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Article: Myocardial stunning secondary to erroneous administration of intravenous epinephrine.

Pathangey, Girish / Moudgal, Rohitha / Lee, Christopher / Henkin, Stanislav

2023 Volume 11, Page(s) 2050313X231159732

Abstract: Epinephrine is a commonly used medication for emergent conditions, such as anaphylaxis, respiratory distress, and shock. However, its versatility can also lead to iatrogenic errors in dosages, concentrations, and routes of administration. In this case, a ...

Abstract	Epinephrine is a commonly used medication for emergent conditions, such as anaphylaxis, respiratory distress, and shock. However, its versatility can also lead to iatrogenic errors in dosages, concentrations, and routes of administration. In this case, a 47-year-old female experiencing anaphylaxis received an intravenous dose of 0.3 mg (1:1000) epinephrine formulated for intramuscular injection, resulting in cardiac arrest and acute heart failure due to myocardial stunning, as diagnosed by echocardiography. Management included invasive ventilation and hemodynamic support until cardiac function recovered. This case highlights the potential dangers of epinephrine overdose, and to our knowledge, is the first reported case of iatrogenic epinephrine-induced Takotsubo cardiomyopathy in a rural area. In addition, we review the literature on iatrogenic epinephrine toxicity-associated cardiomyopathy and the epidemiology of epinephrine errors. Safety measures must be considered for improving communication in emergencies, increasing awareness via training, and changing epinephrine's antiquated packaging design.
Language	English
Publishing date	2023-03-16
Publishing country	England
Document type	Case Reports
ZDB-ID	2736953-5
ISSN	2050-313X
ISSN	2050-313X
DOI	10.1177/2050313X231159732
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Article ; Online: Reproducibility and responsiveness of airway impedance measures derived from the forced oscillation technique across different operating lung volumes.

Aitken, Craig R / Pathangey, Girish / Stamos, Mathew / Kim, Chul-Ho / Johnson, Bruce D / Stewart, Glenn M

Respiratory physiology & neurobiology

2023 Volume 320, Page(s) 104200

Abstract: Background: The forced oscillation technique (FOT) enables non-invasive measurement of respiratory system impedance. Limited data exists on how changes in operating lung volume (OLV) impact FOT-derived measures of airway resistance (Rrs) and reactance ( ... ...

Abstract	Background: The forced oscillation technique (FOT) enables non-invasive measurement of respiratory system impedance. Limited data exists on how changes in operating lung volume (OLV) impact FOT-derived measures of airway resistance (Rrs) and reactance (Xrs). Objectives: This study examined the reproducibility and responsiveness of FOT-derived measures of Rrs and Xrs during simulated changes in OLV. Methods: Participants simulated breathing at six OLVs: total lung capacity (TLC), ∼50% of inspiratory reserve volume (IRV Results: Twelve healthy participants (2 female) completed the study (weight: 76.5 ± 13.6 kg, height: 178.6 ± 9.7 cm, body mass index: 23.9 ± 3.1 kg/m Conclusion: FOT-derived measures of airway Rrs and Xrs are reproducible across a range of OLV's, and are responsive to hyper- and hypo-inflation of the lung. To further understand the impact of lung hyper- and hypo-inflation on FOT-derived airway impedance additional study is required in individuals with pathological variations in operating lung volume.
MeSH term(s)	Humans ; Female ; Reproducibility of Results ; Electric Impedance ; Respiratory Function Tests/methods ; Lung Volume Measurements ; Airway Resistance ; Lung
Language	English
Publishing date	2023-11-28
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2077867-3
ISSN	1878-1519 ; 1569-9048
ISSN (online)	1878-1519
ISSN	1569-9048
DOI	10.1016/j.resp.2023.104200
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Article: Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes.

