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Article ; Online: Inadvertent septal perforation during conduction system pacing device implant: a case report.

Shtembari, Jurgen / Shrestha, Dhan Bahadur / Tung, Roderick / Upadhyay, Gaurav A

European heart journal. Case reports

2024 Volume 8, Issue 3, Page(s) ytae106

Abstract: Background: There has been recent growing interest in the use of conduction system pacing (CSP) for both bradycardia and heart failure indications. There remains a paucity of data, however, regarding complications related to the intraventricular septum ... ...

Abstract	Background: There has been recent growing interest in the use of conduction system pacing (CSP) for both bradycardia and heart failure indications. There remains a paucity of data, however, regarding complications related to the intraventricular septum associated with CSP implant and the management of these events. Case summary: We present a case of a patient with non-ischemic dilated cardiomyopathy presenting for cardiac resynchronization therapy in whom left bundle branch area pacing was complicated with interventricular septal perforation and managed intra-procedurally with repositioning of the lead to provide His bundle pacing (HBP) for QRS correction of underlying left bundle branch block. Post-procedure echocardiography did not show persistent ventricular septal defect. Left ventricular ejection fraction improved from 13% four months before implant to 30% at 32 months post-implant. Corrective HBP pacing thresholds showed a rise at 3-year follow-up. Discussion: Interventricular septal perforation during CSP is a possible complication during lead fixation. Pre-operative septal assessment with imaging can be helpful to provide important septal anatomical features. Septal perforation can be managed appropriately with lead repositioning intra-procedurally and close follow-up.
Language	English
Publishing date	2024-02-27
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytae106
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Article: Kounis syndrome following multiple wasp stings: A case report.

Basnet, Angela / Khadka, Manoj / Alismail, Abdullah / Shrestha, Dhan Bahadur / Thapa, Ashok

Clinical case reports

2023 Volume 11, Issue 3, Page(s) e7026

Abstract: This is a case of Kounis syndrome with chest tightness, lightheadedness, unconsciousness, and features of shock following multiple wasp stings. Despite cardiopulmonary resuscitation and management of allergic and cardiac symptoms, the patient died. ... ...

Abstract	This is a case of Kounis syndrome with chest tightness, lightheadedness, unconsciousness, and features of shock following multiple wasp stings. Despite cardiopulmonary resuscitation and management of allergic and cardiac symptoms, the patient died. Kounis syndrome should be suspected when a patient presents with allergic symptoms and acute coronary syndrome.
Language	English
Publishing date	2023-03-14
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.7026
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Article: Waterhouse-Friderichsen syndrome, septic adrenal apoplexy.

Rijal, Rishikesh / Kandel, Kamal / Aryal, Barun Babu / Asija, Ankush / Shrestha, Dhan Bahadur / Sedhai, Yub Raj

Vitamins and hormones

2023 Volume 124, Page(s) 449–461

Abstract: Waterhouse-Friderichsen syndrome is a rare but potentially fatal disorder of the adrenal gland characterized by bilateral adrenal hemorrhage. It is classically a result of meningococcal sepsis and presents acutely with features of shock, petechial rashes, ...

Abstract	Waterhouse-Friderichsen syndrome is a rare but potentially fatal disorder of the adrenal gland characterized by bilateral adrenal hemorrhage. It is classically a result of meningococcal sepsis and presents acutely with features of shock, petechial rashes, abdominal pain, and non-specific symptoms such as headache, fatigue, and vomiting. Treatment consists of fluid resuscitation, corticosteroid replacement, and possibly surgery. The prognosis is poor despite treatment. This chapter will review the etiology, pathogenesis, clinical features, and management of the disease.
MeSH term(s)	Humans ; Waterhouse-Friderichsen Syndrome/diagnosis ; Waterhouse-Friderichsen Syndrome/therapy ; Hemorrhage ; Adrenal Gland Diseases ; Adrenal Glands ; Stroke
Language	English
Publishing date	2023-11-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	201161-x
ISSN	2162-2620 ; 0083-6729
ISSN (online)	2162-2620
ISSN	0083-6729
DOI	10.1016/bs.vh.2023.06.001
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Article ; Online: Left circumflex STEMI presenting as de Winter sign, an ECG Zebra that gives you the chills! A case report.

Shehata, Kerolus / Shrestha, Dhan Bahadur / Shtembari, Jurgen / Khatiwada, Roshan / Khosla, Sandeep

Journal of electrocardiology

2023 Volume 80, Page(s) 96–98

Abstract: de Winter ECG sign is an anterior ST-segment elevation myocardial infarction equivalent, which refers to an occlusion of the proximal left anterior descending (LAD) coronary artery with tall T waves and the absence of ST elevations in the precordial ... ...

