROUND Alcoholic liver cirrhosis(ALC)is a chronic liver disease with varying disease *** of ALC are associated with poor *** To identify and assess trends of readmissions for ALC over an eight-year *** This retrospective interrupted trend study analysed 30-d readmissions of ALC in the United States from 2010 to 2018 using the National Readmissions *** for ALC was the reason for index admission obtained using the International Classification of Diseases codes(571.2 and K70.3X).Biodemographic characteristics and hospitalization trends were highlighted over time.A multivariate regression analysis model was used to calculate the trend for riskadjusted odds of 30-d all-cause ALC readmissions,ALC specific readmission rate,ALC readmission proportion,inpatient mortality,mean length of stay(LOS)and mean total hospital cost(THC)following adjustments for age,gender,grouped Charlson Comorbidity Index,insurance,mean household income,and hospital *** There was a trend towards increasing total 30-d readmissions of ALC from 7660 in 2010 to 15085 in 2018(P<0.001).Patients readmitted for ALC were noted to have an increasing comorbidity burden over *** noted a rise in the risk-adjusted 30-d all-cause readmission of ALC from 24.9%in 2010 to 29.9%in 2018(P<0.001).ALC-specific readmission rate increased from 6.3%in 2010 to 8.4%in 2018(P<0.001)while ALC readmission proportion increased from 31.4%in 2010 to 36.3%in 2018(P<0.001).Inpatient mortality for 30-d readmissions of ALC declined from 10.5%in 2010 to 8.2%in 2018(P=0.0079).However,there was a trend towards increasing LOS from 5.6 d in 2010 to 6.3 d in 2018(P<0.001)and increasing THC from 13790 dollars in 2010 to 17150 dollars in 2018(P<0.001).The total days of hospital stay attributable to 30-d readmissions of ALC increased by 119.2%while the total attributable hospital costs increased by 149%by the end of *** There was an increase in th

关键词： Alcoholic liver cirrhosis Readmissions Epidemiology Trends Mortality

Gastrointestinal amyloidosis: A focused review

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World Journal of Gastrointestinal Endoscopy 2021年第1期13卷 1-12页

作者： Dushyant Singh Dahiya Asim Kichloo Jagmeet Singh Michael Albosta farah wani Internal Medicine Central Michigan UniversitySaginawMI 48603United States Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Family Medicine Samaritan Medical CenterWatertownNY 13601United States

Amyloidosis,a heterogenous group of disorders,is characterized by the extracellular deposition of autologous,insoluble,fibrillar misfolded *** extracellular proteins deposit in tissues aggregated inß-pleated sheets arranged in an antiparallel fashion and cause distortion to the tissue architecture and *** the current literature,about 60 heterogeneous amyloidogenic proteins have been identified,out of which 27 have been associated with human *** as a rare disease,amyloidosis is known to have a wide range of possible etiologies and clinical *** exact incidence and prevalence of the disease is currently *** both systemic and localized amyloidosis,there is infiltration of the abnormal proteins in the layers of the gastrointestinal(GI)tract or the liver *** gold standard test for establishing a diagnosis is tissue biopsy followed by Congo Red staining and apple-green birefringence of the Congo Red-stained deposits under polarized ***,not all patients may have a positive tissue confirmation of the *** these cases additional workup and referral to a gastroenterologist may be *** with symptomatic management,the treatment for GI amyloidosis consists of observation or localized surgical excision in patients with localized disease,and treatment of the underlying pathology in cases of systemic *** this review of the literature,we describe the subtypes of amyloidosis,with a primary focus on the epidemiology,pathogenesis,clinical features,diagnosis and treatment strategies available for GI amyloidosis.

