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Early antiplatelet therapy used for acute ischemic stroke and intracranial hemorrhage

World Journal of Clinical Cases 2024年第4期12卷 677-680页

作者： Venkata Buddhavarapu rahul kashyap Salim Surani Department of Medicine Banner Baywood Medical CenterMesaAZ 85206United States Department of Research Wellspan HealthYorkPA 17403United States Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical *** evaluate their claims on the benefit of use of Aspirin in the early management of patients with ischemic *** also comment on their contention of using aspirin in the early management of patients with intracranial hemorrhage,a practice not seen in modern *** clinical trials such as the International Stroke Trial and the Chinese Acute Stroke Trial have shown the benefit of Aspirin use within 48 h of patients with Acute Ischemic *** findings were corroborated in the open-label trial performed by Zhang et al in a smaller sample group of 25 patients where they showed improvement in functional scores at 90 days without an increase in adverse *** such,this intervention is also recommended by the American Heart Association stroke guidelines from *** regard to Intracranial hemorrhage,traditional practice has been to discontinue or avoid antiplatelet therapy in these patient ***,no studies have been done to evaluate this management strategy that is more borne out of the mechanism behind Aspirin’s effect on the coagulation *** et al evaluate the benefits of Aspirin on patients with low-volume intracranial hemorrhage,i.e.,less than 30 mL on computed tomo-graphy imaging,and show no increase in *** caveat of this finding is that all outcomes were pooled into one group for results,and the number of patients was *** more studies with larger patient groups are required,the data from Zhang et al suggests that patients with small-volume intracranial hemorrhages may benefit from Aspirin administration in the acute phase of management.

关键词： Aspirin Ischemic stroke Intracranial hemorrhage CVA Antiplatelet therapy

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Safety of teplizumab in patients with high-risk for diabetes mellitus type 1:A systematic review

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World Journal of Diabetes 2024年第8期15卷 1793-1801页

作者： Venkata Buddhavarapu Gagandeep Dhillon Harpreet Grewal Pranjal Sharma rahul kashyap Salim Surani Department of Medicine Banner Baywood Medical CenterBanner HealthMesaAZ 85206United States Department of Medicine UM Baltimore Washington Medical CenterGlen BurnieMD 21061United States Department of Radiology Ascension Sacred Heart HospitalPensacolaFL 32504United States Department of Medicine Northeast Ohio Medical CenterRootstownOH 44272United States Department of Research Wellspan HealthYorkPA 17403United States Anesthesiology Mayo ClinicRochesterMN 55905United States Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-CD4 antibody,Teplizumab,has been shown to delay the progression of DM1 and is the only medication approved for this ***,more information is needed about the safety profile of this *** To identify the odds ratios(OR)of systems-based adverse effects for Teplizumab when compared to *** An extensive systematic review was conducted from the inception of the medication until December 31,*** clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial *** study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO(ID:CRD42024496169).Crude OR were generated using RevMan Software version *** After screening and review,5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo.A total of 561 patients were included in the study *** adverse effects and system-based adverse effects were studied and *** determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal(GI)(OR=1.60,95%CI:1.01-2.52,P=0.04),dermatological(OR=6.33,95%CI:4.05-9.88,P<0.00001)and hematological adverse effects(OR=19.03,95%CI:11.09-32.66,P<0.00001).These patients were also significantly likely to have active Epstein-Barr Virus infection(OR=3.16,95%CI:1.51-6.64,P<0.002).While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo,this finding did not reach statistical significance(OR=2.25,95%CI:0.80-6.29,P=0.12).CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects,primarily related to GI,dermatological,and hematolog

关键词： Teplizumab Diabetes mellitus type 1 Adverse effects Monoclonal antibody Systematic review

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21st century critical care medicine:An overview

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World Journal of Critical Care Medicine 2024年第1期13卷 1-14页

作者： Smitesh Padte Vikramaditya Samala Venkata Priyal Mehta Sawsan Tawfeeq rahul kashyap Salim Surani Department of Research Global Remote Research Scholars ProgramSt.PaulMN 55104United States Department of Hospital Medicine Cheshire Medical Center/Dartmouth HealthKeeneNH 03431United States Department of Research WellSpan HealthYorkPA 17403United States Department of Pulmonary&Critical Care Medicine Mayo ClinicRochesterMN 55905United States Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of *** advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of *** objective is to describe the recent advancements in Critical Care ***:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely *** intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical *** Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ *** Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated *** Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung *** Management:Early recognition and aggressive management of sepsis with tailored ***-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical *** conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative *** ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abs

