Nitasa Sahu - Academia.edu (original) (raw)

Papers by Nitasa Sahu

Research paper thumbnail of Pneumothorax and Pneumomediastinum in Patients with COVID-19 Infection: A Case-Control Study of Risk Factors and Patient Characteristics

RATIONALE: Severe cases of Coronavirus Disease 2019 (COVID-19) are frequently associated with the... more RATIONALE: Severe cases of Coronavirus Disease 2019 (COVID-19) are frequently associated with the development of Acute Respiratory Distress Syndrome (ARDS) which can be complicated by the appearance of pneumothorax and/or pneumomediastinum (PaoP). This single-network, multi-hospital study examines PaoP in a retrospective COVID-19 cohort, including patient characteristics and overall incidence. In addition, risk factor determination is conducted using case-matched COVID-19 controls, hypothesizing that the need for mechanical ventilation and pulmonary comorbidities are associated with PaoP. METHODS: This is an IRB-exempt, retrospective case-control study involving patients with COVID-19 diagnosed by polymerase chain reaction and admitted to the hospital network 03/01/2020-11/30/2020. A total of 25 patients who developed PaoP were matched to COVID-19 patients without PaoP in 1:4 ratio according to age, gender and APACHE 2 score. Detailed chart review included patient demographics, BRIXIA, MuLBSTA, supplemental oxygen use, mechanical ventilation, inflammatory markers (CRP, ferritin, IL-6), pulmonary comorbidities (asthma, COPD, OSA, tobacco use), nonpulmonary comorbidities (diabetes, morbid obesity, malignancy, cardiovascular and renal diseases), and hospitalization characteristics (hospital length of stay or HLOS, ICU admission). Univariate results (Table 1) with significance level of P<0.20 were included in subsequent binary logistic regression to determine factors independently associated with PaoP.RESULTS: A total of 125 patients were evaluated (25 PaoP cases and 100 matched controls). Group characteristics included median age of 72 years [IQR 58-80];84% male sex;56% Caucasian;Median APACHE II 15.6 [6.8-41.0]. There were no significant differences in terms of CRP, ferritin, or IL-6 between the two groups. Patients with PaoP underwent chest tube placement in 76% cases and had significantly higher mortality (68% vs. 43%, p<0.025). In our multivariate analysis, factors independently associated with PaoP included longer hospitalization (OR 1.047, 95%CI 1.001-1.096) and mechanical ventilation (OR 3.271, 95%CI 1.066-10.035). CONCLUSION: Our data demonstrate that longer HLOS and the requirement for mechanical ventilation are independently associated with PaoP. However, our data do not support the hypothesis that pulmonary comorbidities (asthma, COPD, OSA, tobacco use) are significantly associated with PaoP. This, combined with the finding that the level of PEEP did not appear to be a significant risk factor for PaoP, highlights the need for better understanding of the underlying pulmonary pathology. The current series is among the largest studies of this important phenomenon in COVID-19 patients, and provides important insight into our understanding of this rare but prognostically important complication.

Research paper thumbnail of 236: Shock Index as a Marker for Mortality Rates in Those Admitted to the Micu from the Ed

Critical Care Medicine, 2016

Research paper thumbnail of Recurrent Lipoid Pneumonia Associated with Mesothelioma

Research paper thumbnail of DRESS is a Mess: A Case of Cross Reactivity Between Lacosamide and Lamotrigine

South Dakota medicine : the journal of the South Dakota State Medical Association, 2021

Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a rare drug reaction o... more Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a rare drug reaction often presenting with both cutaneous manifestations and potentially life-threatening internal organ involvement. The precise incidence of DRESS is still unclear as it is easily missed due to its highly variable clinical presentation. However, with an expected mortality rate of approximately 10 percent, it is important for clinicians to be familiar with pharmacologic etiologies commonly implicated in the pathogenesis. We present a case of DRESS syndrome attributed to cross-reactivity between two commonly used anticonvulsants- lacosamide and lamotrigine.

Research paper thumbnail of Rare Enough ? Cardiac Device Related Pocket Infection due to Mycobacterium fortuitum

Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED) pocke... more Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED) pocket infections. The defibrillators are more prone to infections when compared to pacemakers. Pocket infections may lead to device-related endocarditis, so preventing them is key. Presence of acid-fast bacilli on smears may aid in the diagnosis. These bacteria grow within 3-7 days on standard agar blood culture media. Accurate diagnosis requires PCR-restriction enzyme analysis. More often than not, with these infections, it is strongly recommended that entire device or hardware be removed urgently. A minimum of 4 months of therapy with at least two agents is necessary.

