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Article ; Online: Navigating the Uncertainty: A New Score to Guide TAVR in Patients With Chronic Kidney Disease.

Desai, Anish K / Betz, Yaqub / Abbate, Antonio

2023 Volume 211, Page(s) 365–366

MeSH term(s)	Humans ; Transcatheter Aortic Valve Replacement ; Uncertainty ; Renal Insufficiency, Chronic/complications ; Aortic Valve/surgery ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/surgery ; Treatment Outcome ; Risk Factors ; Heart Valve Prosthesis Implantation
Language	English
Publishing date	2023-11-18
Publishing country	United States
Document type	Editorial
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.11.030
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Article: Cardiovascular Complications in Community-Acquired Pneumonia.

Desai, Antonio / Aliberti, Stefano / Amati, Francesco / Stainer, Anna / Voza, Antonio

Microorganisms

2022 Volume 10, Issue 11

Abstract: Community-acquired pneumonia (CAP) is accountable for high mortality in both pediatric and adult populations worldwide, about one-third of hospitalized patients pass away within a year of being discharged from the facility. The high mortality and ... ...

Abstract	Community-acquired pneumonia (CAP) is accountable for high mortality in both pediatric and adult populations worldwide, about one-third of hospitalized patients pass away within a year of being discharged from the facility. The high mortality and morbidity rates are closely related to cardiovascular complications that are consequent or concomitant to the acute episode of pneumonia. An updated perspective on the major pathophysiological mechanisms, prevalence, risk factors, outcomes, and relevant treatments of cardiovascular events in CAP patients is provided in the current study. It is possible to evaluate the pathophysiology of cardiac disease in this population based on plaque-related events, such as acute myocardial infarction, or events unrelated to plaque, such as arrhythmias and heart failure. With an absolute rate of cardiovascular problems ranging broadly from 10% to 30%, CAP raises the risk of both plaque-related and plaque-unrelated events. Both in- and out-patients may experience these issues at admission, throughout hospitalization, or even up to a year following discharge. At long-term follow-up, cardiac events account for more than 30% of deaths in CAP patients, making them a significant cause of mortality. If patients at risk for cardiac events are stratified, diagnostic tools, monitoring, and preventive measures may be applied to these patients. A prospective evaluation of cardioprotective treatments is urgently required from a research point of view.
Language	English
Publishing date	2022-11-02
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720891-6
ISSN	2076-2607
ISSN	2076-2607
DOI	10.3390/microorganisms10112177
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Article ; Online: Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine.

Shin, Philip / Desai, Vimal / Conte, Antonio Hernandez / Qiu, Chunyuan

The Permanente journal

2023 Volume 27, Issue 2, Page(s) 160–168

Abstract: Perioperative care delivery is a patient-centered, multidisciplinary process. It relies heavily on synchronized teamwork from a well-coordinated team. Perioperative physicians-surgeons and anesthesiologists-face enormous challenges in surgical care ... ...

Abstract	Perioperative care delivery is a patient-centered, multidisciplinary process. It relies heavily on synchronized teamwork from a well-coordinated team. Perioperative physicians-surgeons and anesthesiologists-face enormous challenges in surgical care delivery due to changing work environments, post-COVID consequences, shift work disorder, value conflict, escalating demands, regulatory complexity, and financial uncertainties. Physician burnout in this working environment has become increasingly prevalent. It is not only harmful to physicians' health and well-being, but it also affects the quality and safety of patient care. Additionally, the economic costs associated with physician burnout are untenable due to the high turnover rate, high recruitment expenses, and potential early permanent exit from medical practice. In this deteriorating environment of unbalanced physician supply/demand, recognizing, managing, and preventing physician burnout may help preserve the system's most valuable asset and contribute to higher quality and safety of patient care. Leaders in government agencies, health care systems, and organizations must work together to re-engineer the health care system for better physicians and patient care.
MeSH term(s)	Humans ; Perioperative Medicine ; COVID-19 ; Physicians ; Burnout, Professional/prevention & control ; Burnout, Psychological ; Patient Care ; Quality of Health Care
Language	English
Publishing date	2023-06-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2062823-7
ISSN	1552-5775 ; 1552-5775
ISSN (online)	1552-5775
ISSN	1552-5775
DOI	10.7812/TPP/23.015
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Article ; Online: Cardiovascular Complications in Community-Acquired Pneumonia

