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12. Su1605: ROLE OF ORAL VANCOMYCIN PROPHYLAXIS IN PREVENTING RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION IN HOSPITALIZED PATIENTS REQUIRING ANTIBIOTICS : A RANDOMIZED CONTROLLED TRIAL

Author

Pisipati, Sailaja, primary, Harrison, Rachel, additional, Jensen, Erik, additional, Abdalla, Abubaker O., additional, Thompson, Jessica, additional, Morton, Tim, additional, Mohadjer, Kiya, additional, Zion, Lauren, additional, Gullapalli, Nageshwara, additional, and Upadhyay, Bishwas, additional

Published
2022
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13. Ensuring trust in COVID-19 data

Author

Antwi-Amoabeng, Daniel, Beutler, Bryce D., Chahal, Gurpreet, Mahboob, Sumaiya, Gullapalli, Nageshwara, Tedja, Rudy, Madhani-Lovely, Farah, and Rowan, Chris

Subjects
Male, Incidental Findings, SARS-CoV-2, viruses, coronavirus disease-2019, coronavirus, COVID-19, Trust, Quality Improvement, Hospitalization, coronavirus disease, COVID-19 Nucleic Acid Testing, Quality Improvement Study, Humans, epidemiology, Female, health systems, Asymptomatic Infections, Pandemics, Research Article, severe acute respiratory syndrome coronavirus 2, Data Management, Retrospective Studies
Abstract

There are no standardized methods for collecting and reporting coronavirus disease-2019 (COVID-19) data. We aimed to compare the proportion of patients admitted for COVID-19-related symptoms and those admitted for other reasons who incidentally tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Retrospective cohort study Data were sampled twice weekly between March 26 and June 6, 2020 from a “COVID-19 dashboard,” a system-wide administrative database that includes the number of hospitalized patients with a positive SARS-CoV-2 polymerase chain reaction test. Patient charts were subsequently reviewed and the principal reason for hospitalization abstracted. Data collected during a statewide lockdown revealed that 92 hospitalized patients had positive SARS-CoV-2 test results. Among these individuals, 4.3% were hospitalized for reasons other than COVID-19-related symptoms but were incidentally found to be SARS-CoV-2-positive. After the lockdown was suspended, the total inpatient census of SARS-CoV-2-positive patients increased to 128, 20.3% of whom were hospitalized for non-COVID-19-related complaints. In the absence of a statewide lockdown, there was a significant increase in the proportion of patients admitted for non-COVID-19-related complaints who were incidentally found to be SARS-CoV-2-positive. In order to ensure data integrity, coding should distinguish between patients with COVID-19-related symptoms and asymptomatic patients carrying the SARS-CoV-2 virus.

Published
2021

18. Association between electrocardiographic features and mortality in COVID‐19 patients

Author

Antwi‐Amoabeng, Daniel, primary, Beutler, Bryce D., additional, Singh, Sahajpreet, additional, Taha, Moutaz, additional, Ghuman, Jasmine, additional, Hanfy, Ahmed, additional, Manasewitsch, Nicholas T., additional, Ulanja, Mark B., additional, Ghuman, Joban, additional, Awad, Munadel, additional, Gullapalli, Nageshwara, additional, and Gbadebo, T. David, additional

Published
2021
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24. Management of hypertension in COVID-19

Author

Antwi-Amoabeng, Daniel, primary, Beutler, Bryce D, additional, Moody, Alastair E, additional, Kanji, Zahara, additional, Gullapalli, Nageshwara, additional, and Rowan, Christopher J, additional

Published
2020
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26. Survival Differences in Men and Women With Primary Malignant Cardiac Tumor: An Analysis Using the Surveillance, Epidemiology and End Results (SEER) Database From 1973 to 2015

Author

Antwi‐Amoabeng, Daniel, primary, Meghji, Zahara, additional, Thakkar, Samarthkumar, additional, Ulanja, Mark B., additional, Taha, Mohamed, additional, Adalja, Devina, additional, Al‐Khafaji, Jaafar, additional, Gullapalli, Nageshwara, additional, Beutler, Bryce D., additional, Boampong‐Konam, Killian, additional, and Doshi, Rajkumar, additional

Published
2020
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28. IN SILICO VERSUS CLINICAL CRITERIA FOR THE DIAGNOSIS OF FAMILIAL HYPERCHOLESTEROLEMIA: A COMPARATIVE EVALUATION

Author

Sheikh, Mohammad Salman, primary, Yadav, Sakshi, additional, Thompson, Molly M., additional, Meghji, Zahara, additional, Wilemon, Katherine, additional, Islam, Raheel, additional, Gullapalli, Nageshwara, additional, Metcalf, Jim, additional, Slonim, Anthony, additional, Grzymski, Joe, additional, and Rowan, Christopher J., additional

