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

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

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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

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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

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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

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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

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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

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Detection of colorectal adenomas using artificial intelligence models in patients with chronic hepatitis C

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World Journal of Hepatology 2023年第1期15卷 107-115页

作者： yuvaraj singh Maya Gogtay Anuroop Yekula Aakriti Soni Ajay Kumar Mishra Kartikeya Tripathi GM Abraham Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Hospice and Palliative Medicine University of Texas Health-San AntonioSan AntonioTX 78201United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States Division of Gastroenterology and Hepatology UMass Chan School-Baystate Medical CenterSpringfieldMA 01199United States Division of Infectious Disease Chief of MedicineSaint Vincent HospitalWorcesterMA 01608United States

BACKGROUND Hepatitis C virus is known for its oncogenic potential,especially in hepatocellular carcinoma and non-Hodgkin *** studies have shown that chronic hepatitis C(CHC)has an increased risk of the development of colorectal cancer(CRC).AIM To analyze this positive relationship and develop an artificial intelligence(AI)-based tool using machine learning(ML)algorithms to stratify these patient populations into risk groups for CRC/adenoma *** To develop the AI automated calculator,we applied ML to train models to predict the probability and the number of adenomas detected on *** sets were split into 70:30 ratios for training and internal *** Scikit-learn standard scaler was used to scale values of continuous *** findings were used as the gold standard and deep learning architecture was used to train six ML models for prediction.A Flask(customizable Python framework)application programming interface(API)was used to deploy the trained ML model with the highest accuracy as a web ***,Heroku was used for the deployment of the web-based API to https://*** Of 415 patients,206 had colonoscopy *** internal validation,the Bernoulli naive Bayes model predicted the probability of adenoma detection with the highest accuracy of 56%,precision of 55%,recall of 55%,and F1 measure of 54%.Support vector regressor predicted the number of adenomas with the least mean absolute error of *** Our AI-based tool can help providers stratify patients with CHC for early referral for screening *** with providing a numerical percentage,the calculator can also comment on the number of adenomatous polyps a gastroenterologist can expect,prompting a higher adenoma detection rate.

关键词： Machine learning Calculator Artificial intelligence Hepatitis C Screening

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Retrospective analysis of aspirin's role in the severity of COVID-19 pneumonia

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World Journal of Critical Care Medicine 2022年第2期11卷 92-101页

作者： Maya Gogtay yuvaraj singh Asha Bullappa Jeffrey Scott Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01604United States Community Medicine and Biostatistics SS Institute of Medical SciencesDavangere 577003KarnatakaIndia Department of Critical Care Medicine and Pulmonology Reliant medical group-Saint Vincent HospitalWorcesterMA 01604United States

BACKGROUND Since December 2019,an outbreak of pneumonia caused by severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)has led to a life-threatening ongoing pandemic worldwide.A retrospective study by Chow et al showed aspirin use was associated with decreased intensive care unit(ICU)admissions in hospitalized coronavirus disease 2019(COVID-19)***,the RECOVERY TRIAL showed no associated reductions in the 28-d mortality or the progression to mechanical ventilation of such *** these conflicting findings,our study was aimed at evaluating the impact of daily aspirin intake on the outcome of COVID-19 *** To study was aimed at evaluating the impact of daily aspirin intake on the outcome of COVID-19 *** This retrospective cohort study was conducted on 125 COVID-19 positive *** analysis to evaluate the association of demographics and comorbidities was *** impact of chronic aspirin use was assessed on the survival outcomes,need for mechanical ventilation,and progression to *** were evaluated using the chi-square test and multinomial logistic regression *** 125 patients were studied,30.40%were on daily aspirin,and 69.60%were ***-tabulation of the clinical parameters showed that hypertension(P=0.004),hyperlipidemia(0.016),and diabetes mellitus(P=0.022)were significantly associated with aspirin *** analysis for progression to the ICU,need for mechanical ventilation and survival outcomes against daily aspirin intake showed no statistical *** Our study suggests that daily aspirin intake has no protective impact on COVID-19 illnessassociated survival outcomes,mechanical ventilation,or progression to ICU level of care.

关键词： COVID-19 Aspirin Intensive care unit progression Antiplatelet Hyper-coagulability Antiinflammatory

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Retrospective study evaluating association of colorectal tumors and hepatitis C virus

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World Journal of Virology 2024年第3期13卷 56-64页

作者： Maya Gogtay Lekha Yadukumar yuvaraj singh Mithil Gowda Suresh Aakriti Soni Anuroop Yekula Asha Bullappa George M Abraham Department of Hematology and Oncology Internal MedicineUniversity of Nebraska Medical CenterOmahaNE 68198United States Department of Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18505United States Department of Gastroenterology and Hepatology University of Massachusetts Chan Medical SchoolWorcesterMA 01605United States Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Internal Medicine St.Vincent HospitalWorcesterMA 01608United States Department of Community Medicine SS Institute of Medical Sciences and Research CentreDavangere 577003KarnatakaIndia

BACKGROUND Chronic hepatitis C virus(HCV)has been associated with hepatic and extrahe-patic *** studies have shown an association between colorectal adenomas and HCV *** To study the prevalence of colorectal adenomas in patients with HCV compared to the general population and to evaluate if it is an independent risk factor for colorectal *** Patients were divided into HCV and non-HCV based on their HCV RNA *** with alcoholic liver disease,hepatitis B infection,and inflammatory bowel disease were *** variables were analyzed using the Mann-Whitney U test,and categorical variables usingχ^(2) with P<0.05 were considered statistically *** significant covariates(independent variables)were matched in both groups by propensity score matching,followed by multivariate regression *** Of the 415 patients screened,109 HCV patients and 97 non-HCV patients with colonoscopy results were included in the *** patients were older,had a smoking history,had less frequent aspirin use,and had a lower body mass index(BMI)(P<0.05).The HCV cohort had a significantly increased number of patients with adenomas(adenoma detection rate of 53.2%vs 34%.P=0.006).We performed a propensity-matched multivariate analysis where HCV infection was significantly associated with colorectal adenoma(OR:2.070,P=0.019).CONCLUSION Our study shows a significantly higher rate of adenomas in HCV patients compared to the general *** studies would help determine if the increase in adenoma detection lowers the risk for colorectal cancer.

关键词： Hepatitis C Colon cancer Adenoma Polyps Colonoscopy

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Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

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World Journal of Virology 2023年第5期12卷 286-295页

作者： Harinivaas Shanmugavel Geetha Sushmita Prabhu Abinesh Sekar Maya Gogtay yuvaraj singh Ajay K Mishra George M Abraham Suzanne Martin Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Hospice and Palliative Medicine University of Texas Health-San AntonioSan AntonioTX 78201United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States Department of Nephrology Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal *** To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and *** We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-Ⅴ*** primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no *** analyses used unpaired t-test for continuous variables and chi-square analysis for categorical *** for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/*** 290 were screened,and 118 met the inclusion ***,D-dimer,and ferritin were significantly different among the three *** univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD *** AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-Ⅴ*** may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

关键词： Coronavirus disease 2019 Chronic kidney disease Inflammatory markers C-reactive protein Invasive mechanical ventilation Non-invasive mechanical ventilation

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