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Article ; Online: Resorptive (obstructive) atelectasis.

Patel, Tarang P / Karle, Ethan M / Krvavac, Armin

BMJ case reports

2019 Volume 12, Issue 11

MeSH term(s)	Aged ; Bronchoscopy ; Carcinoma, Squamous Cell/complications ; Carcinoma, Squamous Cell/diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms/complications ; Lung Neoplasms/diagnostic imaging ; Pleural Effusion, Malignant/diagnostic imaging ; Pleural Effusion, Malignant/etiology ; Pulmonary Atelectasis/diagnostic imaging ; Pulmonary Atelectasis/etiology ; Tomography, X-Ray Computed
Language	English
Publishing date	2019-11-27
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-232405
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The case of a 72-Year-Old Male with Hematemesis and Pneumomediastinum due to Acute Bacterial Esophageal Necrosis.

Karle, Ethan / Patel, Tarang / Krvavac, Armin

Cureus

2019 Volume 11, Issue 9, Page(s) e5698

Abstract: Acute esophageal necrosis (AEN) is a relatively uncommon presentation of esophagitis. AEN is characterized by black necrotic esophageal tissue and is associated with high mortality rates. We discuss the case of a 72-year-old Caucasian male who was ... ...

Abstract	Acute esophageal necrosis (AEN) is a relatively uncommon presentation of esophagitis. AEN is characterized by black necrotic esophageal tissue and is associated with high mortality rates. We discuss the case of a 72-year-old Caucasian male who was admitted to the medical intensive-care unit (MICU) for evaluation of pneumomediastinum. CT of the chest revealed a right lower lobe consolidation, pneumomediastinum, and marked thickening of the distal esophagus. Vital signs on arrival revealed a temperature of 38.3° Celsius, heart rate of 92 beats per minute, respiratory rate of 30 breaths per minute, blood pressure of 144/65, and oxygen saturation of 97% on 15 liters of supplemental oxygen via non-rebreather. Laboratory studies on arrival were remarkable for a white blood cell (WBC) count of 19.75 x10
Language	English
Publishing date	2019-09-19
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.5698
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Avoiding Unnecessary Repeat Laboratory Testing.

Patel, Tarang / Karle, Ethan / Krvavac, Armin

Cureus

2019 Volume 11, Issue 10, Page(s) e5872

Abstract: We present a 44-year-old Caucasian female with a history of diabetes mellitus admitted to the intensive care unit (ICU) for refractory hypoglycemia with an initial blood glucose of 39 mg/dl. The initial evaluation included a random insulin level, C- ... ...

Abstract	We present a 44-year-old Caucasian female with a history of diabetes mellitus admitted to the intensive care unit (ICU) for refractory hypoglycemia with an initial blood glucose of 39 mg/dl. The initial evaluation included a random insulin level, C-peptide, Hemoglobin A1c, and a sulfonylurea screen that were ordered when the patient's blood sugar was 39 mg/dL. She was discharged after demonstrating euglycemia. The test results for sulfonylurea screen, insulin, and C-peptide levels were obtained one day after discharge. The insulin level was elevated, and C-peptide was inappropriately low, establishing the diagnosis of surreptitious exogenous insulin use. Four days after discharge, the patient was readmitted to the same ICU with a similar presentation of refractory hypoglycemia. Once again, the sulfonylurea screen, along with the insulin and C-peptide levels were ordered as there was no mention of the previously obtained results in the discharge summary. The discrepancy between random insulin and C-peptide levels reaffirmed the diagnosis of surreptitious exogenous use of insulin. As high-value medical care becomes a focal point in medicine, the costs, root causes, and impacts of inappropriate laboratory testing must be understood. Upwards of 25% of ordered laboratory tests are unnecessary. Physicians' failure to follow-up on results of correctly ordered tests and repeat testing despite established diagnosis is a significant cause of unneeded laboratory testing. Best practice guidelines recommend a reduction in unnecessary laboratory testing by implementing computer-based solutions to maximize the identification of duplicate requests and to promote clinical education at the time of laboratory test ordering.
Language	English
Publishing date	2019-10-09
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.5872
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Novel Use of N-Acetylcysteine in Management of Tyrosine Kinase Inhibitor Induced Acute Liver Injury.