关键词： Gastroenterology Hepatology Amyloidosis Dysmotility Endoscopy Therapeutics

Telemedicine,the current COVID-19 pandemic and the future:a narrative review and perspectives moving forward in the USA

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Family Medicine and Community Health 2020年第3期8卷 50-58页

作者： Asim Kichloo Michael Albosta Kirk Dettloff farah wani Zain El-Amir Jagmeet Singh Michael Aljadah Raja Chandra Chakinala Ashok Kumar Kanugula Shantanu Solanki Savneek Chugh Internal Medicine Central Michigan University College of Medicine East CampusSaginawMichiganUSA Family Medicine Samaritan Medical CenterWatertownNew YorkUSA Medicine Geisinger Commonwealth School of MedicineScrantonPennsylvaniaUSA Internal Medicine Hurley Medical CenterFlintMichiganUSA Nephrology Westchester Medical CenterValhallaNew YorkUSA

A narrative review was conducted to examine the current state of the utilisation of telemedicine amid the current COVID-19 pandemic and to evaluate the benefits of continuing telemedicine usage in the future.A literature review was performed for articles related to *** including PubMed,Google Scholar,Cochrane Library and Ovid MEDLINE were *** reviewers independently performed article selection based on relevance to our *** included all articles between 1990 and 2020 related to telemedicine using the following keywords:‘telemedicine’,‘telehealth’,‘policy’,‘COVID-19’,‘regulation’,‘rural’,‘physical examination’,‘future’.A total of 60 articles were identified,and through careful selection we narrowed the final number of articles to 42 based on relevance to our *** has been rapidly evolving over the past several *** with regulation and reimbursement have prevented its full immersion into the healthcare *** the current pandemic,Centers for Medicare and Medicaid services have expanded access to telemedicine *** advantages of telemedicine moving forward include its cost-effectiveness,ability to extend access to specialty services and its potential to help mitigate the looming physician *** include lack of available technological resources in certain parts of the country,issues with security of patient data,and challenges in performing the traditional patient *** is critically important that changes are made to fully immerse telemedicine services into the healthcare landscape in order to be prepared for future pandemics as well as to reap the benefits of this service in the future.

关键词： services moving landscape

Emerging therapeutics in the management of COVID-19

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World Journal of Virology 2021年第1期10卷 1-29页

作者： Asim Kichloo Michael Albosta Akshay Kumar Michael Aljadah Mohamed Mohamed Zain El-Amir farah wani Shakeel Jamal Jagmeet Singh Akif Kichloo Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Central Michigan UniversitySaginawMI 48602United States Department of Cardiothoracic Surgery University of PittsburghPittsburghPA 15260United States Deparment of Internal Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Family Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Transplant Nephrology Geisinger Commonwealth School of MedicineSayrePA 18510United States Department of Anesthesiology and Critical Care Saraswathi Institue of Medical SciencesUttar Pradesh 245304India

Abstract The severe acute respiratory syndrome coronavirus 2(coronavirus disease 2019,COVID-19)pandemic has placed a tremendous burden on healthcare systems *** for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical ***,there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19.A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 *** used PubMed,Google Scholar,and *** to search for articles relative to the topic of *** used the following keywords:“COVID-19”,“therapeutics”,“clinical trials”,“treatment”,“FDA”,“ICU”,“mortality”,and“management”.In addition,searches through the references of retrieved articles was also *** this paper,we have elaborated on the therapeutic strategies that have been hypothesized or trialed todate,the mechanism of action of each therapeutic,the clinical trials finished or inprocess that support the use of each therapeutic,and the adverse effects associated with each ***,there is no treatment that has been proven to provide significant benefit in reducing morbidity and *** are many clinical trials for numerous different therapeutic agents currently *** looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research,we provide ourselves with the greatest opportunity to find treatments that are beneficial.