关键词： Critical care medicine Intensive care unit Precision medicine Telemedicine Artificial intelligence Organ support Sepsis Infection control Patient-centered care

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Violence study of healthcare workers and systems in the Caribbean:ViSHWaS-Caribbean study

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World Journal of Methodology 2024年第3期14卷 106-118页

作者： Reshon Hadmon Daniella Myriam Pierre Akshat Banga Jacques W Clerville Hans Mautong Precious Akinsanya Rajat Das Gupta Sama Soliman Tolupe M Hunjah Bamidele A Hunjah Hafeez Hamza Ruman Khurshid Qasba Faisal A Nawaz Salim Surani rahul kashyap Department of Medicine St.George University School of MedicineGrenada FZ818West Indies Department of Research Global Remote Research Scholar ProgramSt PaulMN 55101United States Department of Public Health Cuny Graduate School of Public Health and Health PolicyNew YorkNY 10027United States Department of Internal Medicine Sawai Man Singh Medical CollegeJaipur 302004India School of Public Health Georgia State UniversityAtlantaGA 30302United States Department of Sociology and Demography School of HealthUniversidad de Especialidades Espiritu SantoSamborondon 092301Ecuador Department of Medicine Holy Name Medical CenterTeaneckNJ 07666United States Department of Epidemiology and Biostatistics University of South CarolinaColumbiaSC 29208United States Department of Medicine Pavlov First State Medical University of St PetersburgSankt-Peterburg 197022Russia Department of Medicine University of SuffolkIpswich IP41QJUnited Kingdom Department of Medicine Unicaf University of ZambiaLusaka 20842Zambia Department of Pharmacy School of PharmacyGirne 99428Cyprus Department of Medicine Sher-i-KashmirInstitute of Medical ScienceSrinagar 190011India Department of Psychiatry Al Amal Psychiatric HospitalEmirates Health ServicesDubaiUnited Arab Emirates Department of Medicine and Pharmacology Texas A and M UniversityCollege StationTX 77843United States Anesthesiology and Critical Care Mayo ClinicRochesterMN 55905United States Department of Research Wellspan HealthYorkPA 17403United States

BACKGROUND Violence against healthcare workers(HCWs)in the Caribbean continues to prevail yet remains *** aim is to determine the cause,traits,and consequences of violence on HCWs in the *** To determine the cause,traits,and consequences of violence on HCWs in the *** This research adopted an online cross-sectional survey approach,spanning over eight weeks(between June 6th and August 9th,2022).The survey was generated using Research Electronic Data Capture forms and followed a snowballing strategy to contact individuals using emails,social media,text messages,*** regression analysis was performed to evaluate the variables that influence violence,including gender,age,years of experience,institution type,and night shift *** The survey was completed by 225 *** comprised 61%.Over 51%of respondents belonged to the 21 to 35 age ***(n=61),Haiti(n=50),and Grenada(n=31)had the most *** HCWs(49%)worked for government academic institutions,followed by community hospitals(23%).Medical students(32%),followed by attending physicians(22%),and others(16%)comprised the most common cadre of *** 39%of the participants reported experiencing violence themselves,and 18%reported violence against colleague(s).Verbal violence(48%),emotional abuse(24%),and physical misconduct(14%)were the most common types of *** 63%of respondents identified patients or their relatives as the most frequent *** logistic regression analyses demonstrated that female gender(OR=2.08;95%CI:1.16-3.76,P=0.014)and higher frequency of night shifts(OR=2.22;95%CI:1.08-4.58,P=0.030)were associated with significantly higher odds of experiencing *** than 50%of HCWs felt less motivated and had decreased job satisfaction post-violent *** A large proportion of HCWS in the Caribbean are exposed to violence,yet the phenomenon remains *** a result,HCWs’job s

关键词： ViSHWaS Healthcare workers Violence Survey Workplace violence Caribbean Cross-sectional study

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Anticoagulant use before COVID-19 diagnosis prevent COVID-19 associated acute venous thromboembolism or not:A systematic review and meta-analysis

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World Journal of Methodology 2024年第3期14卷 141-162页

作者： Kinza Iqbal Akshat Banga Taha Bin Arif Sawai Singh Rathore Abhishek Bhurwal Syeda Kisa Batool Naqvi Muhammad Mehdi Pankaj Kumar Mitali Madhu Salklan Ayman Iqbal Jawad Ahmed Nikhil Sharma Amos Lal rahul kashyap Vikas Bansal Juan Pablo Domecq Department of Internal Medicine Dow Medical CollegeKarachi 74200Pakistan Department of Internal Medicine Sawai Man Singh Medical CollegeJaipur 302004India Department of Internal Medicine Dr.Sampurnanand Medical CollegeJodhpur 342003RajasthanIndia Department of Gastroenterology and Hepatology Rutgers Robert Wood Johnson School of MedicineNew BrunswickNJ 08901United States Department of Internal Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical SciencesRohtak 124001HaryanaIndia Department of Nephrology and Hypertension Mayo ClinicRochesterMN 55905United States Department of Medicine Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMN 55905United States Department of Research Wellspan HealthYorkPA 17403United States

BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019(COVID-19)*** is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 *** To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 *** A Literature search was performed on LitCovid PubMed,WHO,and Scopus databases from inception(December 2019)till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with *** primary outcome was the risk of thromboembolic events in COVID-19 patients taking *** outcomes included COVID-19 disease severity,in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection,and *** random effects models were used to calculate crude and adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs).RESULTS Forty-six observational studies met our inclusion *** unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk[n=43851,9 studies,odds ratio(OR)=0.67(0.22,2.07);P=0.49;I2=95%].The association between prior anticoagulation and disease severity was non-significant[n=186782;22 studies,OR=1.08(0.78,1.49);P=0.64;I2=89%].However,pre-hospital anticoagulation significantly increased all-cause mortality risk[n=207292;35 studies,OR=1.72(1.37,2.17);P<0.00001;I2=93%].Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk[aOR=0.87(0.42,1.80);P=0.71],mortality[aOR=0.94(0.84,1.05);P=0.31],and disease severity[aOR=0.96(0.72,1.26);P=0.76].CONCLUSION Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events,improved survival,and lower disease seve

关键词： Prior anticoagulation COVID-19 Prehospital anticoagulation Chronic anticoagulation Mortality Severity Thromboembolic events

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Do we need to screen every patient in intensive care unit for diabetes in community with high prevalence of diabetes?

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World Journal of Diabetes 2019年第3期10卷 137-139页

作者： Taru Dutt rahul kashyap Salim Surani Department of Neurology Research Mayo Clinic Rochester MN 55902 United States Department of Anesthesiology and Peri-operative Medicine Critical Care IMP Mayo Clinic Rochester MN 55902 United States Health Science Center Texas A and M University Corpus Christi TX 78404 United States

Diabetes mellitus (DM) is marked as global health care challenge with almost 10% of the United States population being diagnosed with DM. A sizeable percentage of patients are oblivious of their disease, in spite of easily accessibility knowledge about its early signs and symptoms and rapid diagnostic modalities. Critically ill patients with undiagnosed DM are likely to have an increased mortality as compared to intensive care unit (ICU) patients with diagnosed DM. DM may have adverse effect on ICU patients causing organ failure and complications. Early Screening of patients at the risk of developing disease may prevent long term complications. Early screening and management may be beneficial as controlled DM patients have similar morbidity as non DM patients in ICU. An intense glycaemic and blood pressure control improves retinopathy and albuminuria, but may not affect the macrovascular outcomes.

关键词： Diabetes mellitus Intensive care unit Microvascular Macrovascular Diabetes screening

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Plant-based diet and its effect on coronary artery disease:A narrative review

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World Journal of Clinical Cases 2023年第20期11卷 4752-4762页

作者： Priyal Mehta Sawsan Tawfeeq Smitesh Padte Rayyan Sunasra Heet Desai Salim Surani rahul kashyap Department of General Medicine MWD HospitalMumbai 400097India Department of Research Global Remote Research Scholars ProgramSt.PaulMN 55104United States Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr.R.N Cooper Hospital Mumbai 400056India Department of Internal Medicine CIBNPFairfieldCA 94534United States Department of Pulmonary&Critical Care&Pharmacology Texas A&M UniversityCollege StationTX 77843United States Department of Research WellSpan HealthYorkPA 17403United States

Coronary artery disease(CAD),a primary component of cardiovascular diseases,is one of the top contributors to mortality rates *** 2021,dietary risk was estimated to be attributed to 6.58 million cardiovascular ***-based diets(PBDs),which encourage higher consumption of plant foods and lower intake of animal-based foods,have been shown to reduce the risk of CAD by up to 29% when compared to non-vegetarian diets in a *** article aims to summarize the array of PBDs and compare them with conventional Western diets that include *** review the various proposed mechanisms for how the bioactive nutrients of PBDs aid in preventing atherosclerosis and CAD events,as well as other cardiac *** conducted a detailed search of PubMed using our exclusive search strategy using the keywords plant-based diet,vegan diet,phytosterols,CAD,myocardial ischemia,and atherosclerosis.A total of 162 pertinent articles published within the past decade were identified for qualitative *** ensure the accuracy and reliability of our review,we included a total of 55 full-text,peer-reviewed articles that demonstrated the effects of plant-based diets on CAD and were written in *** excluded animal studies,in vitro or molecular studies,and non-original data like editorials,letters,protocols,and conference *** this article,we emphasize the importance of dietary interventions,such as PBDs,to prevent CAD and their benefits on environmental *** plant foods and whole grains into one's daily eating habits leads to an increase in the intake of nutrient-rich foods while reducing the consumption of processed food could not only prevent millions of premature deaths but also provide prevention against many chronic gastrointestinal and metabolic diseases.