Patel, Tarang / Tarun, Tushar / Hudhud, Dania / Krvavac, Armin

Cureus

2019 Volume 11, Issue 11, Page(s) e6251

Abstract: Tyrosine kinase inhibitors (TKIs) have been adopted in the treatment of a variety of malignancies. Despite their popularity, the underlying mechanism of the adverse effects seen with the use of TKIs is not completely understood. Acute liver injury is a ... ...

Abstract	Tyrosine kinase inhibitors (TKIs) have been adopted in the treatment of a variety of malignancies. Despite their popularity, the underlying mechanism of the adverse effects seen with the use of TKIs is not completely understood. Acute liver injury is a known side effect of many of these drugs. Some papers have demonstrated that N-acetylcysteine may have a role in non-acetaminophen induced acute liver failure (NAI-ALF). There is little evidence supporting the use of N-acetylcysteine in the treatment of tyrosine kinase inhibitor-induced acute liver injury. This case report adds to the limited body of existing knowledge. We present a 67-year-old Caucasian female with a past medical history of anxiety, hyperlipidemia, in utero exposure to diethylstilbestrol (DES), and well-differentiated angiosarcoma of the right breast. She achieved remission for approximately six years after mastectomy with adjuvant chemotherapy and radiation. Subsequent surveillance imaging revealed new hepatic and cervical lesions. Further investigation with cutaneous biopsy near the occipital region confirmed recurrent metastatic angiosarcoma. The patient was started on high-dose pazopanib and initially tolerated the TKI without any adverse effects. However, after approximately two weeks of therapy, she began to experience dark colored urine, myalgias, and fatigue. These symptoms, along with significant elevations in liver enzymes (alanine transaminase of 1377 units/L, aspartate transaminase of 1212 units/L), prompted admission for evaluation of acute liver injury. The etiology of the acute liver injury was suspected to be secondary to TKI therapy. Treatment with intravenous N-acetylcysteine was initiated for non-acetaminophen induced acute liver failure (NAI-ALF) and resulted in a dramatic improvement in transaminases before discharge. Evidence suggests that there is a beneficial role for N-acetylcysteine in the management of NAI-ALF. However, when it comes specifically to the management of TKI induced acute liver injury, there is limited evidence to support its use. This case report highlights a possible use of N-acetylcysteine in the management of TKI mediated acute liver injury. Additional studies should be conducted to determine the role N-acetylcysteine plays in the management of TKI mediated liver injury.
Language	English
Publishing date	2019-11-27
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.6251
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Are We Coping Well with COVID-19?: A Study on Its Psycho-Social Impact on Front-line Healthcare Workers.

Maduke, Tinashe / Dorroh, James / Bhat, Ambarish / Krvavac, Armin / Regunath, Hariharan

Missouri medicine

2020 Volume 118, Issue 1, Page(s) 55–62

Abstract: Background: Global pandemics have a profound psycho-social impact on health systems and their impact on healthcare workers is under-reported.: Methods: We performed a cross-sectional survey with 13 Likert-scale responses and some additional polar ... ...

Abstract	Background: Global pandemics have a profound psycho-social impact on health systems and their impact on healthcare workers is under-reported. Methods: We performed a cross-sectional survey with 13 Likert-scale responses and some additional polar questions pertaining to dressing habits and learning in a university hospital in the midwest United States. Descriptive and analytical statistics were performed. Results: The 370 respondents (66.1% response rate, age 38.5±11.6 years; 64.9% female), included 102 supervising providers [96 (25.9%) physicians, 6 (1.6%) mid-level], 64 (17.3%) residents/fellows, 73 (19.7% nurses, 45 (12.2%) respiratory therapists, 31 (8.4%) therapy services and others: 12 (3.2%) case-managers, 4 (1.1%) dietitians, 39 (10.5%) unclassified]. Overall, 200 (54.1%) had increased anxiety, 115 (31.1%) felt overwhelmed, 159 (42.9%) had fear of death, and 281 (75.9%) changed dressing habits. Females were more anxious (70.7% vs. 56%, X Conclusion: Despite belief of a supportive administration, over half of healthcare workers and learners reported increased anxiety, and nearly a third felt overwhelmed during this current pandemic.
MeSH term(s)	Adaptation, Psychological/physiology ; Adult ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/psychology ; COVID-19/virology ; Cross-Sectional Studies ; Female ; Health Personnel/psychology ; Health Personnel/statistics & numerical data ; Health Personnel/trends ; Humans ; Male ; Middle Aged ; Occupational Stress/epidemiology ; Occupational Stress/psychology ; Psychology/statistics & numerical data ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification
Language	English
Publishing date	2020-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	427362-x
ISSN	0026-6620
ISSN	0026-6620
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Patient Perception of Vaping in the Midst of the Electronic Cigarette and Vaping Product Associated Lung Injury (EVALI) Epidemic.