Pathangey, Girish / D'Anna, Susan P / Moudgal, Rohitha A / Min, David B / Manning, Katharine A / Taub, Cynthia C / Gilstrap, Lauren G

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1155957

Abstract: Purpose: To evaluate the safety, efficacy, and outcomes of outpatient intravenous diuresis in a rural setting and compare it to urban outcomes.: Methods: A single-center study was conducted on 60 patients (131 visits) at the Dartmouth-Hitchcock ... ...

Abstract	Purpose: To evaluate the safety, efficacy, and outcomes of outpatient intravenous diuresis in a rural setting and compare it to urban outcomes. Methods: A single-center study was conducted on 60 patients (131 visits) at the Dartmouth-Hitchcock Medical Center (DHMC) from 1/2021-12/2022. Demographics, visit data, and outcomes were collected and compared to urban outpatient IV centers, and inpatient HF hospitalizations from DHMC FY21 and national means. Descriptive statistics, T-tests and chi-squares were used. Results: The mean age was 70 ± 13 years, 58% were male, and 83% were NYHA III-IV. Post-diuresis, 5% had mild-moderate hypokalemia, 16% had mild worsening of renal function, and 3% had severe worsening of renal function. No hospitalizations occurred due to adverse events. The mean infusion-visit urine output was 761 ± 521 ml, and post-visit weight loss was -3.9 ± 5.0 kg. No significant differences were observed between HFpEF and HFrEF groups. 30-day readmissions were similar to urban outpatient IV centers, DHMC FY21, and the national mean (23.3% vs. 23.5% vs. 22.2% vs. 22.6%, respectively; Conclusion: OP IV diuresis appears safe and effective for rural HF patients, potentially decreasing mortality rates and healthcare expenses while mitigating rural-urban disparities.
Language	English
Publishing date	2023-05-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1155957
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Article ; Online: Angiotensin-converting enzyme 2 and COVID-19: patients, comorbidities, and therapies.

Pathangey, Girish / Fadadu, Priyal P / Hospodar, Alexandra R / Abbas, Amr E

American journal of physiology. Lung cellular and molecular physiology

2020 Volume 320, Issue 3, Page(s) L301–L330

Abstract: On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic, and the reality of the situation has finally caught up to the widespread reach of the disease. The presentation of the disease is highly variable, ... ...

Abstract	On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic, and the reality of the situation has finally caught up to the widespread reach of the disease. The presentation of the disease is highly variable, ranging from asymptomatic carriers to critical COVID-19. The availability of angiotensin-converting enzyme 2 (ACE2) receptors may reportedly increase the susceptibility and/or disease progression of COVID-19. Comorbidities and risk factors have also been noted to increase COVID-19 susceptibility. In this paper, we hereby review the evidence pertaining to ACE2's relationship to common comorbidities, risk factors, and therapies associated with the susceptibility and severity of COVID-19. We also highlight gaps of knowledge that require further investigation. The primary comorbidities of respiratory disease, cardiovascular disease, renal disease, diabetes, obesity, and hypertension had strong evidence. The secondary risk factors of age, sex, and race/genetics had limited-to-moderate evidence. The tertiary factors of ACE inhibitors and angiotensin II receptor blockers had limited-to-moderate evidence. Ibuprofen and thiazolidinediones had limited evidence.
MeSH term(s)	Angiotensin-Converting Enzyme 2/metabolism ; COVID-19/metabolism ; COVID-19/virology ; Comorbidity ; Humans ; SARS-CoV-2/isolation & purification ; COVID-19 Drug Treatment
Chemical Substances	ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Language	English
Publishing date	2020-11-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1013184-x
ISSN	1522-1504 ; 1040-0605
ISSN (online)	1522-1504
ISSN	1040-0605
DOI	10.1152/ajplung.00259.2020
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Article ; Online: Relationship of Activity Patterns to Acute Mountain Sickness in South Pole Workers.