关键词： Plant-based diet Phytosterol Coronary artery disease Low-density lipoprotein-cholesterol Micronutrients Atherosclerosis

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Heart failure in general and cardiac transplant patients with COVID-19

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World Journal of Cardiology 2022年第7期14卷 392-402页

作者： Munish Sharma Gowthami Sai Kogilathota Jagirdhar Kalpalatha K Guntupalli rahul kashyap Salim Surani Department of Medicine Baylor College of MedicineHoustonTX 77030United States Department of Medicine St Michaels'Medical CenterNewarkNJ 07102United States Department of Pulmonary Critical Care and SleepBaylor College of MedicineHoustonTX 77030United States Department of Anesthesiology Mayo ClinicRochesterMN 55905United States Department of Medicine Texas A&M UniversityBryanTX 77807United States

Coronavirus disease 2019(COVID-19)is primarily an infection of the respiratory tract,but it can have multisystem *** complications of COVID-19 can range from acute myocardial injury,cardiac arrhythmias,or heart failure,amongst *** failure(HF)in COVID-19 can be a de novo process or due to worsening of pre-existing cardiovascular *** in a patient with COVID-19 not only poses challenges in clinical presentation and management of COVID-19 but also affect prognosis of the *** article aims to succinctly revisit the implications of this pandemic regarding pre-existing HF or new-onset HF based on prevailing *** also focuses on the management and special recommendations from prior studies and guidelines.

关键词： COVID-19 Coronavirus Cardiomyopathy Heart failure Cardiomyopathy

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What we learned in the past year in managing our COVID-19 patients in intensive care units?

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World Journal of Critical Care Medicine 2021年第4期10卷 81-101页

作者： Jain Nitesh rahul kashyap Salim R Surani Department of Medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of Anesthesiology Mayo ClinicRochesterMN 55905United States Department of Medicine Texas A&M UniversityCorpus ChristiTX 78404United States

Coronavirus disease 2019 is a pandemic,was first recognized at Wuhan province,China in December *** disease spread quickly across the globe,spreading stealthily from human to human through both symptomatic and asymptomatic individuals.A multisystem disease which appears to primarily spread via bio aerosols,it has exhibited a wide clinical spectrum involving multiple organ systems with the respiratory system pathology being the prime cause of morbidity and *** unleashing a huge destructive trail at Wuhan China,Lombardy Italy and New York City,it has now spread to all parts of the globe and has actively thrived and mutated into new *** care systems and Governments responded initially with panic,with containment measures giving way to mitigation *** global medical and scientific community has come together and responded to this huge *** medical societies quickly laid out“expert”guidelines which were conservative in their *** drugs were re formulated and tested quickly with the help of national and international collaborative groups,helping carve out effective treatment strategies and help build a good scientific foundation for evidencebased *** of the darkness of chaos,we now have an orderly approach to manage this disease both from a public health preventive and therapeutic *** preventive measures such as masking and social distancing to the development of highly effective and potent vaccines,the public health success of such measures has been tempered by behavioral responses and resource *** a therapy standpoint,we now have drugs that were promising but now proven ineffective,and those that are effective when given early during viral pathogenesis or later when immune dysregulation has established,and the goal is to help reign in the destructive *** has been a fascinating journey for mankind and our work here recapitulates the evolution of various aspects of

关键词： COVID-19 Respiratory support Renal replacement therapy Extracorporeal membrane oxygenator Medications Therapeutics

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Checklist for early recognition and treatment of acute illness:International collaboration to improve critica care practice

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World Journal of Critical Care Medicine 2015年第1期4卷 55-61页

作者： Marija Vukoja rahul kashyap Srdjan Gavrilovic Yue Dong Oguz Kilickaya Ognjen Gajic The Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica Faculty of MedicineUniversity of Novi Sad Mayo Clinic RochesterMN 55905United States Gulhane Military Medical Faculty

Processes to ensure world-wide best-practice for critical care delivery is likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit(ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness(CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources(included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices(as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.

关键词： Decision support systems Critical care Education Checklists Medical informatics

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