Published
2020
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33. Randomized, double-blinded, placebo-controlled trial evaluating simethicone pretreatment with bowel preparation during colonoscopy

Author

Rishi, Mohit, primary, Kaur, Jaskarin, additional, Ulanja, Mark, additional, Manasewitsch, Nicholas, additional, Svendsen, Molly, additional, Abdalla, Abubaker, additional, Vemala, Shashank, additional, Kewanyama, Julie, additional, Singh, Karmjit, additional, Singh, Nirmal, additional, Gullapalli, Nageshwara, additional, and Osgard, Eric, additional

Published
2019
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35. Comparison of procedural outcomes in patients undergoing catheter vs surgical ablation for atrial fibrillation and heart failure with reduced ejection fraction.

Author

Doshi, Rajkumar, Kumar, Ashish, Shariff, Mariam, Adalja, Devina, Patel, Krunalkumar, Patel, Kirtenkumar, Desai, Rupak, Gullapalli, Nageshwara, and Vallabhajosyula, Saraschandra

Abstract

Background: There is a lack of research comparing procedural outcomes of surgical ablation (SA) and catheter ablation (CA) among patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). The main objective was to compare the short‐term procedural outcomes of SA and CA in patients with HFrEF. Methods: We used the national inpatient sample to identify hospitalizations over 18 years with HFrEF hospitalization and AF, and undergoing SA and CA from 2016 to 2017. Furthermore, the clinical outcomes of SA vs CA in AF stratified as nonparoxysmal and paroxysmal were analyzed. Results: A total of 1,770 HFrEF hospitalizations with AF who underwent SA and 1,620 HFrEF hospitalizations with AF who underwent CA were included in the analysis. Hospitalizations with CA had higher baseline comorbidities. The in‐hospital mortality among HFrEF with AF undergoing SA as compared with CA was similar (2.8% vs 1.9%, respectively, adjusted P‐value 0.09). Hospitalizations with SA had a significantly longer length of hospital stay, a higher percentage of postprocedural, and cardiac complications. In HFrEF hospitalizations with nonparoxysmal AF, SA as compared with CA was associated with a higher percentage of in‐hospital mortality (2.4% vs 1%, adjusted P‐value <.05), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications. Conclusion: CA is associated with lower in‐hospital adverse procedural outcomes as compared with SA among HFrEF hospitalizations with AF. Further research with freedom from AF as one of the outcome is needed between two groups for HFrEF. [ABSTRACT FROM AUTHOR]

Published
2021
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38. Hypertension Management: An Update.

Author

Quang Nguyen, Dominguez, Joann, Loida Nguyen, and Gullapalli, Nageshwara

Abstract

Hypertension is a significant and costly public health problem. It is a major, but modifiable contributor for the development of cardiovascular disease. Randomized controlled trials have shown that controlling hypertension reduces the risk of stroke, coronary artery disease, congestive heart failure, end-stage renal disease, peripheral vascular disease, as well as overall mortality. The risk of developing these hypertension-related complications is continuous, starting at a blood pressure level as low as 115/75 mm Hg. Despite the inherent health risks associated with uncontrolled hypertension, elevated blood pressure remains inadequately treated in the majority of patients. This article reviews guidelines for optimal evaluation of hypertension and current therapeutic options available to combat this common yet pervasive disease. [ABSTRACT FROM AUTHOR]

Published
2010

39. Abstract 13126: Reduction in Stroke Rates With Embolic Protection Device During Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Author

Thakkar, Samarthkumar J, Kumar, Ashish, Shah, Jay, Gullapalli, Nageshwara, Meraj, Perwaiz M, and Doshi, Rajkumar P

Abstract

Introduction:Periprocedural stroke is one of the most important and debilitating adverse events in patients undergoing transcatheter aortic valve replacement (TAVR). This led to the development of embolic protection devices (EPD) to prevent periprocedural stroke. Previous meta-analyses did not show significant reduction in stroke rates with the use of EPDs.Hypothesis:We hypothesize that the use of EPD can reduce stroke rates in patients undergoing TAVR.Methods:A comprehensive search of PubMed and EMBASE databases was conducted for all randomized control trials (RCTs) and propensity score matched (PSM) observational studies that studied efficacy of EPDs during TAVR procedure. We calculated comprehensive odds ratio (ORs) and 95% confidence intervals (CIs) using a fixed-effects model. Additionally, to revamp the results for possible type I error, we also performed a trial sequential analysis (TSA) to support our results.Results:We included 6 studies (5 RCTs and 1 propensity score matched study) totaling 1,181 procedures. Our results demonstrated that use of EPD resulted in significant reduction in the incidence of periprocedural stroke (OR = 0.51; 95% CI: 0.29-0.90, I2= 0%, P value<0.01) (Panel A). We also generated Egger?s plot to analyze publication bias which did not demonstrate significant publication bias(Panel B). The trial sequential analysis however indicated the presence of type I error associated with the conclusion, and need for further procedures to reach the diversity adjusted information size of 1,768. (Panel C).Conclusions:This meta-analysis demonstrated that use of EPD significantly reduced the incidence of periprocedural stroke during TAVR. Use of EPD during TAVR might be very promising in preventing the periprocedural strokes and therefore, use of EPD during TAVR is highly recommended. Identifying future subsets of patients that would benefit from EPD is warranted.

