rutwik patel - Academia.edu (original) (raw)
Papers by rutwik patel
Journal of Community Hospital Internal Medicine Perspectives
ABSTRACT Hypercoagulability has been found in patients diagnosed with the novel coronavirus 19 (C... more ABSTRACT Hypercoagulability has been found in patients diagnosed with the novel coronavirus 19 (COVID-19) and has been identified as a major cause of morbidity and mortality. Herein, we report the challenge in managing a patient presenting with a 5 day history of COVID-19 diagnosis, complicated by deep venous thrombosis, pulmonary embolism and ischemic stroke in the setting of atrial septal aneurysm, presumed patent foramen ovale and paradoxical embolism, identified to have clots in transit on echocardiogram. The application of anticoagulation was felt to be high risk. The patient was transferred to a tertiary facility where the patient underwent thrombus aspiration and was eventually complicated by hemorrhagic conversion of the stroke.
SSRN Electronic Journal, 2021
Journal of International Medical Research, 2021
We present a case of transfusion-related acute lung injury as a complication of convalescent plas... more We present a case of transfusion-related acute lung injury as a complication of convalescent plasma transfusion in a patient who presented with COVID-19–related severe acute respiratory syndrome. Despite treatment with tocilizumab, remdesivir, and intravenous steroids, worsening dyspnea prompted adjunctive treatment with convalescent plasma. Two hours after completion of the plasma transfusion, the patient developed hypoxia-induced cardiac arrest secondary to transfusion-related acute lung injury. This case sheds light on life-threatening transfusion reactions and emphasizes the need to investigate post-transfusion monitoring protocols as well as the possible role of surveillance equipment.
Computational Intelligence for Managing Pandemics, 2021
SSRN Electronic Journal, 2021
SSRN Electronic Journal, 2021
Chest, 2021
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 is a major public health ... more TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 is a major public health emergency with increasing mortality since the first case in December 2019. COVID-19 has multifaceted presentation and only about 15-20% required hospitalizations and a quarter of those required management in an intensive care unit (ICU). Herein, we reviewed the demographics, clinical outcomes, and identified the potential prognostic indicators in patients with COVID-19 who were admitted to our ICU. METHODS: A retrospective cohort study was conducted on patients ≥ 18 years old with confirmed COVID-19, who were admitted to our ICU between 03/17/2020 and 05/14/2020. Demographic, clinical, and laboratory data were reviewed and retrieved. Data was expressed as counts and percentages. T-test and chi-square (χ) were used for continuous and categorical variables respectively. Univariate analysis was also performed to identify the prognostic indicators associated with mortality. GraphPad PRISM was used for data analysis. RESULTS: Seventy-five patients were identified during the study period with an average age of 60.8 (ranged from 19-89), of which males were 99 (71%) and females were 41 (29%). Majority were Hispanic (45%) and African Americans (34%). The average body mass index was 30.6. Hypertension (47.9%) and chronic kidney disease (47.1%) were the most common comorbidities. Mechanical ventilation was required in 99 (70.7%) of the patients. Of those 99, 75 (76%) expired. There was no statistically significant difference between the survival and expired groups in term of age, gender, ethnicities and number of comorbidities. Need of mechanical ventilation (MV) and renal replacement therapy (RRT) were significantly associated with mortality (p<0.0001 for both parameters). Interestingly, use of therapeutic anticoagulation was associated with decrease risk of mortality (p-value 0.03865). When looking into the laboratory parameters, higher blood urea nitrogen (BUN) on Day 5 (p-value 0.0067), initial LDH (p<0.0001), initial CRP (p-value 0.0062), white blood cell counts (WBC) (p<0.0001), and high absolute neutrophil counts (ANC) (p-value 0.0002) were statistically associated with increased risk of mortality. SOFA scores did not predict mortality in these patients (p-value 0.9243) CONCLUSIONS: This retrospective cohort study on patients with COVID-19 who required ICU showed that need for Mechanical Ventilation and Renal Replacement Therapy were significantly associated with mortality. Surprisingly, use of therapeutic anticoagulation decreased the risk of mortality and initial LDH and CRP were the two inflammatory markers that may help predict mortality. This interesting finding need to be corroborated in a larger study. CLINICAL IMPLICATIONS: This study was done using the data during the initial two months of first wave of COVID-19 in the United States and the data represents our observations at that time. Several studies have been done on the use of Anticoagulation in COVID-19 patients thereafter, however