Research paper thumbnail of Discordant Outpatient and Inpatient Osa Diagnoses on a General Internal Medicine Service

Research paper thumbnail of Implementation of a Checklist to Reduce False-Positive Testing in Hospital-Acquired Clostridium Difficile Infection

BACKGROUND Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrh... more BACKGROUND Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. After a spike in Clostridium difficile infection (CDI) cases, the focus team identified several cases of inappropriate sampling, i.e., asymptomatic patients being tested. We hypothesized that the inappropriate samples were leading to a high number of false-positive cases. We explored appropriate patient stool sampling as a strategy for reducing the number of asymptomatic cases in a 275-bed rural community hospital. METHODS We conducted a prospective cohort study of inpatients to determine if appropriate stool sampling would result in a reduction in false positive Clostridium difficile cultures and decrease incidence of Clostridium difficile. We developed a checklist that would guide the nurse to improve the sampling process. RESULTS The study implementation period ran from July through December 2016, with comparison to a control cohort in the prior six months. From Jan. 16 to May 15,...

Research paper thumbnail of Would you Know How to Identify a Victim of Human Trafficking on your Service?

Research paper thumbnail of Catheter-Directed Therapy Combats Convoluted Clot

Research paper thumbnail of A Rare Case Of Cerebral Venous Thrombosis During An Inflammatory Bowel Disease Flare-Up

Inflammatory bowel disease (IBD) represents a group of disorders that involve chronic inflammatio... more Inflammatory bowel disease (IBD) represents a group of disorders that involve chronic inflammation of the digestive tract. These disorders usually present with various symptoms such as abdominal pain, vomiting, diarrhea and rectal bleeding, especially during a flare-up. There is an increased risk of venous thromboembolism during the flare-up and patients usually present with pulmonary embolism or deep vein thrombosis. Rarely, it can present with neurological symptoms due to a cerebrovascular event from thromboembolization. In this case report, we present a 38-year-old female with a seven-year history of IBD who developed acute encephalopathy during her IBD flare-up. Imaging studies of her brain revealed a large cerebral venous thrombosis (CVT) associated with intraparenchymal hemorrhage and surrounding vasogenic edema in the left temporal lobe extending to the parietal lobe. This finding of venous thrombosis was suspected to be from a hypercoagulable state associated with IBD flare-up.

Research paper thumbnail of Acute Acalculous Cholecystitis in a Patient With COVID-19 and a LVAD

Journal of Cardiac Failure

Research paper thumbnail of S3450 Optimal Inpatient Dosing of Proton Pump Inhibitors

American Journal of Gastroenterology

Research paper thumbnail of Retrospective Review of Melatonin in Patients with COVID-19

Research paper thumbnail of Recurrent Hemoptysis in Unilateral Pulmonary Artery Agenesis

Research paper thumbnail of COVID ‐19 in the geriatric population

International Journal of Geriatric Psychiatry

Research paper thumbnail of The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world Setting

Open Forum Infectious Diseases

Bamlanivimab, a monoclonal antibody targeting the spike protein of severe acute respiratory syndr... more Bamlanivimab, a monoclonal antibody targeting the spike protein of severe acute respiratory syndrome coronavirus 2, is available for ambulatory treatment of coronavirus disease 2019 (COVID-19). This real-world study confirms the efficacy of bamlanivimab in reducing hospital admissions and emergency department visits among high-risk outpatients with mild to moderate COVID-19 illness and reveals a trend toward improved mortality.

Research paper thumbnail of Shock Index as a Marker for Mortality Rates in Those Admitted to the Medical Intensive Care Unit from the Emergency Department

Research paper thumbnail of Naproxen-induced thrombocytopenia

Baylor University Medical Center Proceedings

Research paper thumbnail of Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Research paper thumbnail of 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital

Open Forum Infectious Diseases

Background Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined... more Background Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined as bacteriuria of ≥105 colony-forming units (cfu) per mL without any genitourinary signs or symptoms. Treatment for such leads to increased antimicrobial resistance and is especially common in the inpatient setting. One study showed a lack of appropriate clinical indication to order a urinalysis in more than half of the patients. In order to expedite a patient’s care, it is common to order a urinalysis and urine culture together and await the results. One study evaluated the impact of changing the order set in inpatients and yielded a 45% reduction in the urine cultures ordered and cost savings as high as $103,845. Reflex testing is used to facilitate effective and efficient patients care while remaining compliant with state and federal regulations in the ordering of lab test. Methods Starting October 25, 2019, the electronic medical record order set was changed so there were only 2 opt...