Abstract	de Winter ECG sign is an anterior ST-segment elevation myocardial infarction equivalent, which refers to an occlusion of the proximal left anterior descending (LAD) coronary artery with tall T waves and the absence of ST elevations in the precordial leads on the electrocardiogram (ECG). This sign is often under-recognized and not treated as an ST-segment elevation myocardial infarction which can increase the morbidity and mortality of such a life-threatening condition. Here we report a characteristic de Winter ECG sign involving left circumflex artery as culprit vessel, which was managed with PCI.
MeSH term(s)	Humans ; ST Elevation Myocardial Infarction/diagnosis ; Percutaneous Coronary Intervention ; Electrocardiography ; Coronary Vessels
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2023.05.006
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Article ; Online: Kounis syndrome following multiple wasp stings

Angela Basnet / Manoj Khadka / Abdullah Alismail / Dhan Bahadur Shrestha / Ashok Thapa

Clinical Case Reports, Vol 11, Iss 3, Pp n/a-n/a (2023)

A case report

2023

Abstract: Abstract This is a case of Kounis syndrome with chest tightness, lightheadedness, unconsciousness, and features of shock following multiple wasp stings. Despite cardiopulmonary resuscitation and management of allergic and cardiac symptoms, the patient ... ...

Abstract	Abstract This is a case of Kounis syndrome with chest tightness, lightheadedness, unconsciousness, and features of shock following multiple wasp stings. Despite cardiopulmonary resuscitation and management of allergic and cardiac symptoms, the patient died. Kounis syndrome should be suspected when a patient presents with allergic symptoms and acute coronary syndrome.
Keywords	acute coronary syndrome ; case report ; Kounis syndrome ; Medicine ; R ; Medicine (General) ; R5-920
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Transcarotid versus trans-axillary/subclavian transcatheter aortic valve replacement (TAVR): A systematic review and meta-analysis.

Dawadi, Sagun / Oli, Prakash Raj / Shrestha, Dhan Bahadur / Shtembari, Jurgen / Pant, Kailash / Shrestha, Bishesh / Mattumpuram, Jishanth / Katz, Daniel H

Current problems in cardiology

2024 Volume 49, Issue 5, Page(s) 102488

Abstract: Background: Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral ...

Abstract	Background: Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral access is difficult or impossible to obtain. Methods: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023482842). This meta-analysis was performed to compare the safety of the transcarotid and trans-axillary/subclavian approach for TAVR including studies from inception to October 2023. Results: Seven studies with a total of 6227 patients were included in the analysis (TCa: 2566; TAx/Sc: 3661). Transcarotid TAVR approach had a favorable trend for composite of stroke and all-cause mortality (OR 0.79, CI 0.60-1.04), all-cause mortality, stroke, major vascular complication, and new requirement of permanent pacemaker though those were statistically insignificant. On sub-analysis of the results of the studies based on the territory (USA vs French), composite outcome of all cause mortality, stroke and major bleeding (OR 0.54, CI 0.54-0.81), composite of stroke and all cause mortality (OR 0.64, CI 0.50-0.81), and stroke/TIA (OR 0.53, CI 0.39-0.73) showed lower odds of occurrence among patient managed with TCa approach in the American cohort. Conclusion: Overall, transcarotid approach had favorable though statistically insignificant odds for composite (stroke and all-cause mortality) and individual outcomes (stroke, all-cause mortality, etc.). There are significant variations in observed outcomes based on study's geographic location. Large prospective randomized clinical trials comparing the two approaches with representative samples are necessary to guide the clinicians in choosing among these approaches.
MeSH term(s)	Humans ; Transcatheter Aortic Valve Replacement/adverse effects ; Aortic Valve/surgery ; Aortic Valve Stenosis/surgery ; Prospective Studies ; Risk Factors ; Treatment Outcome ; Time Factors ; Stroke/epidemiology ; Stroke/etiology
Language	English
Publishing date	2024-02-28
Publishing country	Netherlands
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	441230-8
ISSN	1535-6280 ; 0146-2806
ISSN (online)	1535-6280
ISSN	0146-2806
DOI	10.1016/j.cpcardiol.2024.102488
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Article ; Online: Immediate vs. multistage revascularization of non-infarct coronary artery(-ies) in patients with hemodynamically stable multivessel disease acute myocardial infarction: a systematic review and meta-analysis.