there is no universally accepted protocol. This study helped us identify the differences in the outcome between first and second use with aggressive use of anticoagulation, Remdesivir, and dexamethasone during the second wave. DISCLOSURES: No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Kok Hoe Chan, source=Web Response No relevant relationships by Joanna Crincoli, source=Web Response No relevant relationships by Claudia Komer, source=Web Response No relevant relationships by Sudha Lagudu, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Meenakshi Sindhuri Nali, source=Web Response No relevant relationships by Amy Paige, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Laxminarayan Prabhakar, source=Web Response No relevant relationships by Amr Ramahi, source=Web Response No relevant relationships by Divya Mounisha Thimmareddygari, source=Web Response
Chest, 2021
TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Emphysematous pyel... more TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Emphysematous pyelonephritis (EPN) is an uncommon acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The clinical course of EPN can be life threatening if not managed astutely. The primary organisms responsible include Escherichia coli and Klebsiella Pneumoniae. We present a rare and uncommon case of severe EPN that was managed conservatively with good outcome. CASE PRESENTATION: A 63-year-old Hispanic female with a past medical history of uncontrolled diabetes and hypertension presented with a four-day history of abdominal pain, nausea, vomiting and diarrhea. Vital signs showed T 38.2°C, HR 99, BP 103/58 mmHg and saturating 100% on RA. Palpation and percussion of the left flank region elicited pain. Lab findings were significant for hyponatremia (132), hypochloremia (95), elevated BUN and Creatinine (43/2.4), hyperglycemia (264), elevated CRP 36.5. Initial lactic acid was found to be 2.8. Urinalysis showed findings suggestive of a UTI. Patient also was incidentally found to have COVID-19 Ag and PCR positive. Chest X-ray showed mild interstitial prominence. Emergent renal ultrasound reported scattered foci of air in the left renal upper pole calyces and proximal ureter. CT Abdomen Pelvis with contrast showed air in the bladder and left ureter and kidney. Despite adequate initial resuscitation with IV fluids and IV piperacillin-tazobactam, her lactic acid increased peaking at 8.5 and she was promptly moved to MICU for hemodynamic monitoring. With a working diagnosis of EPN and SARS-CoV-2 infection, she was switched to Meropenem, placed on IV fluids and her pain was managed supportively. Urology was consulted who recommended close monitoring and plan for emergent intervention if condition worsened. However, since patient started to recover, she did not undergo intervention. Antibiotics were de-escalated to Ceftriaxone after blood cultures grew sensitive Escherichia coli. Patient's condition improved and she was discharged with outpatient follow-up with urology. DISCUSSION: Based on CT findings, emphysematous UTI's are characterized into Class I to IV with increasing mortality associated as you move towards class IV. Our patient initially presented with Class I and as a result was promptly started on antibiotics. If EPN had progressed anymore, she would have needed a percutaneous drainage, or even nephrectomy in refractory cases, in addition to antibiotic therapy. However, due to prompt care and aggressive monitoring provided to her, she was able to improve without further interventions. The rarity of the condition and the decision-making involved while managing the disease makes this case unique. CONCLUSIONS: Emphysematous pyelonephritis is an uncommon severe infection of the renal parenchyma, which with early diagnosis can be managed conservatively. REFERENCE #1: Sharma PK, Sharma R, Vijay MK, Tiwari P, Goel A, Kundu AK. Emphysematous pyelonephritis: Our experience with conservative management in 14 cases. Urol Ann. 2013;5(3):157-162. doi:10.4103/0974-7796.115734 REFERENCE #2: Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160:797–805. DISCLOSURES: No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Laxminarayan Prabhakar, source=Web Response No relevant relationships by Manogjna Prasad, source=Web Response
Journal of Community Hospital Internal Medicine Perspectives, 2021
We present a case report describing a potential rare adverse reaction of the recombinant zoster v... more We present a case report describing a potential rare adverse reaction of the recombinant zoster vaccination. This patient is a 60-year-old female who was admitted for severe rhabdomyolysis after receiving the vaccine. The patient's symptoms and CPK improved with aggressive hydration over several days. The patient did not have any known or reported common risk factors for rhabdomyolysis and the Naranjo Score was used to determine the likelihood of an adverse drug reaction. This is a relevant case to discuss in order to make physicians aware of a possible rare and lethal adverse effect due to a common vaccination.