Pathangey, Girish / Wheatley-Guy, Courtney M / Stewart, Glenn / Anderson, Paul J / Richert, Maile L Ceridon / Miller, Andrew D / Johnson, Jacob B / Johnson, Bruce

International journal of sports medicine

2019 Volume 40, Issue 7, Page(s) 440–446

Abstract: This study aimed to evaluate the influence of physical activity on incidence of acute mountain sickness (AMS) by continuous activity monitoring in a free-living sample of South Pole workers over the initial 72 h at altitude exposure of 2,840 m (9,318 ft). ...

Abstract	This study aimed to evaluate the influence of physical activity on incidence of acute mountain sickness (AMS) by continuous activity monitoring in a free-living sample of South Pole workers over the initial 72 h at altitude exposure of 2,840 m (9,318 ft). Body Media activity monitors were worn by 47 healthy participants. AMS was defined by the Lake Louise symptom questionnaire. Venous blood samples were taken at sea level and approximately 48 h after high altitude exposure. AMS incidence was 34% (n=16/47) over the first 48 h and 40% (n=19/47) over 72 h. On day 2 at high altitude, individuals with AMS demonstrated a significantly greater increase in the percent change in physical activity metrics from baseline: total energy expenditure 19±13 vs. 5±7%, total steps 65±51 vs. 10±18%, metabolic equivalent of tasks 21±13 vs. 7±13%, and time spent performing moderate to vigorous physical activity 114±79 vs. 26±27% for individuals with AMS vs. no AMS, respectively, p<0.05. In addition, erythropoietin and vascular endothelial growth factor were 1.69 and 1.75 times higher, respectively, in those with AMS. In conclusion, workers who engaged in increased physical activity and activity intensity during initial exposure to the South Pole were more susceptible to developing AMS.
MeSH term(s)	Altitude Sickness/blood ; Altitude Sickness/epidemiology ; Altitude Sickness/physiopathology ; Antarctic Regions/epidemiology ; Energy Metabolism ; Erythropoietin/blood ; Exercise ; Fitness Trackers ; Humans ; Incidence ; Physical Exertion ; Risk Factors ; Vascular Endothelial Growth Factor A/blood
Chemical Substances	EPO protein, human ; VEGFA protein, human ; Vascular Endothelial Growth Factor A ; Erythropoietin (11096-26-7)
Language	English
Publishing date	2019-06-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	603122-5
ISSN	1439-3964 ; 0172-4622 ; 0943-917X
ISSN (online)	1439-3964
ISSN	0172-4622 ; 0943-917X
DOI	10.1055/a-0884-3014
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Article ; Online: A High Performance Pulsatile Pump for Aortic Flow Experiments in 3-Dimensional Models.

Chaudhury, Rafeed A / Atlasman, Victor / Pathangey, Girish / Pracht, Nicholas / Adrian, Ronald J / Frakes, David H

Cardiovascular engineering and technology

2016 Volume 7, Issue 2, Page(s) 148–158

Abstract: Aortic pathologies such as coarctation, dissection, and aneurysm represent a particularly emergent class of cardiovascular diseases. Computational simulations of aortic flows are growing increasingly important as tools for gaining understanding of these ... ...

Abstract	Aortic pathologies such as coarctation, dissection, and aneurysm represent a particularly emergent class of cardiovascular diseases. Computational simulations of aortic flows are growing increasingly important as tools for gaining understanding of these pathologies, as well as for planning their surgical repair. In vitro experiments are required to validate the simulations against real world data, and the experiments require a pulsatile flow pump system that can provide physiologic flow conditions characteristic of the aorta. We designed a newly capable piston-based pulsatile flow pump system that can generate high volume flow rates (850 mL/s), replicate physiologic waveforms, and pump high viscosity fluids against large impedances. The system is also compatible with a broad range of fluid types, and is operable in magnetic resonance imaging environments. Performance of the system was validated using image processing-based analysis of piston motion as well as particle image velocimetry. The new system represents a more capable pumping solution for aortic flow experiments than other available designs, and can be manufactured at a relatively low cost.
MeSH term(s)	Aorta/physiology ; Equipment Design/methods ; Humans ; Models, Cardiovascular ; Pulsatile Flow/physiology
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	2543111-0
ISSN	1869-4098 ; 1869-408X
ISSN (online)	1869-4098
ISSN	1869-408X
DOI	10.1007/s13239-016-0260-3
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Article ; Online: Accelerating massively parallel hemodynamic models of coarctation of the aorta using neural networks.