Research paper thumbnail of Pneumothorax and Pneumomediastinum in Patients with COVID-19 Infection: A Case-Control Study of Risk Factors and Patient Characteristics

RATIONALE: Severe cases of Coronavirus Disease 2019 (COVID-19) are frequently associated with the... more RATIONALE: Severe cases of Coronavirus Disease 2019 (COVID-19) are frequently associated with the development of Acute Respiratory Distress Syndrome (ARDS) which can be complicated by the appearance of pneumothorax and/or pneumomediastinum (PaoP). This single-network, multi-hospital study examines PaoP in a retrospective COVID-19 cohort, including patient characteristics and overall incidence. In addition, risk factor determination is conducted using case-matched COVID-19 controls, hypothesizing that the need for mechanical ventilation and pulmonary comorbidities are associated with PaoP. METHODS: This is an IRB-exempt, retrospective case-control study involving patients with COVID-19 diagnosed by polymerase chain reaction and admitted to the hospital network 03/01/2020-11/30/2020. A total of 25 patients who developed PaoP were matched to COVID-19 patients without PaoP in 1:4 ratio according to age, gender and APACHE 2 score. Detailed chart review included patient demographics, BRIXIA, MuLBSTA, supplemental oxygen use, mechanical ventilation, inflammatory markers (CRP, ferritin, IL-6), pulmonary comorbidities (asthma, COPD, OSA, tobacco use), nonpulmonary comorbidities (diabetes, morbid obesity, malignancy, cardiovascular and renal diseases), and hospitalization characteristics (hospital length of stay or HLOS, ICU admission). Univariate results (Table 1) with significance level of P<0.20 were included in subsequent binary logistic regression to determine factors independently associated with PaoP.RESULTS: A total of 125 patients were evaluated (25 PaoP cases and 100 matched controls). Group characteristics included median age of 72 years [IQR 58-80];84% male sex;56% Caucasian;Median APACHE II 15.6 [6.8-41.0]. There were no significant differences in terms of CRP, ferritin, or IL-6 between the two groups. Patients with PaoP underwent chest tube placement in 76% cases and had significantly higher mortality (68% vs. 43%, p<0.025). In our multivariate analysis, factors independently associated with PaoP included longer hospitalization (OR 1.047, 95%CI 1.001-1.096) and mechanical ventilation (OR 3.271, 95%CI 1.066-10.035). CONCLUSION: Our data demonstrate that longer HLOS and the requirement for mechanical ventilation are independently associated with PaoP. However, our data do not support the hypothesis that pulmonary comorbidities (asthma, COPD, OSA, tobacco use) are significantly associated with PaoP. This, combined with the finding that the level of PEEP did not appear to be a significant risk factor for PaoP, highlights the need for better understanding of the underlying pulmonary pathology. The current series is among the largest studies of this important phenomenon in COVID-19 patients, and provides important insight into our understanding of this rare but prognostically important complication.

Research paper thumbnail of 236: Shock Index as a Marker for Mortality Rates in Those Admitted to the Micu from the Ed

Critical Care Medicine, 2016

Research paper thumbnail of Recurrent Lipoid Pneumonia Associated with Mesothelioma

Research paper thumbnail of DRESS is a Mess: A Case of Cross Reactivity Between Lacosamide and Lamotrigine

South Dakota medicine : the journal of the South Dakota State Medical Association, 2021

Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a rare drug reaction o... more Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a rare drug reaction often presenting with both cutaneous manifestations and potentially life-threatening internal organ involvement. The precise incidence of DRESS is still unclear as it is easily missed due to its highly variable clinical presentation. However, with an expected mortality rate of approximately 10 percent, it is important for clinicians to be familiar with pharmacologic etiologies commonly implicated in the pathogenesis. We present a case of DRESS syndrome attributed to cross-reactivity between two commonly used anticonvulsants- lacosamide and lamotrigine.

Research paper thumbnail of Rare Enough ? Cardiac Device Related Pocket Infection due to Mycobacterium fortuitum

Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED) pocke... more Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED) pocket infections. The defibrillators are more prone to infections when compared to pacemakers. Pocket infections may lead to device-related endocarditis, so preventing them is key. Presence of acid-fast bacilli on smears may aid in the diagnosis. These bacteria grow within 3-7 days on standard agar blood culture media. Accurate diagnosis requires PCR-restriction enzyme analysis. More often than not, with these infections, it is strongly recommended that entire device or hardware be removed urgently. A minimum of 4 months of therapy with at least two agents is necessary.