SSRN Electronic Journal, 2021
Urban cities all around the world are suffering from increasing vehicular traffic density, increa... more Urban cities all around the world are suffering from increasing vehicular traffic density, increasing population density, narrow roads, and overburdened public infrastructure. As traffic jams become a common sight in urban cities, the average transit time for vehicles has increased. These trends have grave consequences for emergency vehicles like ambulances which need to reach their destinations in the shortest time possible. Taking advantage of miniature processing units, communication networks, many systems have been designed to address this problem. The systems which aim to reduce the transit time of emergency vehicles are called Emergency Vehicle Priority (EVP) systems. EVP systems are systems that control the flow of traffic efficiently to let emergency vehicles travel faster. In this paper, we present a review of different EVP systems.
SSRN Electronic Journal, 2020
Maximize the coverage is one of the important aspects, in designing the wireless sensor network. ... more Maximize the coverage is one of the important aspects, in designing the wireless sensor network. One should aim at a nearly optimum coverage rate without reducing the life span of the network. Numerous solutions were suggested for this from which most try to select the least number of nodes as active, while the others remain in the sleep mode to save energy. This approach extends the life span of the network also. Nevertheless, these methods suffer from a lack of mathematical bases for the initial seed node choice in selecting active nodes. In this manuscript, a distributed method is suggested to address the challenge of maximum coverage with maximum network life. The exploitation of the game theory as a mathematical basis for the choice of active nodes is demonstrated in the current manuscript. The basis of the game theory in node planning, is node compete with each other to become active. Node tries to avoid coverage redundancy using the costs of the activation. This cost use number of the active neighbors and the uncovered area. The comparison of the simulation results with the results of the actual network deployed with nodeMCUs is done. We found that the network lifetimes almost doubles from 52 Hours to 98 hours with actual deployment on two nodeMCUs. The suggested method works well for maximum coverage, life span, and energy efficiency. The proposed method also causes a reduction in the redundancy rate.
C68. THORACIC ONCOLOGY CASE REPORTS II, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Journal of Community Hospital Internal Medicine Perspectives
ABSTRACT Hypercoagulability has been found in patients diagnosed with the novel coronavirus 19 (C... more ABSTRACT Hypercoagulability has been found in patients diagnosed with the novel coronavirus 19 (COVID-19) and has been identified as a major cause of morbidity and mortality. Herein, we report the challenge in managing a patient presenting with a 5 day history of COVID-19 diagnosis, complicated by deep venous thrombosis, pulmonary embolism and ischemic stroke in the setting of atrial septal aneurysm, presumed patent foramen ovale and paradoxical embolism, identified to have clots in transit on echocardiogram. The application of anticoagulation was felt to be high risk. The patient was transferred to a tertiary facility where the patient underwent thrombus aspiration and was eventually complicated by hemorrhagic conversion of the stroke.
SSRN Electronic Journal, 2021
Journal of International Medical Research, 2021
We present a case of transfusion-related acute lung injury as a complication of convalescent plas... more We present a case of transfusion-related acute lung injury as a complication of convalescent plasma transfusion in a patient who presented with COVID-19–related severe acute respiratory syndrome. Despite treatment with tocilizumab, remdesivir, and intravenous steroids, worsening dyspnea prompted adjunctive treatment with convalescent plasma. Two hours after completion of the plasma transfusion, the patient developed hypoxia-induced cardiac arrest secondary to transfusion-related acute lung injury. This case sheds light on life-threatening transfusion reactions and emphasizes the need to investigate post-transfusion monitoring protocols as well as the possible role of surveillance equipment.