Antonio Desai / Stefano Aliberti / Francesco Amati / Anna Stainer / Antonio Voza

Microorganisms, Vol 10, Iss 2177, p

2022 Volume 2177

Abstract	Community-acquired pneumonia (CAP) is accountable for high mortality in both pediatric and adult populations worldwide, about one-third of hospitalized patients pass away within a year of being discharged from the facility. The high mortality and morbidity rates are closely related to cardiovascular complications that are consequent or concomitant to the acute episode of pneumonia. An updated perspective on the major pathophysiological mechanisms, prevalence, risk factors, outcomes, and relevant treatments of cardiovascular events in CAP patients is provided in the current study. It is possible to evaluate the pathophysiology of cardiac disease in this population based on plaque-related events, such as acute myocardial infarction, or events unrelated to plaque, such as arrhythmias and heart failure. With an absolute rate of cardiovascular problems ranging broadly from 10% to 30%, CAP raises the risk of both plaque-related and plaque-unrelated events. Both in- and out-patients may experience these issues at admission, throughout hospitalization, or even up to a year following discharge. At long-term follow-up, cardiac events account for more than 30% of deaths in CAP patients, making them a significant cause of mortality. If patients at risk for cardiac events are stratified, diagnostic tools, monitoring, and preventive measures may be applied to these patients. A prospective evaluation of cardioprotective treatments is urgently required from a research point of view.
Keywords	acute myocardial infarction ; arrhythmia ; cardiovascular complications ; community-acquired pneumonia ; heart failure ; stroke ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Endoscopic retrograde cholangiopancreatography outcomes in inflammatory bowel disease patients: a 12-year analysis of a national database.

Deshmukh, Ameya / Desai, Parth M / Chrusciel, Timothy / Nwankwo, Eugene / Tripathi, Rohan / Cheesman, Antonio R

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 137

Abstract: Background: Despite inflammatory bowel disease's (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly ... ...

Abstract	Background: Despite inflammatory bowel disease's (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly studied area within the literature. The purpose of this study is to examine the effect of IBD on the occurrence of adverse events (AE) pertaining to ERCP. Methods: This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the USA. All patients 18 years or older with and without IBD undergoing ERCP were identified from 2008 to 2019. Post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI). Results: There was no difference in post-ERCP pancreatitis (PEP) or mortality. IBD patients were also found to have a lower risk of bleeding and decreased length of stay (LOS) despite adjustment for comorbidities. They also underwent less sphincterotomies when compared to the non-IBD cohort. Subgroup analysis between ulcerative colitis (UC) and Crohn's disease (CD) did not find any significant differences in outcomes. Conclusion: To our knowledge, this is the largest study to date evaluating ERCP outcomes in IBD patients. After adjustment of co-variates, there was no difference in the occurrence of PEP, infections, and perforation. IBD patients were less likely to experience post-ERCP bleeding and mortality and had shorter LOS which may be due to the decreased frequency of sphincterotomy in this population.
MeSH term(s)	Humans ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Retrospective Studies ; Pancreatitis/etiology ; Pancreatitis/diagnosis ; Pancreatitis/epidemiology ; Inflammatory Bowel Diseases/complications ; Inflammatory Bowel Diseases/epidemiology ; Comorbidity ; Hemorrhage/etiology ; Risk Factors
Language	English
Publishing date	2023-05-19
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04427-4
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Article: Comparative Analysis of Antithrombotic Therapy Outcomes in Mild Traumatic Brain-Injury Patients: A Focus on Bleeding Risk and Hospital-Stay Duration.

Desai, Antonio / Shiffer, Dana / Giordano, Mauro / Giotta Lucifero, Alice / Generali, Elena / Reggiani, Francesco / Calatroni, Marta / Savioli, Gabriele / Luzzi, Sabino / Voza, Antonio

Life (Basel, Switzerland)

2024 Volume 14, Issue 3

Abstract: Background: Traumatic brain injury (TBI) in the elderly is a noteworthy pathology due to the exponential increase in population age, and the effects of antiplatelet and anticoagulation on patients' outcomes are still a matter of dispute. The aim of the ... ...

