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  1. Article: A Case of Successful Direct Oral Anticoagulant Use for the Treatment of Warfarin-Induced Vasculitis in a Patient With Left Ventricular Thrombus.

    Nader, Georgette / Yavari, Majid / Timilsina, Anisha / Rayamajhi, Sumugdha

    Cureus

    2023  Volume 15, Issue 12, Page(s) e50885

    Abstract: Cutaneous small vessel leukocytoclastic vasculitis (LCV) is isolated to the dependent areas of the skin. LCV can be induced by pharmaceutical drugs, and management requires abrupt discontinuation of the offending drug. Warfarin is a rare medication to ... ...

    Abstract Cutaneous small vessel leukocytoclastic vasculitis (LCV) is isolated to the dependent areas of the skin. LCV can be induced by pharmaceutical drugs, and management requires abrupt discontinuation of the offending drug. Warfarin is a rare medication to cause LCV, with sparse literature to date. Here, we present a case of warfarin-induced LCV, complicated by a patient's comorbid left ventricular thrombus, and successful treatment with discontinuation of warfarin and replacement with a direct oral anticoagulant (apixaban).
    Language English
    Publishing date 2023-12-21
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.50885
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Cardiac Challenges in Immune Checkpoint Therapy: Complete Heart Block With Pembrolizumab.

    Sabanci, Rand / Saeed, Moiz / Watat, Kevin / Kim, Andrew G / Shaban, Dina / Nader, Georgette / Ghnaima, Harith / Wilcox, Matthew / Ali-Ahmed, Fatima

    Cureus

    2024  Volume 16, Issue 3, Page(s) e57244

    Abstract: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, yet they come with a spectrum of immune-related adverse events, including cardiac complications. We present the case of a 72-year-old male with metastatic renal cell carcinoma who ... ...

    Abstract Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, yet they come with a spectrum of immune-related adverse events, including cardiac complications. We present the case of a 72-year-old male with metastatic renal cell carcinoma who developed complete heart block and ventricular arrhythmias following pembrolizumab therapy. Despite no evidence of myocarditis, the patient's condition rapidly deteriorated, ultimately resulting in his demise. This case underscores the critical need for vigilance in recognizing and managing potential cardiotoxicity associated with ICIs. Additionally, it highlights the importance of multidisciplinary collaboration in optimizing diagnostic and therapeutic strategies for patients undergoing immune checkpoint inhibitor therapy.
    Language English
    Publishing date 2024-03-30
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.57244
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Right Coronary Artery-to-Right Atrial Fistula Accompanied by Multiple Right Coronary Artery Aneurysms: A Case Report.

    Watat, Kevin / Nader, Georgette / Sabanci, Rand / Martinez, Adolfo / Boumegouas, Manel / Hanson, Christopher A / Wilcox, Matthew

    Cureus

    2024  Volume 16, Issue 3, Page(s) e56398

    Abstract: A coronary artery aneurysm (CAA) denotes a localized dilation of the coronary artery, while a coronary artery fistula signifies an aberrant connection between a coronary artery and a cardiac chamber or adjacent vessel. Here, we present a case study of a ... ...

    Abstract A coronary artery aneurysm (CAA) denotes a localized dilation of the coronary artery, while a coronary artery fistula signifies an aberrant connection between a coronary artery and a cardiac chamber or adjacent vessel. Here, we present a case study of a 68-year-old female with a previously diagnosed right coronary artery-to-right atrial fistula concomitant with multiple right coronary artery aneurysms. Initially asymptomatic, the patient subsequently manifested atrial fibrillation. Management involved augmenting the patient's home regimen with metoprolol tartrate, followed by successful cardioversion and restoration of sinus rhythm. Given the stability of the fistula and the absence of symptomatic exacerbation, no further interventional measures were undertaken. The patient was discharged with an adjusted metoprolol regimen and scheduled follow-up with her cardiologist. Subsequent imaging assessments unveiled progressive fistula expansion alongside the development of concurrent CAA, inciting deliberations concerning optimal treatment modalities.
    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.56398
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Severe psoriasis presenting with rapidly progressive (crescentic) IgA-predominant glomerulonephritis.

    Garces, Christopher Cantoria / Hernandez Garcilazo, Nora / Sharma, Akhil / Nader, Georgette

    BMJ case reports

    2021  Volume 14, Issue 5

    Abstract: IgA nephropathy (IgAN) is commonly associated with psoriasis; however, psoriasis presenting with crescentic IgAN is uncommon. A 49-year-old man with erythrodermic psoriasis with arthritis and stage 2 chronic kidney disease presented to the emergency ... ...

    Abstract IgA nephropathy (IgAN) is commonly associated with psoriasis; however, psoriasis presenting with crescentic IgAN is uncommon. A 49-year-old man with erythrodermic psoriasis with arthritis and stage 2 chronic kidney disease presented to the emergency department with worsening peripheral oedema and difficulty breathing. The patient had been hospitalised previously for a psoriasis flare. He was found to have an acute kidney injury on chronic kidney disease and was diagnosed with crescentic IgA glomerulonephritis on his first hospitalisation. He was treated with corticosteroids and was discharged stable with a plan to start cyclophosphamide in the outpatient setting. On his current hospitalisation, cyclophosphamide was added to his corticosteroids. Crescentic IgAN is rare. Its management has been based largely on observational studies. Our case highlights the importance of starting combined corticosteroids and cyclophosphamide early in crescentic IgAN and that corticosteroid monotherapy is insufficient in controlling disease progression.
    MeSH term(s) Acute Kidney Injury ; Cyclophosphamide/therapeutic use ; Glomerulonephritis/complications ; Glomerulonephritis/diagnosis ; Glomerulonephritis/drug therapy ; Glomerulonephritis, IGA/complications ; Glomerulonephritis, IGA/diagnosis ; Glomerulonephritis, IGA/drug therapy ; Humans ; Immunoglobulin A ; Male ; Middle Aged ; Psoriasis/complications ; Psoriasis/diagnosis ; Psoriasis/drug therapy
    Chemical Substances Immunoglobulin A ; Cyclophosphamide (8N3DW7272P)
    Language English
    Publishing date 2021-05-26
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-242627
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: A Rare Case of SARS-CoV-2-Induced Microscopic Polyangiitis.

