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  1. Article ; Online: Myocardial ischemia in patients with large prior infarction

    Talal Asif, MD / Rami Doukky, MD, MSc, MBA

    Radiology Case Reports, Vol 18, Iss 2, Pp 538-

    Clinical decision making and review of literature

    2023  Volume 544

    Abstract: Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) or positron emission tomography (PET) is a widely used technique for the evaluation of coronary artery disease (CAD). Interpreting physicians rely on regional ... ...

    Abstract Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) or positron emission tomography (PET) is a widely used technique for the evaluation of coronary artery disease (CAD). Interpreting physicians rely on regional variations in myocardial radiotracer uptake between rest and stress images to identify hemodynamically significant epicardial coronary artery stenosis. However, interpretation of MPI is very difficult in patients with large infarcts where there is no scintigraphically normal reference myocardium for comparison. In these patients, the stress and rest images appear similar due to balanced ischemia in the non-infarct territory. There are no clear guidelines on how to approach these cases. We present a case of MPI with a large right coronary artery territory (RCA) infarct where the left main (LM) coronary artery territory has no relative comparator and the images looked the same on stress and rest. However, the patient had multiple high-risk ancillary findings including electrocardiographic (ECG) changes with regadenoson, transient ischemic dilatation (TID), large severe inferior infarct, low myocardial blood flow (MBF) and myocardial flow reserve (MFR), but most notably increased right ventricular (RV) uptake on the stress images that was a subtle clue that we were dealing with LM equivalent in non-infarct zone. The coronary angiogram confirmed our findings. Through our case, we provide a comprehensive approach and review of literature on how to approach such challenging encounters.
    Keywords Multivessel coronary artery disease ; Rubidium-82 positron emission tomography ; Transient ischemic dilatation ; Myocardial blood flow ; Myocardial flow reserve ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
    Subject code 610
    Language English
    Publishing date 2023-02-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Transient ST Segment Elevation in Two Patients with COVID-19 and a Normal Transthoracic Echocardiogram

    Talal Asif / Zafar Ali

    European Journal of Case Reports in Internal Medicine (2020)

    2020  

    Abstract: We continue to learn about cardiac involvement in patients with COVID-19. These patients can develop acute coronary syndrome and severe myocarditis with a reduced ejection fraction. We describe two critically ill COVID-19 patients who developed ST ... ...

    Abstract We continue to learn about cardiac involvement in patients with COVID-19. These patients can develop acute coronary syndrome and severe myocarditis with a reduced ejection fraction. We describe two critically ill COVID-19 patients who developed ST elevation that resolved on repeat ECG without any intervention.
    Keywords st segment elevation ; covid-19 ; Medicine ; R ; covid19
    Language English
    Publishing date 2020-04-01T00:00:00Z
    Publisher SMC MEDIA SRL
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19

    Talal Asif / Kameel Kassab / Fady Iskander / Tareq Alyousef

    European Journal of Case Reports in Internal Medicine (2020)

    A Therapeutic Challenge

    2020  

    Abstract: We report a case of acute viral pericarditis and cardiac tamponade in a patient with COVID-19 to highlight the associated treatment challenges, especially given the uncertainty associated with the safety of standard treatment. We also discuss ... ...

    Abstract We report a case of acute viral pericarditis and cardiac tamponade in a patient with COVID-19 to highlight the associated treatment challenges, especially given the uncertainty associated with the safety of standard treatment. We also discuss complications associated with delayed diagnosis in patients who potentially may need mechanical ventilation.
    Keywords covid-19 ; acute pericarditis ; cardiac tamponade ; Medicine ; R ; covid19
    Language English
    Publishing date 2020-05-01T00:00:00Z
    Publisher SMC MEDIA SRL
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Ruptured Sinus of Valsalva Aneurysm Causing Aorto–Atrial Fistula and Acute Heart Failure

    Zafar Ali / Talal Asif / Justin Sheehy / Dany Jacob / Paramdeep S Baweja

    European Journal of Case Reports in Internal Medicine (2020)

    A Rare Encounter

    2020  

    Abstract: A ruptured sinus of Valsalva aneurysm as a cause of aorto–atrial fistula is very rare. We present the case of a 53-year-old female who presented with symptoms of acute heart failure and suspicion of an aorto–atrial fistula found on a transthoracic ... ...