Published
2019
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40. Abstract 11215: Incidence Of Atrial Fibrillation In Patients Treated With Transcatherter Versus Surgical Aortic Valve Replacement In Low Risk Patients: A Meta-analysis

Author

Shah, Jay, Kumar, Ashish, Thakkar, Samarthkumar J, Khan, Muhammad, Gullapalli, Nageshwara, Meraj, Perwaiz M, and Doshi, Rajkumar P

Abstract

Introduction:New onset atrial fibrillation (NOAF) commonly develops following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). NOAF is independently associated with adverse outcomes. We therefore performed a meta-analysis of randomized control trials (RCTs) assessing NOAF rates at one year follow up following treatment with TAVR as compared to SAVR in low surgical risk patients.Hypothesis:We hypothesize that treatment with TAVR is associated with lower NOAF rates in low surgical risk patients.Methodology:A comprehensive search of PubMed and EMBASE databases was conducted from inception to April 2019, for all RCTs that compared TAVR versus SAVR in low surgical risk patients and reported NOAF. We calculated comprehensive odds ratio (ORs) and 95% confidence intervals (CIs) using a random-effects model. The analysis was conducted as per the recommendations of the Cochrane Collaboration.Results:We included 5 RCTs totaling 2793 procedures (1452 TAVR and 1341 SAVR). NOAF was reported in a total of 704 patients (153 post TAVR and 551 post SAVR). Our analysis demonstrated that TAVR was associated with significantly lower incidence of NOAF as compared to SAVR at one year follow up in low surgical risk patients (OR = 0.16; 95% CI: 0.12-0.21, I2= 34%, P value<0.01). We also generated egger?s plot to detect publication bias which showed minimal publication bias.Conclusion:In patient with low surgical risk, treatment with TAVR is associated with lower incidence of NOAF as compared to SAVR. TAVR could be preferred treatment option for patients with severe aortic stenosis and low surgical risk.

Published
2019
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41. Abstract 16364: Readmission Rates Associated With Infective Endocarditis After Transcatheter Aortic Valve Replacement

Author

Viquez, Karolina, Kudaravalli, Praneeth, Woods, Elizabeth, Gullapalli, Nageshwara, and Doshi, Rajkumar

Abstract

Introduction:Infective endocarditis (IE) is one of the common and debilitating adverse events in patients undergoing aortic valve replacement (AVR). This might be associated with increased readmission rates and added financial burden.Hypothesis:We hypothesize that the IE is associated with high readmission rates after AVR procedure.Methods:This retrospective evaluation was conducted using Truven MarketScan database from January 2011 to December 2016. Patients were included in the analysis only if they developed IE after AVR procedure. Patients were divided mainly into 3 groups: 1) Undergoing transcatheter AVR (TAVR) 2) Surgical AVR (SAVR) and 3) Balloon aortic valvuloplasty (BAV). Main outcomes of this study were incidence of IE after each procedure and readmission within 30 and 90 days.Results:A total of 183,858 patients were included in the analysis of which 15,405 underwent TAVR, 161,064 underwent SAVR and 7,389 underwent BAV. Mean age of the study participants was 68.5 years. Overall incidence of IE declined significantly during the study period. Incidence of IE were highest among patients undergoing TAVR followed by BAV and least with SAVR. In TAVR, transapical route was associated with highest rates of IE and transaortic route was associated with least IE. In SAVR, prosthetic valve was associated with least IE rates. Readmission within 30 and 90 days were highest with BAV and least with SAVR.Conclusions:We demonstrated that the overall incidence of IE has been decreasing since 2014. However, the rate of IE after TAVR is still elevated and it is higher when compared with other AVR modalities. These could be secondary to higher paravalvular leak after TAVR which needs further evaluation. More studies are needed in order to propose strategies to decrease its incidence.