Feiger, Bradley / Gounley, John / Adler, Dale / Leopold, Jane A / Draeger, Erik W / Chaudhury, Rafeed / Ryan, Justin / Pathangey, Girish / Winarta, Kevin / Frakes, David / Michor, Franziska / Randles, Amanda

Scientific reports

2020 Volume 10, Issue 1, Page(s) 9508

Abstract: Comorbidities such as anemia or hypertension and physiological factors related to exertion can influence a patient's hemodynamics and increase the severity of many cardiovascular diseases. Observing and quantifying associations between these factors and ... ...

Abstract	Comorbidities such as anemia or hypertension and physiological factors related to exertion can influence a patient's hemodynamics and increase the severity of many cardiovascular diseases. Observing and quantifying associations between these factors and hemodynamics can be difficult due to the multitude of co-existing conditions and blood flow parameters in real patient data. Machine learning-driven, physics-based simulations provide a means to understand how potentially correlated conditions may affect a particular patient. Here, we use a combination of machine learning and massively parallel computing to predict the effects of physiological factors on hemodynamics in patients with coarctation of the aorta. We first validated blood flow simulations against in vitro measurements in 3D-printed phantoms representing the patient's vasculature. We then investigated the effects of varying the degree of stenosis, blood flow rate, and viscosity on two diagnostic metrics - pressure gradient across the stenosis (ΔP) and wall shear stress (WSS) - by performing the largest simulation study to date of coarctation of the aorta (over 70 million compute hours). Using machine learning models trained on data from the simulations and validated on two independent datasets, we developed a framework to identify the minimal training set required to build a predictive model on a per-patient basis. We then used this model to accurately predict ΔP (mean absolute error within 1.18 mmHg) and WSS (mean absolute error within 0.99 Pa) for patients with this disease.
MeSH term(s)	Aorta/physiopathology ; Constriction, Pathologic/physiopathology ; Hemodynamics ; Kinetics ; Models, Biological ; Neural Networks, Computer
Language	English
Publishing date	2020-06-11
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-020-66225-0
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Article ; Online: Does the degree of coarctation of the aorta influence wall shear stress focal heterogeneity?

Gounley, John / Chaudhury, Rafeed / Vardhan, Madhurima / Driscoll, Michael / Pathangey, Girish / Winarta, Kevin / Ryan, Justin / Frakes, David / Randles, Amanda

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2017 Volume 2016, Page(s) 3429–3432

Abstract: The development of atherosclerosis in the aorta is associated with low and oscillatory wall shear stress for normal patients. Moreover, localized differences in wall shear stress heterogeneity have been correlated with the presence of complex plaques in ... ...