    Abstract A ruptured sinus of Valsalva aneurysm as a cause of aorto–atrial fistula is very rare. We present the case of a 53-year-old female who presented with symptoms of acute heart failure and suspicion of an aorto–atrial fistula found on a transthoracic echocardiogram, which was confirmed on transesophageal echocardiography. A coronary angiogram showed normal coronary arteries but confirmed the right aorto–atrial fistula on aortogram. She underwent successful surgical repair of the fistula. Her postoperative echocardiogram showed a normal right atrium and right ventricle with no shunt. A ruptured sinus of Valsalva aneurysm is a devastating event and presents as acute heart failure. Prompt diagnosis and surgical repair is necessary to prevent mortality.
    Keywords sinus of valsalva aneurysm ; aorto–atrial fistula ; heart failure ; Medicine ; R
    Language English
    Publishing date 2020-03-01T00:00:00Z
    Publisher SMC MEDIA SRL
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Call for Vigilance – Red Flags in Systemic Lupus Erythematous

    Badar Hasan / Talal Asif / Maryam Hasan / Amr Edrees

    Marshall Journal of Medicine, Vol 3, Iss 3, Pp 20-

    2017  Volume 26

    Abstract: Systemic Lupus Erythematous(SLE) is a multisystem autoimmune disease. It has been identified as the underlying cause for death for an average 1,034 deaths from 2000 and 2014. Our cases highlight two rare but life threatening complications of SLE; ... ...

    Abstract Systemic Lupus Erythematous(SLE) is a multisystem autoimmune disease. It has been identified as the underlying cause for death for an average 1,034 deaths from 2000 and 2014. Our cases highlight two rare but life threatening complications of SLE; Catastrophic antiphospholipid syndrome (CAPS) and Diffuse alveolar hemorrhage (DAH) with mortality as high as 50-90%. Both cases presenting with respiratory symptoms, required meticulous monitoring in ICU and initially treated with broad spectrum antibiotics However, unlike pneumonia these patients required immunosuppressive and plasmapheresis leading to clinical improvement.
    Keywords Systemic Lupus Erythematous ; Catastrophic Antiphospholipid Syndrome ; Diffuse Alveolar Hemorrhage ; Medicine (General) ; R5-920
    Language English
    Publishing date 2017-07-01T00:00:00Z
    Publisher Marshall University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Species Diversity Induces Idiosyncratic Effects on Litter Decomposition in a Degraded Meadow Steppe

    Iqra Naeem / Talal Asif / Xuefeng Wu / Nazim Hassan / Liu Yiming / Hongjun Wang / Ling Wang / Deli Wang

    Frontiers in Environmental Science, Vol

    2021  Volume 9

    Abstract: Litter decomposition is a fundamental path for nutrient cycling in a natural ecosystem. However, it remains unclear how species diversity, including richness and evenness, affects the decomposition dynamics in the context of grassland degradation. Using ... ...

    Abstract Litter decomposition is a fundamental path for nutrient cycling in a natural ecosystem. However, it remains unclear how species diversity, including richness and evenness, affects the decomposition dynamics in the context of grassland degradation. Using a litter bag technique, we investigated the litter-mixing effects of two coexisting dominant species (Leymus chinensis Lc and Phragmites australis Pa), as monocultures and mixtures with evenness (Lc:Pa) from M1 (30:70%), M2 (50:50%), and M3 (70:30%), on decomposition processes over time (60 and 365 days). The litter bags were placed on the soil surface along a degradation gradient [near pristine (NP), lightly degraded (LD), and highly degraded (HD)]. We found that 1) mass loss in mixture compositions was significantly and positively correlated with initial nitrogen (N) and cellulose contents; 2) litter mixing (richness and evenness) influenced decomposition dynamics individually and in interaction with the incubation days and the degradation gradients; 3) in a general linear model (GLM), nonadditive antagonistic effects were more prominent than additive or neutral effects in final litter and nutrients except for carbon (C); and 4) in nutrients (C, N, lignin) and C/N ratio, additive effects shifted to nonadditive with incubation time. We speculated that the occurrence of nonadditive positive or negative effects varied with litter and nutrients mass remaining in each degraded gradient under the mechanism of initial litter quality of monoculture species, soil properties of experimental sites, and incubation time. Our study has important implications for grassland improvement and protection by considering species biodiversity richness, as well as species evenness.
    Keywords litter mixing ; nutrient cycling ; litter quality ; evenness ; non-additive effects ; incubation time ; Environmental sciences ; GE1-350
    Subject code 580
    Language English
    Publishing date 2021-03-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Betel nut use and hyperglycemia