Research paper thumbnail of Discordant Outpatient and Inpatient Osa Diagnoses on a General Internal Medicine Service

Research paper thumbnail of Implementation of a Checklist to Reduce False-Positive Testing in Hospital-Acquired Clostridium Difficile Infection

BACKGROUND Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrh... more BACKGROUND Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. After a spike in Clostridium difficile infection (CDI) cases, the focus team identified several cases of inappropriate sampling, i.e., asymptomatic patients being tested. We hypothesized that the inappropriate samples were leading to a high number of false-positive cases. We explored appropriate patient stool sampling as a strategy for reducing the number of asymptomatic cases in a 275-bed rural community hospital. METHODS We conducted a prospective cohort study of inpatients to determine if appropriate stool sampling would result in a reduction in false positive Clostridium difficile cultures and decrease incidence of Clostridium difficile. We developed a checklist that would guide the nurse to improve the sampling process. RESULTS The study implementation period ran from July through December 2016, with comparison to a control cohort in the prior six months. From Jan. 16 to May 15,...

Research paper thumbnail of Would you Know How to Identify a Victim of Human Trafficking on your Service?

Research paper thumbnail of Catheter-Directed Therapy Combats Convoluted Clot

Research paper thumbnail of A Rare Case Of Cerebral Venous Thrombosis During An Inflammatory Bowel Disease Flare-Up

Inflammatory bowel disease (IBD) represents a group of disorders that involve chronic inflammatio... more Inflammatory bowel disease (IBD) represents a group of disorders that involve chronic inflammation of the digestive tract. These disorders usually present with various symptoms such as abdominal pain, vomiting, diarrhea and rectal bleeding, especially during a flare-up. There is an increased risk of venous thromboembolism during the flare-up and patients usually present with pulmonary embolism or deep vein thrombosis. Rarely, it can present with neurological symptoms due to a cerebrovascular event from thromboembolization. In this case report, we present a 38-year-old female with a seven-year history of IBD who developed acute encephalopathy during her IBD flare-up. Imaging studies of her brain revealed a large cerebral venous thrombosis (CVT) associated with intraparenchymal hemorrhage and surrounding vasogenic edema in the left temporal lobe extending to the parietal lobe. This finding of venous thrombosis was suspected to be from a hypercoagulable state associated with IBD flare-up.

Research paper thumbnail of Acute Acalculous Cholecystitis in a Patient With COVID-19 and a LVAD

Journal of Cardiac Failure

Research paper thumbnail of S3450 Optimal Inpatient Dosing of Proton Pump Inhibitors

American Journal of Gastroenterology

Research paper thumbnail of Retrospective Review of Melatonin in Patients with COVID-19

Research paper thumbnail of Recurrent Hemoptysis in Unilateral Pulmonary Artery Agenesis

Research paper thumbnail of COVID ‐19 in the geriatric population

International Journal of Geriatric Psychiatry

Research paper thumbnail of The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world Setting

Open Forum Infectious Diseases

Bamlanivimab, a monoclonal antibody targeting the spike protein of severe acute respiratory syndr... more Bamlanivimab, a monoclonal antibody targeting the spike protein of severe acute respiratory syndrome coronavirus 2, is available for ambulatory treatment of coronavirus disease 2019 (COVID-19). This real-world study confirms the efficacy of bamlanivimab in reducing hospital admissions and emergency department visits among high-risk outpatients with mild to moderate COVID-19 illness and reveals a trend toward improved mortality.

Research paper thumbnail of Shock Index as a Marker for Mortality Rates in Those Admitted to the Medical Intensive Care Unit from the Emergency Department

Research paper thumbnail of Naproxen-induced thrombocytopenia

Baylor University Medical Center Proceedings

Research paper thumbnail of Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Research paper thumbnail of 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital

Open Forum Infectious Diseases

Background Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined... more Background Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined as bacteriuria of ≥105 colony-forming units (cfu) per mL without any genitourinary signs or symptoms. Treatment for such leads to increased antimicrobial resistance and is especially common in the inpatient setting. One study showed a lack of appropriate clinical indication to order a urinalysis in more than half of the patients. In order to expedite a patient’s care, it is common to order a urinalysis and urine culture together and await the results. One study evaluated the impact of changing the order set in inpatients and yielded a 45% reduction in the urine cultures ordered and cost savings as high as $103,845. Reflex testing is used to facilitate effective and efficient patients care while remaining compliant with state and federal regulations in the ordering of lab test. Methods Starting October 25, 2019, the electronic medical record order set was changed so there were only 2 opt...