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Lupus enteritis as the only active manifestation of systemic lupus erythematosus: A case report

World Journal of Clinical Cases 2019年第11期7卷 1315-1322页

作者： Adalberto Gonzalez vaibhav wadhwa Fayssa Salomon Jeevna Kaur Fernando J Castro Department of Internal Medicine Cleveland Clinic Florida Weston FL 33331 United States Department of Gastroenterology and Hepatology Cleveland Clinic Florida Weston FL 33331 United States

BACKGROUND Lupus enteritis is a rare manifestation of systemic lupus erythematosus (SLE). Diagnosis of this condition is difficult, especially in the absence of other symptoms related to active SLE. We present the case of a 25-year-old female with lupus enteritis as the sole initial manifestation of active SLE. CASE SUMMARY A 25-year-old African American female presented to the Emergency Department complaining of diffuse abdominal pain, diarrhea, nausea, and vomiting for 2 days. Her past medical history was significant for seasonal allergies and family history was pertinent for discoid lupus in her father and SLE in a cousin. The patient’s vital signs on presentation were normal. Her physical exam was remarkable for significant lower abdominal tenderness without guarding or rigidity. A computed tomography of the abdomen and pelvis revealed marked circumferential wall thickening and edema of the proximal and mid small bowel predominantly involving the submucosa. Our main differential diagnoses were intestinal angioedema and mesenteric vein thrombosis. However, mesenteric vessels were patent, and laboratory testing for hereditary angioedema showed a normal C1 Esterase Inhibitor level and low C3 and C4 levels. Infectious work-up was negative. Autoimmune tests showed elevated anti-nuclear antibodies (ANA)(13.6), anti-Smith antibody, and anti-ribonucleoprotein (anti-RNP) antibody. The patient was diagnosed with SLE enteritis. She was maintained on bowel rest, given intravenous hydration, and started on methylprednisolone 60 mg IV daily. She had significant improvement in her abdominal pain, diarrhea, and emesis after 2 days of treatment. Steroids were tapered and maintained on Hydroxychloroquine with no relapses one year after *** This case of lupus enteritis represents a rare manifestation of SLE. Diagnosis requires clinical suspicion, characteristic imaging and laboratory tests. Endoscopic appearance and biopsies usually yield non-specific findings.

关键词： Lupus enteritis Systemic lupus erythematous Abdominal pain Hereditary angioedema Case report

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Healthcare utilization and costs associated with gastroparesis

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World Journal of Gastroenterology 2017年第24期23卷 4428-4436页

作者： vaibhav wadhwa Dhruv Mehta Yash Jobanputra Rocio Lopez Prashanthi N Thota Madhusudhan R Sanaka Department of Internal Medicine Fairview HospitalCleveland Clinic Department of Internal Medicine Westchester Medical Center Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland Clinic Center for Advanced Endoscopy Digestive Disease InstituteCleveland Clinic

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient cost

关键词： Inpatient admission rates Gastroparesis Cancer epidemiology National inpatient database

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Nationwide trends of hospital admissions for acute cholecystitis in the United States

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Gastroenterology Report 2017年第1期5卷 36-42,I0002页

作者： vaibhav wadhwa Yash Jobanputra Sushil K Garg Soumil Patwardhan Dhruv Mehta Madhusudhan R.Sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicOHUSA Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Internal Medicine University of MinnesotaMinneapolisMNUSA Department of Internal Medicine University of MassachusettsWorcesterMAUSA Department of Internal Medicine Westchester Medical CenterValhallaNYUSA

Background and aims:Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal *** aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute ***:We analyzed the National Inpatient Sample Database(NIS)for all patients in which acute cholecystitis(ICD-9 codes:574.00,574.01,574.30,574.31,574.60,574.61 or 575.0)was the principal discharge diagnosis from 1997 to *** NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each *** statistical significance of the difference in the number of hospital discharges,lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for ***:In 1997,there were 149661 hospital admissions with a principal discharge diagnosis of acute cholecystitis,which increased to 215995 in 2012(P<0.001).The mean length of stay for acute cholecystitis decreased by 17% between 1997 and 2012(*** 4.7 days to 3.9 days);(P<0.05).During the same time period,however,mean hospital charges have increased by 195.4% from US$14608 per patient in 1997 to US$43152 per patient in 2012(P<0.001).Conclusion:The number of inpatient discharges related to acute cholecystitis has increased significantly in the United States over the last 16 years,along with a great increase in the associated hospital ***,there has been a gradual decline in the mean length of *** costs associated with acute cholecystitis contribute significantly to the total healthcare *** research on cost-effective evaluation and management of acute cholecystitis is required.