    Edward Nabrinsky / Badar Hasan / Talal Asif / Rebecca R. Pauly

    Marshall Journal of Medicine, Vol 3, Iss 3, Pp 8-

    2017  Volume 13

    Abstract: Betel nut chewing previously has not been common in North America, yet it is the fourth major source of addiction and abuse worldwide. Approximately 700 million individuals, or 10 % of the global population, chew beetle nut on regular basis. It is ... ...

    Abstract Betel nut chewing previously has not been common in North America, yet it is the fourth major source of addiction and abuse worldwide. Approximately 700 million individuals, or 10 % of the global population, chew beetle nut on regular basis. It is important for patient safety and improved quality to recognize its use in uncontrolled diabetes. Our case is of a 49 year-old Burmese female with PMH of DM2, HTN, and benign paroxysmal positional vertigo (BPPV) who presented with a complaint of dizziness. Patient denied alcohol or tobacco use, but reported a 20-year history of betel nut chewing (4-5 times/day). Physical exam showed oral mucosa was dry with poor dentition along with eroded enamel and gums. Point-of-care glucose was extremely elevated at 522 mg/dL with HbA1c of 10.8%. Dix-Hallpike maneuver was negative and CTA of the head and neck was unremarkable. Neurology was also consulted regarding her dizziness, and MRI head demonstrated no acute infarct or hemorrhage. Throughout admission, patient’s point of care glucose fluctuated between 91 and 316 (mg/dL), with several daily spikes. Her dizziness improved by day 2 of hospitalization. At the time of discharge, her glucose was controlled on 50 units of glargine at nighttime along with 8 units of insulin at meals. After a negative initial workup for occult causes of dizziness, it was concluded that her 20-year history of betel nut chewing contributed to dizziness and hyperglycemia. Multiple studies show high risk of diabetes, increased likelihood of coronary artery disease and all-cause mortality in betel nut users. Specifically, one study in Taiwan demonstrated increasing incidence ratios of type II diabetes with increasing age. Conclusion: 1.4 million Americans are diagnosed with diabetes every year. It is the seventh leading cause of death in US, and costs $69 billion in reduced productivity. Prevention and tight glycemic control remain the core of diabetes management. With an increasing Indian and South Asian immigrant population, physicians need to be aware of potential harmful effects of betel nut to improve quality of care. Screening for betel nut use should be a routine part of social history in susceptible populations. Counseling should be provided to educate patients about its harmful effects, and cessation should be encouraged.
    Keywords betel nut ; hyperglycemia ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2017-07-01T00:00:00Z
    Publisher Marshall University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Mechanical pulmonic valve thrombosis

    Ahmed A. Kolkailah, MD, MSc / Talal Asif, MD / Fady H. Iskander, MD, MSc / Javier Gomez-Valencia, MD, MSc, FACC / Saurabh Malhotra, MD, MPH, FACC

    Radiology Case Reports, Vol 17, Iss 9, Pp 3270-

    expanding role of cardiac CT and multimodality imaging

    2022  Volume 3273

    Abstract: We report a case of a 44-year-old man with a clinical history of Tetralogy of Fallot status post staged surgical correction with mechanical pulmonic valve replacement who presented with progressive exertional dyspnea in the setting of non-compliance with ...