Oli, Prakash Raj / Shrestha, Dhan Bahadur / Dawadi, Sagun / Shtembari, Jurgen / Regmi, Laxmi / Pant, Kailash / Shrestha, Bishesh / Mattumpuram, Jishanth / Katz, Daniel H

Coronary artery disease

2024

Abstract: Background: Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year . Current guidelines recommend percutaneous coronary intervention (PCI) for significant ...

Abstract	Background: Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year . Current guidelines recommend percutaneous coronary intervention (PCI) for significant non-infarct artery (-ies) (non-IRA) stenosis in hemodynamically stable AMI patients with MVD, either during or after successful primary PCI, within 45-days. However, deciding the timing of revascularization for non-IRA in cases of MVD is uncertain. Methods: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023472652). Databases were searched for relevant articles published before 10 November 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. Results: Out of 640 studies evaluated, there were 13 RCTs with 5144 patients with AMI with MVD. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44-0.83) and target-vessel revascularization (OR 0.72; CI 0.53-0.97) . Although there is a favorable trend for major adverse cardiovascular and cerebrovascular events (MACCE), nonfatal AMI, cerebrovascular events, and major bleeding in the immediate non-culprit artery (-ies) PCI, those were statistically non-significant. Similarly, all-cause mortality, cardiovascular mortality, stent thrombosis, and acute renal insufficiency did not show significant differences between two groups. Conclusion: Among hemodynamically stable patients with multivessel AMI, the immediate PCI strategy was superior to the multistage PCI strategy for the unplanned ischemia-driven PCI and target-vessel revascularization while odds are favorable in terms of MACCE, nonfatal AMI, cerebrovascular events, and major bleeding at longest follow-up.
Language	English
Publishing date	2024-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1047268-x
ISSN	1473-5830 ; 0954-6928
ISSN (online)	1473-5830
ISSN	0954-6928
DOI	10.1097/MCA.0000000000001353
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Article ; Online: Rectus sheath hematoma secondary to acute exacerbation of COPD

Prashant Pant / Oshan Shrestha / Nebula Devkota / Pawan Budhathoki / Sanjit Adhikari / Dhan Bahadur Shrestha

Clinical Case Reports, Vol 10, Iss 3, Pp n/a-n/a (2022)

A case report

2022

Abstract: Abstract Rectus sheath hematoma, a rare condition, develops due to rupture of epigastric arteries or the rectus abdominis muscle. This case report conveys that such condition can occur due to violent coughing spells, and this should not be missed when a ... ...

Abstract	Abstract Rectus sheath hematoma, a rare condition, develops due to rupture of epigastric arteries or the rectus abdominis muscle. This case report conveys that such condition can occur due to violent coughing spells, and this should not be missed when a patient with chronic obstructive pulmonary disease presents with abdominal pain.
Keywords	acute exacerbation ; chronic obstructive pulmonary disease ; cough ; hematoma ; rectus sheath ; Medicine ; R ; Medicine (General) ; R5-920
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Hansen's disease masquerading as rheumatoid arthritis: A case report.

Pant, Prashant / Shrestha, Oshan / Singh, Pragyat / Paudyal, Vivek / Alam, Istiyaque / Rajput, Prabhat Singh / Shrestha, Dhan Bahadur

Clinical case reports

2022 Volume 10, Issue 5, Page(s) e05822

Abstract: Hansen's disease, a chronic granulomatous disease, classically has cutaneous and neurological manifestations. Musculoskeletal manifestation of the disease is underappreciated. This case report conveys that musculoskeletal manifestation of the disease ... ...

Abstract	Hansen's disease, a chronic granulomatous disease, classically has cutaneous and neurological manifestations. Musculoskeletal manifestation of the disease is underappreciated. This case report conveys that musculoskeletal manifestation of the disease should not be missed, as sometimes it is the only presenting symptom, to avoid delay in correct diagnosis and treatment.
Language	English
Publishing date	2022-05-12
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.5822
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Article ; Online: Is Hydroxychloroquine with Azithromycin a Good Combination in COVID-19 Compared to Hydroxychloroquine Alone from Cardiac Perspective? A Systematic Review and Meta-Analysis

Pravash Budhathoki / Dhan Bahadur Shrestha / Sitaram Khadka / Era Rawal

Journal of Nepal Health Research Council, Vol 19, Iss 50, Pp 1-

2021 Volume 9

Abstract: Background: The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to ... ...

Abstract	Background: The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment. Methods: PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities. Results: The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice. Conclusions: The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.
Keywords	covid-19 ; covid-19 drug treatment ; hydroxychloroquine ; macrolides ; severe acute respiratory syndrome coronavirus 2 ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	Nepal Health Research Council
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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