Akash Ajmera | Marshall University (original) (raw)
Papers by Akash Ajmera
The American Journal of Gastroenterology, Oct 1, 2009
American Surgeon, Jul 1, 2018
The American Journal of the Medical Sciences, Apr 1, 2010
Renal veins rarely thrombose. However, when they do, the cause is almost always obvious. The clin... more Renal veins rarely thrombose. However, when they do, the cause is almost always obvious. The clinical circumstances underlying acute or chronic renal vein thrombosis are well defined. Interestingly, the use of oral contraceptive medications is not recognized among the risk factors for renal vein thrombosis. We report a case of spontaneous renal vein thrombosis in an otherwise healthy young woman taking an oral contraceptive. This report is intended to alert clinicians to a previously unknown and serious event associated with the use of a common medication.
ACG Case Reports Journal, 2017
ACG Case Reports Journal, 2015
The American Journal of Gastroenterology, Oct 1, 2012
Gastrointestinal Endoscopy, May 1, 2013
The American Journal of Gastroenterology, Oct 1, 2013
Learning Objectives: Obesity is a widespread epidemic with 65.7% of US adults age 20 and older ar... more Learning Objectives: Obesity is a widespread epidemic with 65.7% of US adults age 20 and older are overweight, while 30.6% are obese. The specific effect of obesity on patients treated for sepsis & septic shock is unclear. Body Mass Index (BMI) is a measure of total body fat content & surrogate marker for obesity. We aimed to identify if BMI was an independent risk factor for poor survival or increased length of stay (LOS) in patients with sepsis. Methods: We retrospectively selected patients coded for sepsis & septic shock who were admitted to the ICU over three years and then separated them into groups of alive & deceased. Based on association with mortality in sepsis, numerous variables were investigated: BMI, LOS, age, cirrhosis, chronic kidney disease (CKD), lactate, age, multiple organ dysfunction syndrome (MODS), & APACHE II scores. Specifically, BMI was classified into sub-groups: underweight (BMI<18), normal (BMI 18-24.9), overweight (BMI 25-29.9), & obese (BMI>30). T...
The American Surgeon, 2018
Although the overall rate of colorectal cancer (CRC) has remained stable, studies have shown an i... more Although the overall rate of colorectal cancer (CRC) has remained stable, studies have shown an increase in the rate of CRC in young patients (<50) nationwide. We hypothesize that the rectal cancer (RC) rate in young people has increased in rural Appalachia. The goal is to provide insight into the future of RC epidemiology in underserved populations. This Institutional Review Board–approved retrospective study evaluated RC patients diagnosed in 2003 to 2016, and compared the ratio of early-onset RC to the state and national ratios using West Virginia State Cancer Registry, North American Association of Central Cancer Registries (NAACCR) and Surveillance, Epidemiology, and End Results Program Database. Demographics include age, gender, ethnicity, and county. We also evaluated cancer stage, family history, and comorbidities, including body mass index, smoking, and alcohol history. The rate of early-onset RC in our area is 1.5 times higher than the national rates. In our population,...
American Journal of Gastroenterology, 2012
American Journal of Gastroenterology, 2011
American Journal of Gastroenterology, 2013
American Journal of Gastroenterology, 2009
American Journal of Gastroenterology, 2011
American Journal of Gastroenterology, 2010
American Journal of Gastroenterology, 2010
Purpose: Th e recently published International Consensus Recommendations on the Management of Pat... more Purpose: Th e recently published International Consensus Recommendations on the Management of Patients with Nonvariceal Upper Gastrointestinal Bleeding recommends: “early risk stratifi cation, by using validated prognostic scales” (Ann Intern Med 2010; 152: 101). Unfortunately, the existing risk stratifi cation scores for upper GI bleeding can be diffi cult to calculate and some require endoscopic information. Preliminary data from our group examined predictors of mortality in over 30,000 patients with upper gastrointestinal bleeding. Five factors determined at the time of presentation provided the best discrimination: albumin<2.9, INR>1.5, altered mental status, systolic blood pressure <90 mmHg, and age >65 years (AIMS65). Th e current study evaluated the AIMS65 risk classifi cation rule in a separate database to determine the eff ect of the score on the timing of endoscopy, blood transfusion requirement, and length of stay. Methods: Our hospital’s research patient database was queried for ICD-9 codes related to upper GI bleeding, and the diagnosis was confi rmed by examining the patients’ discharge summaries. Over a 5-year period, 278 patients were identifi ed who met the inclusion criteria and had adequate documentation to calculate the AIMS65 score. Th e outcomes of interest were timing of endoscopy, blood transfusion requirement and length of stay. Patients were defi ned as “low-risk” for the outcomes if the AIMS65 score was 0 or 1, and “high-risk” if it was greater than one. Statistical analyses were carried out using the non-parametric Wilcoxon rank-sum test. Results: Th e timing of endoscopy, blood transfusion requirements, and length of stay were all predicted by the AIMS65 score. Endoscopies occurred earlier for those patients in the high risk group compared to their low risk counterparts (mean 0.78 days vs. 1.01 days) [p=0.047]. Patients in the lowrisk group were more likely to not require transfusions compared with those in the high-risk group (27% vs. 9%, p=0.001) and had a lower median transfusion requirement (2 versus 4 units, p<0.001). Th e AIMS65 criteria also predicted length of stay: the low-risk group had signifi cantly shorter stays than did the high-risk group (median: 3 versus 4 days, p=0.0023). Conclusion: Th e AIMS65 bleeding risk score predicted the timing of endoscopy, blood transfusion requirement, and length of stay in patients presenting with upper GI bleeding. Th is easily derived risk score can be utilized early in the course of a patient with upper GI bleeding to prognosticate clinical outcomes.