关键词： inpatient admission rates acute cholecystitis epidemiology trends

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Healthcare utilization and costs associated with cholangiocarcinoma

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Gastroenterology Report 2017年第3期5卷 213-218,I0002页

作者： vaibhav wadhwa Yash Jobanputra Prashanthi N.Thota KVNarayanan Menon Mansour A.Parsi Madhusudhan R.Sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOhio Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicOhio

Background and *** is a rare but devastating malignancy associated with a poor prognosis and a high mortality *** the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United *** aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the *** utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge *** temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for *** was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in *** in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).*** was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and ***,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.

关键词： cholangiocarcinoma inpatient admissions hospital charges in-hospital mortality epidemiology

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Endometriosis mimicking colonic stromal tumor

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Gastroenterology Report 2016年第3期4卷 257-259,I0003页

作者： vaibhav wadhwa Eoin Slattery Sagar Garud Saurabh Sethi Helen Wang Vitaliy YPoylin Tyler M.Berzin Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOHUSA Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Department of Pathology Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Department of Surgery Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA

Endometriosis is defined as the presence of endometrial glands and stroma at extra-uterine sites;it is a common disease affecting women of reproductive *** tissue can implant itself to various organs,including the gastrointestinal tract,and can cause significant gastrointestinal *** ectopic endometrial tissue implants are usually located in the pelvis but can be present almost anywhere in the *** seems to be the most frequent cause of chronic pelvic pain in women of reproductive age and may cause prolonged suffering and disability that negatively affect health-related quality of *** report a case in a generally healthy young female patient who presented for evaluation of diarrhea.

关键词： endometriosis gastrointestinal stromal tumor pathology

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Novel device for monitoring respiratory rate during endoscopy-A thermodynamic sensor

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2019年第3期10卷 57-66页

作者： vaibhav wadhwa Adalberto J Gonzalez Kristen Selema Ronen Feldman Rocio Lopez John J Vargo Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33324United States Department of Internal Medicine Cleveland Clinic FloridaWestonFL 33331United States Department of Technology Artep IncorporatedElliot CityMD 21042United States Department of Quantitative Health Sciences Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology and Hepatology Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH 44195United States

BACKGROUND Monitoring ventilation accurately is an indispensable aspect of patient care in procedural *** current gold standard method of monitoring ventilation is by measuring exhaled carbon dioxide concentration,known as capnography.A new device utilizing thermodynamic measurement,the Linshom Respiratory Monitoring Device(LRMD),has been designed to measure respiratory rate(RR)by using the temperature of exhaled *** hypothesized that the temperature sensor is at least equivalent in accuracy to capnography in monitoring *** To determine if the temperature sensor is equivalent to capnography in monitoring procedural *** In this prospective study,participants were individually fitted with a face mask monitored by both LRMD and *** following data were collected:gender,age,body mass index,type of procedure,and doses of *** each patient,we report the mean RR for each device as well as the mean *** analyses were performed using SAS,and a P<0.05 was considered statistically *** Twelve consecutive patients undergoing endoscopic procedures at our institution were *** patients were excluded due to incomplete data,inadequate data,patient cooperation,and capnography ***,we found that LRMD RR highly correlated to capnography RR(P<0.001);the average capnography RR increases by 0.66 breaths for every one additional breath measured by the *** addition,apnea rates were 7.4%for the capnography and 6.4%for the LRMD(95%confidence interval:0.92-1.10).CONCLUSION The LRMD correlated with the gold standard capnography with respect to respiratory rate detection and apnea *** LRMD could be used as an alternative to capnography for measuring respiration in endoscopy.