Patel, Tarang / Karle, Ethan / Gubeladze, Tamar / Pentecost, Genevieve / Krvavac, Armin

Missouri medicine

2020 Volume 117, Issue 3, Page(s) 265–270

Abstract: Purpose of study: EVALI has reached epidemic proportions. With the increasing prevalence, new information has come to light regarding the safety of electronic cigarettes. We investigate the impact of the recent EVALI epidemic on patient perception ... ...

Abstract	Purpose of study: EVALI has reached epidemic proportions. With the increasing prevalence, new information has come to light regarding the safety of electronic cigarettes. We investigate the impact of the recent EVALI epidemic on patient perception surrounding vaping. Methods: An anonymous survey was developed to evaluate patient perception regarding vaping. The survey was administered to adult patients at various clinics at University of Missouri. A total of 287 survey responses were analyzed. Results: In all, 81.5% of respondents reported that e-cigarettes are unsafe, 73.2% did not feel that the absence of THC oils or vitamin E acetate made e-cigarettes safer, and 55.1% felt that e-cigarettes are less safe than traditional cigarettes. A majority (76%) felt that e-cigarettes/vaping products should be more regulated and pose a public health concern. Most surprising, 67.6% of participants answered that they knew somebody who was negatively affected by EVALI. Conclusion: The survey responses suggest that the current EVALI epidemic is changing the public's perception and the narrative surrounding safety of e-cigarettes and vaping products.
MeSH term(s)	Adolescent ; Adult ; Female ; Humans ; Lung Injury/etiology ; Lung Injury/physiopathology ; Male ; Middle Aged ; Patients/psychology ; Perception ; Surveys and Questionnaires ; Vaping/adverse effects ; Vaping/psychology
Language	English
Publishing date	2020-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	427362-x
ISSN	0026-6620
ISSN	0026-6620
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Article ; Online: Understanding the Knowledge Gap and Assessing Comfort Level among Healthcare Professionals Who Provide Inhaler Education.

Karle, Ethan / Patel, Tarang P / Zweig, Jason / Krvavac, Armin

COPD

2020 Volume 17, Issue 2, Page(s) 197–204

Abstract: Inhaled medications play a pivotal role in the management of COPD and asthma. Provider knowledge and ability to teach various devices is paramount as poor inhaler technique directly correlates with worse disease control. The goal of our survey was to ... ...

Abstract	Inhaled medications play a pivotal role in the management of COPD and asthma. Provider knowledge and ability to teach various devices is paramount as poor inhaler technique directly correlates with worse disease control. The goal of our survey was to assess the knowledge and comfort level with various inhaled devices among providers involved in patient inhaler education. We constructed a 20-question survey consisting of a five-question Likert scale-based comfort assessment and a 15-question multiple-choice inhaler knowledge test that was distributed both internally and nationwide. Groups surveyed included internal medicine residents, family medicine residents, pulmonary fellows, respiratory therapists, nursing staff, and pharmacists. A total of 557 providers responded to the survey. The overall correct response rate among all respondents was only 47%. There was no significant difference between correct response rates among prescribers (internal medicine residents, family medicine residents, and pulmonary fellows) and non-prescribers (respiratory therapists, nursing staff, and pharmacists), 47% and 47%, respectively (
MeSH term(s)	Dry Powder Inhalers ; Family Practice/education ; Health Knowledge, Attitudes, Practice ; Health Personnel/psychology ; Humans ; Internal Medicine/education ; Internship and Residency ; Metered Dose Inhalers ; Nursing Staff ; Patient Education as Topic ; Pharmacists ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Pulmonary Medicine/education ; Respiratory Therapy ; Self Efficacy ; Surveys and Questionnaires
Language	English
Publishing date	2020-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2171107-0
ISSN	1541-2563 ; 1541-2555
ISSN (online)	1541-2563
ISSN	1541-2555
DOI	10.1080/15412555.2020.1746251
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Article ; Online: Therapeutic plasma exchange for severe hyperlipidaemia in a patient with poorly controlled diabetes.