Computational Intelligence for Managing Pandemics, 2021
SSRN Electronic Journal, 2021
SSRN Electronic Journal, 2021
Chest, 2021
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 is a major public health ... more TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 is a major public health emergency with increasing mortality since the first case in December 2019. COVID-19 has multifaceted presentation and only about 15-20% required hospitalizations and a quarter of those required management in an intensive care unit (ICU). Herein, we reviewed the demographics, clinical outcomes, and identified the potential prognostic indicators in patients with COVID-19 who were admitted to our ICU. METHODS: A retrospective cohort study was conducted on patients ≥ 18 years old with confirmed COVID-19, who were admitted to our ICU between 03/17/2020 and 05/14/2020. Demographic, clinical, and laboratory data were reviewed and retrieved. Data was expressed as counts and percentages. T-test and chi-square (χ) were used for continuous and categorical variables respectively. Univariate analysis was also performed to identify the prognostic indicators associated with mortality. GraphPad PRISM was used for data analysis. RESULTS: Seventy-five patients were identified during the study period with an average age of 60.8 (ranged from 19-89), of which males were 99 (71%) and females were 41 (29%). Majority were Hispanic (45%) and African Americans (34%). The average body mass index was 30.6. Hypertension (47.9%) and chronic kidney disease (47.1%) were the most common comorbidities. Mechanical ventilation was required in 99 (70.7%) of the patients. Of those 99, 75 (76%) expired. There was no statistically significant difference between the survival and expired groups in term of age, gender, ethnicities and number of comorbidities. Need of mechanical ventilation (MV) and renal replacement therapy (RRT) were significantly associated with mortality (p<0.0001 for both parameters). Interestingly, use of therapeutic anticoagulation was associated with decrease risk of mortality (p-value 0.03865). When looking into the laboratory parameters, higher blood urea nitrogen (BUN) on Day 5 (p-value 0.0067), initial LDH (p<0.0001), initial CRP (p-value 0.0062), white blood cell counts (WBC) (p<0.0001), and high absolute neutrophil counts (ANC) (p-value 0.0002) were statistically associated with increased risk of mortality. SOFA scores did not predict mortality in these patients (p-value 0.9243) CONCLUSIONS: This retrospective cohort study on patients with COVID-19 who required ICU showed that need for Mechanical Ventilation and Renal Replacement Therapy were significantly associated with mortality. Surprisingly, use of therapeutic anticoagulation decreased the risk of mortality and initial LDH and CRP were the two inflammatory markers that may help predict mortality. This interesting finding need to be corroborated in a larger study. CLINICAL IMPLICATIONS: This study was done using the data during the initial two months of first wave of COVID-19 in the United States and the data represents our observations at that time. Several studies have been done on the use of Anticoagulation in COVID-19 patients thereafter, however there is no universally accepted protocol. This study helped us identify the differences in the outcome between first and second use with aggressive use of anticoagulation, Remdesivir, and dexamethasone during the second wave. DISCLOSURES: No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Kok Hoe Chan, source=Web Response No relevant relationships by Joanna Crincoli, source=Web Response No relevant relationships by Claudia Komer, source=Web Response No relevant relationships by Sudha Lagudu, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Meenakshi Sindhuri Nali, source=Web Response No relevant relationships by Amy Paige, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Laxminarayan Prabhakar, source=Web Response No relevant relationships by Amr Ramahi, source=Web Response No relevant relationships by Divya Mounisha Thimmareddygari, source=Web Response
Chest, 2021
TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Emphysematous pyel... more TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Emphysematous pyelonephritis (EPN) is an uncommon acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The clinical course of EPN can be life threatening if not managed astutely. The primary organisms responsible include Escherichia coli and Klebsiella Pneumoniae. We present a rare and uncommon case of severe EPN that was managed conservatively with good outcome. CASE PRESENTATION: A 63-year-old Hispanic female with a past medical history of uncontrolled diabetes and hypertension presented with a four-day history of abdominal pain, nausea, vomiting and diarrhea. Vital signs showed T 38.2°C, HR 99, BP 103/58 mmHg and saturating 100% on RA. Palpation and percussion of the left flank region elicited pain. Lab findings were significant for hyponatremia (132), hypochloremia (95), elevated BUN and Creatinine (43/2.4), hyperglycemia (264), elevated CRP 36.5. Initial lactic acid was found to be 2.8. Urinalysis showed findings suggestive of a UTI. Patient also was incidentally found to have COVID-19 Ag and PCR positive. Chest X-ray showed mild interstitial prominence. Emergent renal ultrasound reported scattered foci of air in the left renal upper pole calyces and proximal ureter. CT Abdomen Pelvis with contrast showed