关键词： Sedation Capnography Linshom Thermodynamic sensor Endoscopy

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Endoscopic retrograde cholangiopancreatography-related early perforations:A study of effects of procedure duration,complexity,and endoscopist experience

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World Journal of Gastrointestinal Endoscopy 2023年第11期15卷 641-648页

作者： Mark Aloysius Hemant Goyal Tejas Nikumbh Niraj James Shah Ghassan M Hammoud Pritesh Mutha Mairin Joseph-Talreja Savio John Ganesh Aswath vaibhav wadhwa Nirav Thosani Division of Gastroenterology Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseNY13210United States Department of Surgery The University of Texas Health Science CenterHoustonTX 77030United States Department of Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18510United States Department of Medicine Division of Digestive DiseasesThe University of Missouri at ColumbiaColumbiaMO 65211United States Division of Gastroenterology Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseNY 13210United States

BACKGROUND Perforations(Perf)during endoscopic retrograde cholangiopancreatography(ERCP)are rare(<1%)but potentially fatal events(up to 20%mortality).Given its rarity,most data is through case series studies from centers or analysis of large *** a meta-analysis has shown fewer adverse events as a composite(bleeding,pancreatitis,Perf)during ERCP performed at high-volume centers,there is very little real-world data on endoscopist and center procedural volumes,ERCP duration and complexity on the occurrence of *** To study the profile of Perf related to ERCP by center and endoscopist procedure volume,ERCP time,and complexity from a national endoscopic *** from clinical outcomes research initiative-national endoscopic database(2000-2012)who underwent ERCP were stratified based on the endoscopist and center volume(quartiles),and total procedure duration and complexity grade of the ERCP based on procedure *** effects of these variables on the Perf that occurred were *** variables were compared between Perf and no perforations(NoPerf)using the Mann-Whitney U test as the data demonstrated significant skewness and *** A total of 14153 ERCPs were performed by 258 endoscopists,with 20 reported Perf(0.14%)among 16 *** patient age in years 61.6±14.8 vs 58.1±18.8(Perf ***,P=NS).The cannulation rate was 100%and 91.5%for Perf and NoPerf groups,respectively.13/20(65%)of endoscopists were high-volume performers in the 4th quartile,and 11/20(55%)of Perf occurred in centers with the highest volumes(4th quartile).Total procedure duration in minutes was 60.1±29.9 vs 40.33±23.5(Perf vs NoPerf,P<0.001).Fluoroscopy duration in minutes was 3.3±2.3 vs 3.3±2.6(Perf vs NoPerf P=NS).50%of the procedures were complex and greater than grade 1 difficulty.3/20(15%)patients had prior biliary surgery.13/20(65%)had sphincterotomies performed with stent *** occurred in only 1/20(0.5%).CONCLUSION

关键词： Endoscopic retrograde cholangiopancreatography Endoscopy complications Perforations

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Ameta-analysis on efficacy and safety:single-balloon ***-balloon enteroscopy

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Gastroenterology Report 2015年第2期3卷 148-155页

作者： vaibhav wadhwa Saurabh Sethi Sumeet Tewani Sushil Kumar Garg Douglas K.Pleskow Ram Chuttani Tyler M.Berzin Nidhi Sethi Mandeep S.Sawhney Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOHUSA Division of Gastroenterology Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Division of Basic and Translational Research Department of SurgeryUniversity of MinnesotaMinneapolisMNUSA

Background and aim:Double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)are new techniques capable of providing deep *** of individual studies comparing these techniques have not been able to identify a superior *** aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small ***:Databases were searched,including PubMed,Embase,and the Cochrane Central Register of Controlled *** main outcome measures were complete small-bowel visualization,diagnostic yield,therapeutic yield,and complication *** analysis was performed using Review Manager(RevMan version 5.2).Meta-analysis was performed using fixed-effect or random-effect methods,depending on the absence or presence of significant *** used the v2 and I2 test to assess heterogeneity between *** were expressed as risk ratios(RR)or mean differences with 95%confidence intervals(CI).Results:Four prospective,randomized,controlled trials with a total of 375 patients were *** was superior to SBE for visualization of the entire small bowel[pooled RR=0.37(95%CI:0.19–0.73;P=0.004)].DBE and SBE were similar in ability to provide diagnosis[pooled RR=0.95(95%CI:0.77–1.17;P=0.62)].There was no significant difference between DBE and SBE in therapeutic yield[pooled RR=0.78(95%CI:0.59–1.04;P=0.09)]and complication rate[pooled RR=1.08(95%CI:0.28–4.22);P=0.91].Conclusions:DBE was superior to SBE with regard to complete small bowel *** was similar to SBE with regard to diagnostic yield,ability to provide treatment and complication rate,but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low tomoderate,due to the small sample size.