Hermelin, Daniela / Dinarvand, Peyman / Krvavac, Armin / Blackall, Douglas

BMJ case reports

2018 Volume 2018

MeSH term(s)	Administration, Intravenous ; Adult ; Combined Modality Therapy ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/therapy ; Humans ; Hyperlipidemias/etiology ; Hyperlipidemias/therapy ; Hypoglycemic Agents/administration & dosage ; Insulin/administration & dosage ; Male ; Plasma Exchange/methods
Chemical Substances	Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2018-03-27
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2018-224227
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Article: Plastic Bronchitis in Adult and Pediatric Patients: A Review of its Presentation, Diagnosis, and Treatment.

Patel, Niel / Patel, Mayur / Inja, Ravali / Krvavac, Armin / Lechner, Andrew J

Missouri medicine

2021 Volume 118, Issue 4, Page(s) 363–373

Abstract: Purpose of study: Plastic Bronchitis (PB) is a rare pulmonary condition characterized by the presence of casts in the trachea or bronchial tree. While there are many individual cases reported in pediatric and adult populations, no thorough reviews of ... ...

Abstract	Purpose of study: Plastic Bronchitis (PB) is a rare pulmonary condition characterized by the presence of casts in the trachea or bronchial tree. While there are many individual cases reported in pediatric and adult populations, no thorough reviews of pediatric and adult cases of PB exist in the literature. The purpose of this article is to conduct a comprehensive review of PB regarding presentation, diagnosis, pathophysiology, and treatments. Etiology: In the pediatric population, PB can be attributed to pediatric cardiothoracic surgeries such as Fontan procedures, infections, inflammatory processes, acute chest syndrome, or iatrogenic processes. In the adult population, PB can be idiopathic or due to infections, anatomic variations in lymphatic vessels, surgeries, medications, or other comorbidities. Pathophysiology: The pathophysiology of PB is still widely unknown; however, associations with inflammatory diseases and cardiac surgery have been proposed. There are two types of cast formations found in plastic bronchitis: Type I casts are associated with inflammatory diseases and Type II casts are associated with surgical procedures. Treatment: Historically, PB has been treated by a variety of pharmacological methods including the use of corticosteroids and mucolytics. Recently, the treatment paradigm has shifted towards procedures such as lymphatic embolization, duct ligation, and stent grafting. Conclusions: The information available regarding PB is still sparse, hence future research is necessary for further understanding of the disease. Due to its numerous presentations and disease associations, awareness of plastic bronchitis, and its treatment options is essential for primary care providers and respiratory specialists.
MeSH term(s)	Adrenal Cortex Hormones ; Adult ; Bronchitis/diagnosis ; Bronchitis/therapy ; Child ; Fontan Procedure ; Humans ; Lymphatic Vessels ; Plastics
Chemical Substances	Adrenal Cortex Hormones ; Plastics
Language	English
Publishing date	2021-07-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	427362-x
ISSN	0026-6620
ISSN	0026-6620
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Article: Diffuse Alveolar Hemorrhage: An Uncommon Manifestation of Vaping-associated Lung Injury.

Wilhite, Rodger / Patel, Tarang / Karle, Ethan / Shankar, Shyam / Krvavac, Armin

Cureus

2019 Volume 11, Issue 12, Page(s) e6519

Abstract: Vaping involves the use of a device to deliver aerosolized nicotine and tetrahydrocannabinol (THC) oils to the lungs. Vaping continues to increase in popularity; however, because it is a novel drug delivery system there is little evidence regarding its ... ...

Abstract	Vaping involves the use of a device to deliver aerosolized nicotine and tetrahydrocannabinol (THC) oils to the lungs. Vaping continues to increase in popularity; however, because it is a novel drug delivery system there is little evidence regarding its safety and long-term consequences. Here, we present a 22-year-old Caucasian male who was admitted with acute hypoxic respiratory failure and massive hemoptysis. Contrasted computed tomography of the chest demonstrated ground glass opacities throughout all lung fields and bilateral pulmonary emboli. Bronchoalveolar lavage revealed increased red blood cell counts in serial aliquots, consistent with the diagnosis of diffuse alveolar hemorrhage (DAH). An extensive workup did not reveal an etiology for the DAH. However, further history was obtained, and the patient divulged daily vaping of THC. E-cigarette, or vaping, product use associated lung injury (EVALI) consists of a myriad of different lung injury patterns. Our case illustrates an uncommon presentation of EVALI with DAH and multiple pulmonary emboli.
Language	English
Publishing date	2019-12-31
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.6519
Database	MEDical Literature Analysis and Retrieval System OnLINE

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