Abstract	Background: Traumatic brain injury (TBI) in the elderly is a noteworthy pathology due to the exponential increase in population age, and the effects of antiplatelet and anticoagulation on patients' outcomes are still a matter of dispute. The aim of the present study was to evaluate the impact of various antithrombotic agents on patients with mild TBI, focusing on the risk of intracranial bleeding (ICH) and length of hospitalization (LOS). Methods: A retrospective analysis was conducted, including patients with a diagnosis of TBI admitted to the Emergency Department between 2021 and 2022. Patients were classified according to the concurrent antithrombotic therapy as aspirin (ASA), antiplatelets, direct oral anticoagulants (DOACs), and low-molecular-weight heparin (LMWH). The primary outcome was the ICH occurrence, while the secondary outcome was the LOS. The statistical analysis was performed via logistic regression models in R and STATA 13.1 software. Fisher's exact test was used for the statistical significance. Results: 267 patients with mild TBI were included; 148 were not on antithrombotic agents, 43 were on aspirin, 33 on DOACs, 5 on LMWH, 22 on antiplatelets, and 16 on VKA. Out of the total, 9 patients experienced ICH, none of which were on DOACs, LMWH, or VKA, but 4-out of 65-were on antiplatelets, and 5-out of 148-were not on antithrombotic therapies. Patients not on antithrombotic therapy had the shortest LOS at 0.46 days, while those on VKA had the longest LOS at 1.19 days; similar trends were observed for patients on DOAC and LMWH. Conclusions: The results reveal that TBI patients on anticoagulants/antiplatelets had longer hospital stays compared with those on aspirin alone. Notably, VKA was the strongest predictor for an extended LOS. Regarding ICH, patients taking only aspirin were twice as likely to experience bleeding compared with those on anticoagulants/antiplatelets. However, to achieve statistically significant evidence, further research with a larger cohort of patients is needed.
Language	English
Publishing date	2024-02-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life14030308
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Article ; Online: Epidemiology and risk factors for hyperkalaemia in heart failure.

Grobbee, Diederick E / Filippatos, Gerasimos / Desai, Nihar R / Coats, Andrew J S / Pinto, Fausto / Rosano, Giuseppe M C / Cleland, John G F / Kammerer, Jennifer / de Arellano, Antonio Ramirez

ESC heart failure

2024

Abstract: Patients with heart failure (HF), particularly those with impaired renal function receiving renin-angiotensin-aldosterone system inhibitors (RAASis), are at risk of hyperkalaemia; when hyperkalaemia is severe, this can have serious clinical consequences. ...

Abstract	Patients with heart failure (HF), particularly those with impaired renal function receiving renin-angiotensin-aldosterone system inhibitors (RAASis), are at risk of hyperkalaemia; when hyperkalaemia is severe, this can have serious clinical consequences. The incidence, prevalence, and risk factors for hyperkalaemia reported in randomized trials of RAASis may not reflect clinical practice due to exclusion of patients with elevated serum potassium (sK
Language	English
Publishing date	2024-03-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2814355-3
ISSN	2055-5822 ; 2055-5822
ISSN (online)	2055-5822
ISSN	2055-5822
DOI	10.1002/ehf2.14661
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Article ; Online: Neurological features in SARS-CoV-2-infected patients with smell and taste disorder.

Cocco, Antoniangela / Amami, Paolo / Desai, Antonio / Voza, Antonio / Ferreli, Fabio / Albanese, Alberto

Journal of neurology

2020 Volume 268, Issue 5, Page(s) 1570–1572

MeSH term(s)	COVID-19 ; Humans ; Olfaction Disorders/etiology ; SARS-CoV-2 ; Smell ; Taste Disorders/etiology
Keywords	covid19
Language	English
Publishing date	2020-08-07
Publishing country	Germany
Document type	Letter
ZDB-ID	187050-6
ISSN	1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
ISSN (online)	1432-1459
ISSN	0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
DOI	10.1007/s00415-020-10135-8
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Article ; Online: Risk of post-sphincterotomy bleeding with antiplatelet and anticoagulant use: a propensity-matched analysis of the U.S. Collaborative Network.