关键词： small bowel enteroscopy single-balloon enteroscopy double-balloon enteroscopy meta-analysis outcomes

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Multidisciplinary approach toward enhanced recovery after surgery for total knee arthroplasty improves outcomes

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World Journal of Clinical Cases 2024年第9期12卷 1549-1554页

作者： Deb Sanjay Nag Amlan Swain Seelora Sahu Ayaskant Sahoo Gunjan wadhwa Department of Anaesthesiology Tata Main HospitalJamshedpur 831001India Department of Anaesthesiology Manipal Tata Medical CollegeJamshedpur 831001India

Knee osteoarthritis is a degenerative disorder of the knee,which leads to joint pain,stiffness,and inactivity and significantly affects the quality of *** an increased prevalence of obesity and greater life expectancies,total knee arthroplasty(TKA)is now one of the major arthroplasty surgeries performed for knee *** enhanced recovery after surgery(ERAS)was introduced in TKA,clinical outcomes were enhanced and the economic burden on the healthcare system was *** is an evidence-based scientific protocol aimed at ameliorating the surgical stress *** aims to enhance the recovery phase,which encompasses multidisciplinary strategies at every step of perioperative care,including the rehabilitation *** of ERAS in TKA aids in reducing the length of hospital stay,improving pain management,reducing perioperative complications,and enhancing patient *** collaboration,integrating the expertise of anesthesiologists,orthopedic surgeons,nursing personnel,and other healthcare professionals,is the cornerstone of ERAS in patients undergoing TKA.

关键词： Arthroplasty Replacement Knee Recovery of function Anesthesia Care Nursing

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Targeting brain tumors with innovative nanocarriers:bridging the gap through the blood-brain barrier

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Oncology Research 2024年第5期32卷 877-897页

作者： KARAN wadhwa PAYAL CHAUHAN SHOBHIT KUMAR RAKESH PAHWA RAVINDER VERMA RAJAT GOYAL GOVIND SINGH ARCHANA SHARMA NEHA RAO DEEPAK KAUSHIK Department of Pharmaceutical Sciences Maharshi Dayanand UniversityRohtak124001India Department of Pharmaceutical Technology Meerut Institute of Engineering and Technology(MIET)NH-58Delhi-Roorkee HighwayMeerut250005India Institute of Pharmaceutical Sciences Kurukshetra UniversityKurukshetra136119India Department of Pharmaceutical Sciences Chaudhary Bansi Lal UniversityBhiwani127021India MM College of Pharmacy Maharishi Markandeshwar(Deemed to be University)Mullana-AmbalaHaryana133207India Delhi Pharmaceutical Sciences and Research University(DIPSAR) Delhi Pharmaceutical Sciences and Research UniversityNew Delhi110017India

Background:Glioblastoma multiforme(GBM)is recognized as the most lethal and most highly invasive *** high likelihood of treatment failure arises fromthe presence of the blood-brain barrier(BBB)and stemcells around GBM,which avert the entry of chemotherapeutic drugs into the ***:Recently,several researchers have designed novel nanocarrier systems like liposomes,dendrimers,metallic nanoparticles,nanodiamonds,and nanorobot approaches,allowing drugs to infiltrate the BBB more efficiently,opening up innovative avenues to prevail over therapy problems and radiation ***:Relevant literature for this manuscript has been collected from a comprehensive and systematic search of databases,for example,PubMed,Science Direct,Google Scholar,and others,using specific keyword combinations,including“glioblastoma,”“brain tumor,”“nanocarriers,”and several ***:This review also provides deep insights into recent advancements in nanocarrier-based formulations and technologies for GBM *** of various scientific advances in conjunction with encouraging findings concerning the future perspectives and challenges of nanocarriers for effective brain tumor management has also been discussed.

关键词： Glioblastoma Brain tumor Blood-brain barrier Liposomes Metallic nanoparticles Nanocarriers

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