air in the bladder and left ureter and kidney. Despite adequate initial resuscitation with IV fluids and IV piperacillin-tazobactam, her lactic acid increased peaking at 8.5 and she was promptly moved to MICU for hemodynamic monitoring. With a working diagnosis of EPN and SARS-CoV-2 infection, she was switched to Meropenem, placed on IV fluids and her pain was managed supportively. Urology was consulted who recommended close monitoring and plan for emergent intervention if condition worsened. However, since patient started to recover, she did not undergo intervention. Antibiotics were de-escalated to Ceftriaxone after blood cultures grew sensitive Escherichia coli. Patient's condition improved and she was discharged with outpatient follow-up with urology. DISCUSSION: Based on CT findings, emphysematous UTI's are characterized into Class I to IV with increasing mortality associated as you move towards class IV. Our patient initially presented with Class I and as a result was promptly started on antibiotics. If EPN had progressed anymore, she would have needed a percutaneous drainage, or even nephrectomy in refractory cases, in addition to antibiotic therapy. However, due to prompt care and aggressive monitoring provided to her, she was able to improve without further interventions. The rarity of the condition and the decision-making involved while managing the disease makes this case unique. CONCLUSIONS: Emphysematous pyelonephritis is an uncommon severe infection of the renal parenchyma, which with early diagnosis can be managed conservatively. REFERENCE #1: Sharma PK, Sharma R, Vijay MK, Tiwari P, Goel A, Kundu AK. Emphysematous pyelonephritis: Our experience with conservative management in 14 cases. Urol Ann. 2013;5(3):157-162. doi:10.4103/0974-7796.115734 REFERENCE #2: Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160:797–805. DISCLOSURES: No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Laxminarayan Prabhakar, source=Web Response No relevant relationships by Manogjna Prasad, source=Web Response
Journal of Community Hospital Internal Medicine Perspectives, 2021
We present a case report describing a potential rare adverse reaction of the recombinant zoster v... more We present a case report describing a potential rare adverse reaction of the recombinant zoster vaccination. This patient is a 60-year-old female who was admitted for severe rhabdomyolysis after receiving the vaccine. The patient's symptoms and CPK improved with aggressive hydration over several days. The patient did not have any known or reported common risk factors for rhabdomyolysis and the Naranjo Score was used to determine the likelihood of an adverse drug reaction. This is a relevant case to discuss in order to make physicians aware of a possible rare and lethal adverse effect due to a common vaccination.
SSRN Electronic Journal, 2021
Urban cities all around the world are suffering from increasing vehicular traffic density, increa... more Urban cities all around the world are suffering from increasing vehicular traffic density, increasing population density, narrow roads, and overburdened public infrastructure. As traffic jams become a common sight in urban cities, the average transit time for vehicles has increased. These trends have grave consequences for emergency vehicles like ambulances which need to reach their destinations in the shortest time possible. Taking advantage of miniature processing units, communication networks, many systems have been designed to address this problem. The systems which aim to reduce the transit time of emergency vehicles are called Emergency Vehicle Priority (EVP) systems. EVP systems are systems that control the flow of traffic efficiently to let emergency vehicles travel faster. In this paper, we present a review of different EVP systems.
SSRN Electronic Journal, 2020
Maximize the coverage is one of the important aspects, in designing the wireless sensor network. ... more Maximize the coverage is one of the important aspects, in designing the wireless sensor network. One should aim at a nearly optimum coverage rate without reducing the life span of the network. Numerous solutions were suggested for this from which most try to select the least number of nodes as active, while the others remain in the sleep mode to save energy. This approach extends the life span of the network also. Nevertheless, these methods suffer from a lack of mathematical bases for the initial seed node choice in selecting active nodes. In this manuscript, a distributed method is suggested to address the challenge of maximum coverage with maximum network life. The exploitation of the game theory as a mathematical basis for the choice of active nodes is demonstrated in the current manuscript. The basis of the game theory in node planning, is node compete with each other to become active. Node tries to avoid coverage redundancy using the costs of the activation. This cost use number of the active neighbors and the uncovered area. The comparison of the simulation results with the results of the actual network deployed with nodeMCUs is done. We found that the network lifetimes almost doubles from 52 Hours to 98 hours with actual deployment on two nodeMCUs. The suggested method works well for maximum coverage, life span, and energy efficiency. The proposed method also causes a reduction in the redundancy rate.
C68. THORACIC ONCOLOGY CASE REPORTS II, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.