关键词： COVID-19 Therapeutics Infectious disease SARS-CoV-2 Pharmacology Virology

Systemic adverse effects and toxicities associated with immunotherapy:A review

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World Journal of Clinical Oncology 2021年第3期12卷 150-163页

作者： Asim Kichloo Michael Albosta Dushyant Dahiya Jean Claude Guidi Michael Aljadah Jagmeet Singh Hafeez Shaka farah wani Akshay Kumar Manidhar Lekkala Department of Internal Medicine Central Michigan UniversitySaginawMI 48603United States Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Medical College of WisconsinMilwaukeeWI 53201United States Department of Nephrology Guthrie Robert Packer HospitalSayrePA 18840United States Department of Internal Medicine John H Stroger Jr.Hospital of Cook CountyChicagoIL 60612United States Department of Family Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Surgery University of PittsburghPittsburghPA 15213United States Department of Hematology and Oncology University of Rochester Medical CenterRochesterNY 14642United States

Immunotherapy is rapidly evolving secondary to the advent of newer immunotherapeutic agents and increasing approval of the current agents by the United States Food and Drug Administration to treat a wide spectrum of *** agents have gained immense popularity due to their tumorspecific *** is slowly transforming into a separate therapeutic entity,and the fifth pillar of management for cancers alongside surgery,radiotherapy,chemotherapy,and targeted ***,like any therapeutic entity it has its own adverse *** the increasing use of immunotherapeutic agents,it is vital for physicians to acquaint themselves with these adverse *** aim of this review is to investigate the common systemic adverse effects and toxicities associated with the use of different classes of immunotherapeutic *** provide an overview of potential adverse effects and toxicities associated with different classes of immunotherapeutic agents organized by organ systems,as well as an extensive discussion of the current recommendations for treatment and clinical trial *** we continue to see increasing usage of these agents in clinical practice,it is vital for physicians to familiarize themselves with these effects.

关键词： Immunotherapy Cancer Malignancy Adverse effects Immune checkpoint inhibitor Monoclonal antibody

Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population

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World Journal of Gastrointestinal Pathophysiology 2021年第2期12卷 14-24页

作者： Asim Kichloo Shantanu Solanki Khwaja F Haq Dushyant Dahiya Beth Bailey Dhanshree Solanki Jagmeet Singh Michael Albosta farah wani Michael Aljadah Harshil Shah Hafiz Khan Syed-Mohammed Jafri Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48602United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Department of Gastroenterology Henry Ford HospitalDetroitMI 48202United States Health Administration Rutgers UniversityNew BrunswickNJ 08901United States Department of Nephrology Guthrie Robert Packer HospitalSayrePA 18840United States Family Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Gastroenterology Guthrie Robert Packer HospitalSayrePA 18840United States

BACKGROUND Gallstones and cholecystectomy have been proposed as risk factors for nonalcoholic fatty liver disease(NAFLD).The reason for this may be that both gallstones,as well as NAFLD share several risk factors with regards to their ***,there is a lack of sufficient evidence showing an association between these clinical *** To determine whether there is a meaningful association between gallstones and cholecystectomy with *** We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases,10th revision,Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease(GSD)(includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder)as well as NAFLD(includes simple fatty liver and non-alcoholic steatohepatitis).Odds ratios(ORs)measuring the association between GSD(includes gallstones and cholecystectomy)and NAFLD were calculated using logistic regression after adjusting for confounding *** Out of 14294784 hospitalizations in 2016-2017,159259 were found to have *** prevalence of NAFLD was 3.3%in patients with GSD and 1%in those *** was prevalent in 64.3%of women with GSD as compared to 35.7%of men with *** controlling for various confounders associated with NAFLD and GSD,multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones[OR=6.32;95%confidence interval(CI):6.15-6.48]as well as cholecystectomy(OR=1.97;95%CI:1.93-2.01).The association between NAFLD and gallstones was stronger in men(OR=6.67;95%CI:6.42-6.93)than women(OR=6.05;95%CI:5.83-6.27).The association between NAFLD and cholecystectomy was stronger in women(OR=2.01;95%CI:1.96-2.06)than men(OR=1.85;95%CI:1.79-1.92).P value was less than 0.001 for all *** NAFLD is more prevalent in women with GSD than *** association between N

关键词： Gallstones Non-alcoholic fatty liver disease Gastroenterology Hepatology Non-alcoholic steatohepatitis Cholecystectomy