    Abstract We report a case of a 44-year-old man with a clinical history of Tetralogy of Fallot status post staged surgical correction with mechanical pulmonic valve replacement who presented with progressive exertional dyspnea in the setting of non-compliance with anticoagulation. In the context of this suggestive clinical presentation, the diagnosis of mechanical pulmonic valve thrombosis (MPVT) was made possible via multimodality imaging, including transthoracic echocardiogram and cardiac computed tomography angiography. Due to the uncommon nature of the condition, the patient was treated with systemic thrombolysis and anticoagulation using evidence-based guidelines, largely extrapolated from left-sided mechanical valve thrombosis. Our case underscores the importance of anticoagulation in MPVT and recognizing the features of MPVT on clinical history, physical examination, and multimodality imaging. It is essential to understand the pivotal role of multimodality imaging in the assessment of MPVT and realize the limitations of available data regarding the management of MPVT in the current era.
    Keywords Mechanical pulmonic valve thrombosis ; Cardiac computed tomography angiography ; Multimodality imaging ; Anticoagulation ; Systemic thrombolysis ; Evidence-based guidelines ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
    Subject code 610
    Language English
    Publishing date 2022-09-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Dislodging Anchored Diagnoses

    Talal Asif / Ravali Gummi / Zara Wadood / Kristy E. Steigerwalt / Rebecca R. Pauly

    Marshall Journal of Medicine, Vol 3, Iss 2, Pp 12-

    An Unusual Presentation Of Acute Appendicitis

    2017  Volume 18

    Abstract: Cognitive errors are the most common cause of diagnostic errors in the process of clinical decision making. Recently, there has been an immense focus on the new science of error prevention in health care. Anchored thinking or heuristics is a form of ... ...

    Abstract Cognitive errors are the most common cause of diagnostic errors in the process of clinical decision making. Recently, there has been an immense focus on the new science of error prevention in health care. Anchored thinking or heuristics is a form of cognitive error that portrays shortcuts or abbreviated thinking in the light of diagnostic uncertainty. The risk is of comfort in a typical scenario and not being able to adapt to a new situation. Here we present an intriguing case of acute appendicitis in a patient who was initially admitted and treated for hypothermia and alcohol withdrawal. As the patient recovered from his withdrawal and neared the end of his hospital stay, he developed persistent leukocytosis, mild metabolic acidosis and vague abdominal discomfort, leading us to pursue further work up resulting in a new diagnosis. If unrecognized, delayed diagnosis and significant harm with potential for rupture of the appendix, peritonitis, significant morbidity and even mortality could have occurred. This case serves as an example of how to avoid errors resulting from heuristic thinking for the reason that incongruity of data was specifically looked for and consequently recognized.
    Keywords Anchored thinking ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2017-04-01T00:00:00Z
    Publisher Marshall University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Spinal Cord Injury and Autonomic Dysreflexia- A Case Report

    Apurva Bhatt / Brit Moore / Talal Asif / Kristy E. Steigerwalt / Rebecca R. Pauly

    Marshall Journal of Medicine, Vol 2, Iss 4, Pp 1-

    2016  Volume 6

    Abstract: Autonomic dysreflexia (AD) is a life threatening condition affecting patients with spinal cord lesions T6 level and above. A 51 year old male with a history of paraplegia due to a C6 spinal cord injury (30 years prior) presented with recurrent ... ...

    Abstract Autonomic dysreflexia (AD) is a life threatening condition affecting patients with spinal cord lesions T6 level and above. A 51 year old male with a history of paraplegia due to a C6 spinal cord injury (30 years prior) presented with recurrent debilitating episodic diaphoresis, hypertension, low body temperature, and bradycardia. Previous hospitalizations presumed sepsis from UTI to be the etiology, however on further evaluation his symptoms were consistent with undiagnosed AD. This article describes a unique case presentation and reviews AD in depth, including the etiology, pathophysiology and management.
    Keywords spinal cord injury ; autonomic dysreflexia ; diaphoresis ; hypertension ; Medicine (General) ; R5-920
    Language English
    Publishing date 2016-10-01T00:00:00Z
    Publisher Marshall University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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