Marshall Journal of Medicine, 2018
Twenty species of oak (Quercus) are known from California. The white oak group is the most divers... more Twenty species of oak (Quercus) are known from California. The white oak group is the most diverse, and includes a complex of scrub oak species that are often encountered in chaparral, mixed forest and desert margin habitats. The Protobalanus group (e.g., Quercus chrysolepis) is a unique and distinctive clade of western North American species that appears to be most closely related to the white oak group. Within the white oaks and red oaks (black oaks), the majority of California species do not have obvious, close relationships to species outside of the region. In addition, these species either have lobed leaves (e.g., Q. kelloggii, Q. lobata, Q. garryana) or have leaves that appear to be derived from ancestors with lobed leaves by reduction (e.g., Q. dumosa, Q. berberidifolia, Q. john-tuckeri, Q. cornelius-mulleri, Q. agrifolia). Lobed leaves, such as those found in numerous oaks of the eastern U.S., are characteristic of species from temperate or cold climates, but not any of the more tropical species, thus suggesting a temperate ancestry for the bulk of California oak species in the white oak and red oak groups. In contrast, the Protobalanus group, which is truly evergreen and has entire or merely dentate leaves, probably has a more tropical origin.
ACG Case Reports Journal, 2015
The American Journal of Gastroenterology, Oct 1, 2009
American Surgeon, Jul 1, 2018
The American Journal of the Medical Sciences, Apr 1, 2010
Renal veins rarely thrombose. However, when they do, the cause is almost always obvious. The clin... more Renal veins rarely thrombose. However, when they do, the cause is almost always obvious. The clinical circumstances underlying acute or chronic renal vein thrombosis are well defined. Interestingly, the use of oral contraceptive medications is not recognized among the risk factors for renal vein thrombosis. We report a case of spontaneous renal vein thrombosis in an otherwise healthy young woman taking an oral contraceptive. This report is intended to alert clinicians to a previously unknown and serious event associated with the use of a common medication.
ACG Case Reports Journal, 2017
ACG Case Reports Journal, 2015
The American Journal of Gastroenterology, Oct 1, 2012
Gastrointestinal Endoscopy, May 1, 2013
The American Journal of Gastroenterology, Oct 1, 2013
Learning Objectives: Obesity is a widespread epidemic with 65.7% of US adults age 20 and older ar... more Learning Objectives: Obesity is a widespread epidemic with 65.7% of US adults age 20 and older are overweight, while 30.6% are obese. The specific effect of obesity on patients treated for sepsis & septic shock is unclear. Body Mass Index (BMI) is a measure of total body fat content & surrogate marker for obesity. We aimed to identify if BMI was an independent risk factor for poor survival or increased length of stay (LOS) in patients with sepsis. Methods: We retrospectively selected patients coded for sepsis & septic shock who were admitted to the ICU over three years and then separated them into groups of alive & deceased. Based on association with mortality in sepsis, numerous variables were investigated: BMI, LOS, age, cirrhosis, chronic kidney disease (CKD), lactate, age, multiple organ dysfunction syndrome (MODS), & APACHE II scores. Specifically, BMI was classified into sub-groups: underweight (BMI<18), normal (BMI 18-24.9), overweight (BMI 25-29.9), & obese (BMI>30). T...