Chandan, Saurabh / Desai, Aakash / Dahiya, Dushyant S / Ramai, Daryl / Mohan, Babu P / Facciorusso, Antonio / Adler, Douglas G / Kochhar, Gursimran S

Gastrointestinal endoscopy

2023 Volume 97, Issue 6, Page(s) 1129–1136.e3

Abstract: Background and aims: GI bleeding after ERCP is a serious adverse event and most commonly occurs after endoscopic biliary and/or pancreatic sphincterotomy. Although the strength of available evidence for post-sphincterotomy GI bleeding risk is high for ... ...

Abstract	Background and aims: GI bleeding after ERCP is a serious adverse event and most commonly occurs after endoscopic biliary and/or pancreatic sphincterotomy. Although the strength of available evidence for post-sphincterotomy GI bleeding risk is high for therapeutic warfarin and heparin, it remains unknown for antiplatelet agents like clopidogrel and prasugrel. We conducted a retrospective United States-based, propensity-matched cohort study to assess the risk of post-sphincterotomy bleeding in patients receiving anticoagulant (AC) and antiplatelet (APT) therapy. Methods: We analyzed the U.S. Collaborative Network in the TriNetX platform through December 27, 2022, to include patients receiving APT and AC therapy who underwent ERCP within 7 days of hospitalization. One-to-one propensity score matching was performed. The primary outcome was the incidence of GI bleeding within 7 days of sphincterotomy. Secondary outcomes included need for blood transfusion, intensive care unit care, and all-cause mortality within 30 days of bleeding. Results: Overall, 2806 patients (1806 in the AC cohort and 1000 in the APT cohort) underwent ERCP with sphincterotomy. One-to-one propensity score matching was performed for age, body mass index ≥30 kg/m Conclusions: Our database analysis shows that patients receiving AC and APT therapy are at a higher risk of post-sphincterotomy bleeding compared with matched control subjects. An appropriate drug cessation period or alternative biliary decompression modalities may be used in these patients.
MeSH term(s)	Humans ; United States/epidemiology ; Retrospective Studies ; Cohort Studies ; Anticoagulants/adverse effects ; Heparin/therapeutic use ; Gastrointestinal Hemorrhage/epidemiology ; Gastrointestinal Hemorrhage/etiology ; Sphincterotomy/adverse effects
Chemical Substances	Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2023-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2023.01.043
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Article ; Online: Veiled Harm: Impacts of Microaggressions on Psychological Safety and Physician Burnout.

Desai, Vimal / Conte, Antonio Hernandez / Nguyen, Vu T / Shin, Philip / Sudol, Neha T / Hobbs, Janet / Qiu, Chunyuan

The Permanente journal

2023 Volume 27, Issue 2, Page(s) 169–178

Abstract: Microaggression is widespread in the health care industry and occurs in every health care delivery setting. It comes in many forms, from subtle to obvious, unconscious to conscious, and verbal to behavioral. Women and minority groups (eg, race/ethnicity, ...

Abstract	Microaggression is widespread in the health care industry and occurs in every health care delivery setting. It comes in many forms, from subtle to obvious, unconscious to conscious, and verbal to behavioral. Women and minority groups (eg, race/ethnicity, age, gender, sexual orientation) are often marginalized during medical training and subsequent clinical practice. These contribute to the development of psychologically unsafe working environments and widespread physician burnout. Physicians experiencing burnout who work in unsafe psychological environments impact the safety and quality of patient care. In turn, these conditions impose high costs on the health care system and organizations. Microaggressions and psychological unsafe work environments are intricately related and mutually enhanced. Therefore, addressing both simultaneously is a good business practice and a responsibility for any health care organization. Additionally, addressing them can reduce physician burnout, decrease physician turnover, and improve the quality of patient care. To counter microaggression and psychological unsafe, it takes conviction, initiative, and sustainable efforts from individuals, bystanders, organizations, and government agencies.
MeSH term(s)	Humans ; Male ; Female ; Microaggression ; Burnout, Professional/psychology ; Burnout, Psychological ; Delivery of Health Care ; Physicians/psychology
Language	English
Publishing date	2023-06-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2062823-7
ISSN	1552-5775 ; 1552-5775
ISSN (online)	1552-5775
ISSN	1552-5775
DOI	10.7812/TPP/23.017
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