    Allena, Nishant / Patel, Jay / Nader, Georgette / Patel, Madanmohan / Medvedovsky, Boris

    Cureus

    2021  Volume 13, Issue 5, Page(s) e15259

    Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection triggers elevated levels of circulating cytokines and immune-cell hyperactivation, called a cytokine storm, which leads to dysregulated immune response not only towards the pathogen ... ...

    Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection triggers elevated levels of circulating cytokines and immune-cell hyperactivation, called a cytokine storm, which leads to dysregulated immune response not only towards the pathogen itself but also contributes to cellular, vascular injury and multiorgan dysfunction. The cytokine-induced endothelial inflammation and vascular pathology of COVID-19 is well reported in post-mortem biopsies and several cases reporting small, medium and large vessel micro/macro thrombotic events and vasculitis in multiple organs. So far, few cases have been reported with newly diagnosed antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis at the time of acute COVID-19 infection. The exact pathophysiology of SARS-CoV-2 and ANCA-associated vasculitis continues to be studied and reviewed. Here we report a case of a 60-year-old female who presented to our institution with sudden onset of shortness of breath and hemoptysis. A detailed history revealed a recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Labs showed elevated serum creatinine, urine analysis with large blood and nephrotic range proteinuria. CT chest was remarkable for abnormal appearance of the parenchyma bilaterally compatible with a crazy paving pattern, suggesting pulmonary alveolar proteinosis versus diffuse alveolar hemorrhage. Vasculitis was suspected and the patient was started on IV corticosteroids and plasmapheresis. Diagnostic workup was positive for antineutrophil cytoplasmic antibodies-myeloperoxidase (ANCA-MPO), anti-Sjögren's syndrome-related antigen A autoantibodies (anti-SS-A) and antinuclear antibodies (ANA). Renal biopsy confirmed focal segmental necrotizing, crescentic and sclerosing glomerulonephritis, pauci-immune type, anti-MPO antibody/P-ANCA associated. A diagnosis of microscopic polyangiitis was made and she was started on rituximab immunosuppressive therapy following which she showed clinical improvement. In this document, we present a unique case of microscopic polyangiitis possibly induced by SARS-CoV-2 infection confirmed by renal biopsy and clinical presentation. In the current setting of a global pandemic, we strongly recommend that vasculitis be high on the differential diagnosis in patients who are currently infected or had been infected with SARS-CoV-2 and present with acute kidney injury (AKI).
    Language English
    Publishing date 2021-05-26
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.15259
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Factors impacting COVID-19 vaccination intention among medical students.

    Gala, Dhir / Parrill, Allison / Patel, Krishna / Rafi, Ibnul / Nader, Georgette / Zhao, Ruby / Shoaib, Adeel / Swaminath, Girish / Jahoda, Jessica / Hassan, Rehana / Colello, Raymond / Rinker, Dipali V

    Human vaccines & immunotherapeutics

    2022  Volume 18, Issue 1, Page(s) 2025733

    Abstract: Medical students represent a significant part of the health-care community and are active members of the coronavirus disease 2019 (COVID-19) response. This study aimed to evaluate various factors associated with COVID-19 vaccine intention among medical ... ...

    Abstract Medical students represent a significant part of the health-care community and are active members of the coronavirus disease 2019 (COVID-19) response. This study aimed to evaluate various factors associated with COVID-19 vaccine intention among medical students via an online anonymous survey. A total of 370 students completed the online survey, with 229 (61.89%) not vaccinated for COVID-19. Of students not yet vaccinated, 45 (19.65%) were unsure or did not intend to accept the vaccine, while 184 (80.35%) intend to be vaccinated within 6 months. Overall, female gender, health status, clinical science enrollment, and the practice of COVID-19 preventative behaviors significantly correlated with the intention to be vaccinated within 6 months. Greater perceived risk for contracting COVID-19, lesser beliefs that the COVID-19 vaccination trials were rushed, and greater beliefs that being vaccinated would help complete their medical education were uniquely associated with the intention to be vaccinated within 6 months. Collectively, this study identified several factors that influenced medical students' intention to receive the COVID-19 vaccination. This information may be used in future immunization strategies to increase the vaccination rates among this group of future medical professionals.
    MeSH term(s) COVID-19/prevention & control ; COVID-19 Vaccines ; Cross-Sectional Studies ; Female ; Humans ; Intention ; SARS-CoV-2 ; Students, Medical ; Vaccination
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2022-02-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2664176-8
    ISSN 2164-554X ; 2164-5515
    ISSN (online) 2164-554X
    ISSN 2164-5515
    DOI 10.1080/21645515.2022.2025733
    Database MEDical Literature Analysis and Retrieval System OnLINE

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