The American Surgeon, 2018
Although the overall rate of colorectal cancer (CRC) has remained stable, studies have shown an i... more Although the overall rate of colorectal cancer (CRC) has remained stable, studies have shown an increase in the rate of CRC in young patients (<50) nationwide. We hypothesize that the rectal cancer (RC) rate in young people has increased in rural Appalachia. The goal is to provide insight into the future of RC epidemiology in underserved populations. This Institutional Review Board–approved retrospective study evaluated RC patients diagnosed in 2003 to 2016, and compared the ratio of early-onset RC to the state and national ratios using West Virginia State Cancer Registry, North American Association of Central Cancer Registries (NAACCR) and Surveillance, Epidemiology, and End Results Program Database. Demographics include age, gender, ethnicity, and county. We also evaluated cancer stage, family history, and comorbidities, including body mass index, smoking, and alcohol history. The rate of early-onset RC in our area is 1.5 times higher than the national rates. In our population,...
American Journal of Gastroenterology, 2012
American Journal of Gastroenterology, 2011
American Journal of Gastroenterology, 2013
American Journal of Gastroenterology, 2009
American Journal of Gastroenterology, 2011
American Journal of Gastroenterology, 2010
American Journal of Gastroenterology, 2010
Purpose: Th e recently published International Consensus Recommendations on the Management of Pat... more Purpose: Th e recently published International Consensus Recommendations on the Management of Patients with Nonvariceal Upper Gastrointestinal Bleeding recommends: “early risk stratifi cation, by using validated prognostic scales” (Ann Intern Med 2010; 152: 101). Unfortunately, the existing risk stratifi cation scores for upper GI bleeding can be diffi cult to calculate and some require endoscopic information. Preliminary data from our group examined predictors of mortality in over 30,000 patients with upper gastrointestinal bleeding. Five factors determined at the time of presentation provided the best discrimination: albumin<2.9, INR>1.5, altered mental status, systolic blood pressure <90 mmHg, and age >65 years (AIMS65). Th e current study evaluated the AIMS65 risk classifi cation rule in a separate database to determine the eff ect of the score on the timing of endoscopy, blood transfusion requirement, and length of stay. Methods: Our hospital’s research patient database was queried for ICD-9 codes related to upper GI bleeding, and the diagnosis was confi rmed by examining the patients’ discharge summaries. Over a 5-year period, 278 patients were identifi ed who met the inclusion criteria and had adequate documentation to calculate the AIMS65 score. Th e outcomes of interest were timing of endoscopy, blood transfusion requirement and length of stay. Patients were defi ned as “low-risk” for the outcomes if the AIMS65 score was 0 or 1, and “high-risk” if it was greater than one. Statistical analyses were carried out using the non-parametric Wilcoxon rank-sum test. Results: Th e timing of endoscopy, blood transfusion requirements, and length of stay were all predicted by the AIMS65 score. Endoscopies occurred earlier for those patients in the high risk group compared to their low risk counterparts (mean 0.78 days vs. 1.01 days) [p=0.047]. Patients in the lowrisk group were more likely to not require transfusions compared with those in the high-risk group (27% vs. 9%, p=0.001) and had a lower median transfusion requirement (2 versus 4 units, p<0.001). Th e AIMS65 criteria also predicted length of stay: the low-risk group had signifi cantly shorter stays than did the high-risk group (median: 3 versus 4 days, p=0.0023). Conclusion: Th e AIMS65 bleeding risk score predicted the timing of endoscopy, blood transfusion requirement, and length of stay in patients presenting with upper GI bleeding. Th is easily derived risk score can be utilized early in the course of a patient with upper GI bleeding to prognosticate clinical outcomes.
Marshall Journal of Medicine, 2018
Twenty species of oak (Quercus) are known from California. The white oak group is the most divers... more Twenty species of oak (Quercus) are known from California. The white oak group is the most diverse, and includes a complex of scrub oak species that are often encountered in chaparral, mixed forest and desert margin habitats. The Protobalanus group (e.g., Quercus chrysolepis) is a unique and distinctive clade of western North American species that appears to be most closely related to the white oak group. Within the white oaks and red oaks (black oaks), the majority of California species do not have obvious, close relationships to species outside of the region. In addition, these species either have lobed leaves (e.g., Q. kelloggii, Q. lobata, Q. garryana) or have leaves that appear to be derived from ancestors with lobed leaves by reduction (e.g., Q. dumosa, Q. berberidifolia, Q. john-tuckeri, Q. cornelius-mulleri, Q. agrifolia). Lobed leaves, such as those found in numerous oaks of the eastern U.S., are characteristic of species from temperate or cold climates, but not any of the more tropical species, thus suggesting a temperate ancestry for the bulk of California oak species in the white oak and red oak groups. In contrast, the Protobalanus group, which is truly evergreen and has entire or merely dentate leaves, probably has a more tropical origin.
ACG Case Reports Journal, 2015