Published
2019
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42. Abstract 11120: Major Adverse Cardiac Events With Combined Use of Eicosapentaenoic Acid and Statin: A Meta-analysis

Author

Doshi, Rajkumar P, Shah, Jay, Thakkar, Samarthkumar, Kumar, Ashish, Meghji, Zahara, and Gullapalli, Nageshwara

Abstract

Introduction:Statin is traditionally utilized for primary and secondary prevention of cardiovascular risk reduction. Role of omega-3-Fatty acids, especially eicosapentaenoic acid (EPA), in reducing cardiovascular events is not clear. Hence, we sought to determine the role of EPA in combination with the standard statin therapy on major adverse cardiac events (MACE). We conducted a meta-analysis including trial sequential analysis (TSA) of all available randomized controlled trials (RCTs) assessing the impact of EPA + statin on cardiovascular risk reduction.Hypothesis:We hypothesize that combined use of EPA + Statin reduces MACE.Methods:A comprehensive search of PubMed and EMBASE databases was conducted for all RCTs that compared EPA + Statin versus placebo + statins and included outcomes related to cardiovascular health. We calculated comprehensive odds ratio (ORs) and 95% confidence intervals (CIs) using a random-effects model.Results:We included 5 RCTs totaling 27,415 patients. Our results demonstrated that EPA + statin resulted in 18% reduction in the incidence of MACE (OR = 0.78; 95% CI: 0.65-0.93, I2= 54%, P value<0.01) as compared to statin alone. With respect to MACE, the number needed to treat was 49. The statistical significance for reduction in the incidence of MACE with EPA+ statin was further augmented with TSA.Conclusions:This meta-analysis demonstrated that EPA significantly reduced the incidence of MACE when combined with statin therapy. EPA combined with statin might be a very promising combination in preventing the major adverse cardiovascular events and therefore, augmentation with conventional statin therapy is highly recommended. Future guidelines should include a combination of EPA with statin for primary and secondary prevention of cardiovascular diseases.

Published
2019
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43. Incidental Coronary Artery Calcification and the Risk of Major Adverse Cardiovascular Outcomes.

Author

Antwi-Amoabeng D, Beutler BD, Awad M, Taha M, Syed K, Boppana SH, Ghuman J, Ghuman J, Sathappan S, Pisane M, Ulanja MB, Neelam V, Gullapalli N, Roongsritong C, and Canaday O

Abstract

Background Incidental findings of coronary artery calcifications (CACs) are not consistently reported, and the clinical significance relating to cardiovascular outcomes remains to be established. In this single-center cross-sectional study, we assessed the association between incidental coronary artery calcification documented on formal chest CT reports and the incidence of major adverse cardiovascular events (MACE). Methods A MACE was defined as the occurrence of stroke or transient ischemic attack or ST-segment elevation myocardial infarction, non-ST-elevation myocardial infarction, or undergoing coronary artery bypass grafting. A composite endpoint included either MACE or the occurrence of cardiovascular death. We assessed the predictors of the composite outcome and the effect of lipid-lowering therapy on the composite outcome in the studied cohort.  Results The composite outcome occurred in 39.1% of the 1,354 subjects studied. Peripheral arterial disease was the only comorbid condition associated with increased odds (adjusted odds ratio (aOR) 2.6, p < 0.001, 95% CI: 1.9 - 3.56). The average treatment effect of lipid-lowering therapy was 0.11 (p = 0.002, 95% CI: 0.04 - 0.17). At 10 years after the first CAC report, the presence of peripheral artery disease appears to present the lowest odds of survival, which is <50% (hazard ratio (HR) 2.44, p < 0.001, 95% CI: 1.67 - 3.56). Conclusion In patients with CAC on incidental chest CT scans, the presence of peripheral arterial disease is associated with increased odds of MACE and/or cardiovascular death. In those with incidental CAC on non-gated chest CT scans, the residual risk for MACE remains high despite lipid-lowering therapy and antiplatelet agents., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Antwi-Amoabeng et al.)

Published
2024
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44. Hypertension management: an update.

Author

Nguyen Q, Dominguez J, Nguyen L, and Gullapalli N

Abstract

Hypertension is a significant and costly public health problem. It is a major, but modifiable contributor for the development of cardiovascular disease. Randomized controlled trials have shown that controlling hypertension reduces the risk of stroke, coronary artery disease, congestive heart failure, end-stage renal disease, peripheral vascular disease, as well as overall mortality. The risk of developing these hypertension-related complications is continuous, starting at a blood pressure level as low as 115/75 mm Hg. Despite the inherent health risks associated with uncontrolled hypertension, elevated blood pressure remains inadequately treated in the majority of patients. This article reviews guidelines for optimal evaluation of hypertension and current therapeutic options available to combat this common yet pervasive disease.

Published
2010

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