Abstract	The development of atherosclerosis in the aorta is associated with low and oscillatory wall shear stress for normal patients. Moreover, localized differences in wall shear stress heterogeneity have been correlated with the presence of complex plaques in the descending aorta. While it is known that coarctation of the aorta can influence indices of wall shear stress, it is unclear how the degree of narrowing influences resulting patterns. We hypothesized that the degree of coarctation would have a strong influence on focal heterogeneity of wall shear stress. To test this hypothesis, we modeled the fluid dynamics in a patient-specific aorta with varied degrees of coarctation. We first validated a massively parallel computational model against experimental results for the patient geometry and then evaluated local shear stress patterns for a range of degrees of coarctation. Wall shear stress patterns at two cross sectional slices prone to develop atherosclerotic plaques were evaluated. Levels at different focal regions were compared to the conventional measure of average circumferential shear stress to enable localized quantification of coarctation-induced shear stress alteration. We find that the coarctation degree causes highly heterogeneous changes in wall shear stress.
MeSH term(s)	Aorta ; Aorta, Thoracic/physiopathology ; Aortic Coarctation/physiopathology ; Cross-Sectional Studies ; Humans ; Models, Cardiovascular ; Plaque, Atherosclerotic/physiopathology ; Stress, Mechanical
Language	English
Publishing date	2017-03-08
Publishing country	United States
Document type	Journal Article
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC.2016.7591465
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Article: Relationship of Activity Patterns to Acute Mountain Sickness in South Pole Workers

Pathangey, Girish / Wheatley-Guy, Courtney M. / Stewart, Glenn / Anderson, Paul J. / Richert, Maile L. Ceridon / Miller, Andrew D. / Johnson, Jacob B. / Johnson, Bruce

International Journal of Sports Medicine

2019 Volume 40, Issue 07, Page(s) 440–446

Abstract	This study aimed to evaluate the influence of physical activity on incidence of acute mountain sickness (AMS) by continuous activity monitoring in a free-living sample of South Pole workers over the initial 72 h at altitude exposure of 2,840 m (9,318 ft). Body Media activity monitors were worn by 47 healthy participants. AMS was defined by the Lake Louise symptom questionnaire. Venous blood samples were taken at sea level and approximately 48 h after high altitude exposure. AMS incidence was 34% (n=16/47) over the first 48 h and 40% (n=19/47) over 72 h. On day 2 at high altitude, individuals with AMS demonstrated a significantly greater increase in the percent change in physical activity metrics from baseline: total energy expenditure 19±13 vs. 5±7%, total steps 65±51 vs. 10±18%, metabolic equivalent of tasks 21±13 vs. 7±13%, and time spent performing moderate to vigorous physical activity 114±79 vs. 26±27% for individuals with AMS vs. no AMS, respectively, p<0.05. In addition, erythropoietin and vascular endothelial growth factor were 1.69 and 1.75 times higher, respectively, in those with AMS. In conclusion, workers who engaged in increased physical activity and activity intensity during initial exposure to the South Pole were more susceptible to developing AMS.
Keywords	acclimatization ; altitude ; exercise ; hypobaric
Language	English
Publishing date	2019-06-12
Publisher	© Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	603122-5
ISSN	1439-3964 ; 0172-4622 ; 0943-917X
ISSN (online)	1439-3964
ISSN	0172-4622 ; 0943-917X
DOI	10.1055/a-0884-3014
Database	Thieme publisher's database

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Article ; Online: Surrogate in vitro activation of innate immunity synergizes with interleukin-7 to unleash rapid antigen-driven outgrowth of CD4+ and CD8+ human peripheral blood T-cells naturally recognizing MUC1, HER2/neu and other tumor-associated antigens.

Pathangey, Latha B / McCurry, Dustin B / Gendler, Sandra J / Dominguez, Ana L / Gorman, Jessica E / Pathangey, Girish / Mihalik, Laurie A / Dang, Yushe / Disis, Mary L / Cohen, Peter A

Oncotarget

2016 Volume 8, Issue 7, Page(s) 10785–10808

Abstract: Effective adoptive immunotherapy has proved elusive for many types of human cancer, often due to difficulties achieving robust expansion of natural tumor-specific T-cells from peripheral blood. We hypothesized that antigen-driven T-cell expansion might ... ...

Abstract	Effective adoptive immunotherapy has proved elusive for many types of human cancer, often due to difficulties achieving robust expansion of natural tumor-specific T-cells from peripheral blood. We hypothesized that antigen-driven T-cell expansion might best be triggered in vitro by acute activation of innate immunity to mimic a life-threatening infection. Unfractionated peripheral blood mononuclear cells (PBMC) were subjected to a two-step culture, first synchronizing their exposure to exogenous antigens with aggressive surrogate activation of innate immunity, followed by γ-chain cytokine-modulated T-cell hyperexpansion. Step 1 exposure to GM-CSF plus paired Toll-like receptor agonists (resiquimod and LPS), stimulated abundant IL-12 and IL-23 secretion, as well as upregulated co-stimulatory molecules and CD11c expression within the myeloid (CD33+) subpopulation. Added synthetic long peptides (>20aa) derived from widely expressed oncoproteins (MUC1, HER2/neu and CMVpp65), were reliably presented to CD4+ T-cells and cross-presented to CD8+ T-cells. Both presentation and cross-presentation demonstrated proteasomal and Sec61 dependence that could bypass the endoplasmic reticulum. Step 2 exposure to exogenous IL-7 or IL-7+IL-2 produced selective and sustained expansion of both CD4+ and CD8+ peptide-specific T-cells with a predominant interferon-γ-producing T1-type, as well as the antigen-specific ability to lyse tumor targets. Other γ-chain cytokines and/or combinations were initially proliferogenic, but followed by a contractile phase not observed with IL-7 or IL-7+IL-2. Regulatory T-cells were minimally propagated under these culture conditions. This mechanistically rational culture sequence, effective even for unvaccinated donors, enables rapid preparation of T-cells recognizing tumor-associated antigens expressed by the majority of human cancers, including pancreatic cancers, breast cancers and glioblastomas.
MeSH term(s)	Antigens, Neoplasm/immunology ; Antigens, Neoplasm/metabolism ; CD4-Positive T-Lymphocytes/immunology ; CD4-Positive T-Lymphocytes/metabolism ; CD8-Positive T-Lymphocytes/immunology ; CD8-Positive T-Lymphocytes/metabolism ; Cell Proliferation/drug effects ; Cells, Cultured ; Cross-Priming/immunology ; Granulocyte-Macrophage Colony-Stimulating Factor/immunology ; Granulocyte-Macrophage Colony-Stimulating Factor/pharmacology ; Humans ; Imidazoles/pharmacology ; Immunity, Innate/drug effects ; Immunity, Innate/immunology ; Immunotherapy, Adoptive/methods ; Interferon-gamma/immunology ; Interferon-gamma/metabolism ; Interleukin-2/immunology ; Interleukin-2/pharmacology ; Interleukin-7/immunology ; Interleukin-7/pharmacology ; Leukocytes, Mononuclear/immunology ; Leukocytes, Mononuclear/metabolism ; Lipopolysaccharides/immunology ; Lipopolysaccharides/pharmacology ; Lymphocyte Activation/drug effects ; Lymphocyte Activation/immunology ; Mucin-1/immunology ; Mucin-1/metabolism ; Neoplasms/immunology ; Neoplasms/therapy ; Peptides/immunology ; Peptides/pharmacology ; Receptor, ErbB-2/immunology ; Receptor, ErbB-2/metabolism ; T-Lymphocytes, Regulatory/immunology ; T-Lymphocytes, Regulatory/metabolism
Chemical Substances	Antigens, Neoplasm ; Imidazoles ; Interleukin-2 ; Interleukin-7 ; Lipopolysaccharides ; MUC1 protein, human ; Mucin-1 ; Peptides ; Interferon-gamma (82115-62-6) ; Granulocyte-Macrophage Colony-Stimulating Factor (83869-56-1) ; ERBB2 protein, human (EC 2.7.10.1) ; Receptor, ErbB-2 (EC 2.7.10.1) ; resiquimod (V3DMU7PVXF)
Language	English
Publishing date	2016-12-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2560162-3
ISSN	1949-2553 ; 1949-2553
ISSN (online)	1949-2553
ISSN	1949-2553
DOI	10.18632/oncotarget.13911
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