Shradha Ahuja | University of Mississippi (original) (raw)

Papers by Shradha Ahuja

Blood, Dec 7, 2017

Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospect... more Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospective studies suggest that women with hemophilia have increased risk of bleeding and obstetric complications however the exact burden of this remains unknown. By analyzing the Nationwide Inpatient sample database (NIS) of Healthcare Cost and Utilization Project(AHRQ), we attempted to identify pregnant women with hemophilia A or B and compared their outcome and Obstetric complications with pregnant women who did not have a diagnosis of hemophilia. Method: By using NIS database 2003-2011, we identified the number of obstetric hospitalization, deliveries and caesarean deliveries in women between the age group 18-50 years. Patients hospitalized with Hemophilia A or B were also identified (ICD-9 286.0, 286.1 respectively). We then compared pregnancy related complications for women with and without Hemophilia. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR). Results: The total number of obstetric hospitalizations was 42.31 million of which 2415 were Hemophilia A or B. After adjusting for potential confounding factors, compared with patients without Hemophilia, those with hemophilia had significantly higher caesarian section rate [37.5% vs 28%, OR 1.44(CI 1.31-1.59)], intrauterine growth retardation [3.2% vs 1.8%, OR 1.66(CI 1.26-2.19)], preterm deliveries [7.9% vs 6.6%, OR 1.22(CI 1.03-1.45)], antepartum hemorrhage [4.5% vs 2%, OR 1.92(CI 1.52-2.42)], postpartum hemorrhage [5% vs 2.6%, OR 1.84(CI 1.49-2.29)] and transfusion rate [4.2% vs 1.1%, OR 3.44(CI 2.68-4.41)] . Conversely, the incidence of premature rupture of membranes in the hemophiliac group was less as compared to the control group. Inpatient fetal and maternal mortality was found to be zero. The frequencies of the above outcomes with Odds Ratio are reported in Table 1. Conclusion: The overall risk of cesarean section, intrauterine growth retardation, preterm deliveries, risk of transfusion and antepartum and postpartum hemorrhage was higher in pregnant women who have hemophilia. This cross sectional study would help to understand the magnitude of these complications so that they could be managed optimally during antenatal period. Further studies are needed to examine these findings in relation to severity of disease, medications used and the presence of other comorbidities. Disclosures No relevant conflicts of interest to declare.

Case reports in endocrinology, 2018

Aim. To present a case of Graves' disease complicated by methimazole induced agranulocytosis trea... more Aim. To present a case of Graves' disease complicated by methimazole induced agranulocytosis treated with therapeutic plasma exchange (TPE) and review of the literature. Case Presentation. A 21-year-old patient with a history of Graves' disease presented to the endocrine clinic. His history was significant for heat intolerance, weight loss, and tremors. Upon examination he had tachycardia, smooth goiter, thyroid bruit, and hyperactive reflexes. He was started on methimazole and metoprolol and thyroidectomy was to be done once his thyroid function tests normalized. On follow-up, the patient symptoms persisted. Complete blood count done showed a white blood cell count of 2100 (4000-11,000 cells/cu mm) with a neutrophil count of 400 cells/cu mm, consistent with neutropenia. He was admitted to the hospital and underwent 3 cycles of TPE and was also given filgrastim. He improved clinically and his thyroxine (T4) levels also came down. Thyroidectomy was done. He was discharged on levothyroxine for postsurgical hypothyroidism. Conclusion. Plasmapheresis may be useful in the treatment of hyperthyroidism. It works by removing protein bound hormones and also possibly inflammatory cytokines. Further studies are needed to clarify the role of various modalities of TPE in the treatment of hyperthyroidism.

SM journal of nephrology and therapeutics, 2017

End Stage Renal Disease (ESRD) patients have been found to exhibit high prevalence of Atrial Fibr... more End Stage Renal Disease (ESRD) patients have been found to exhibit high prevalence of Atrial Fibrillation (AF), which demonstrates the possibility of a relationship of causality between the two conditions. The increased risk of stroke and mortality among ESRD patients with AF has also prompted a desire to understand the exact linkages between these different conditions. We conducted extensive reviews of relevant literature and established that indeed ESRD patients with AF exhibited higher risks for mortality and stroke occurrence compared to individuals with AF that did not suffer from ESRD. We also established that anticoagulation is regularly used as a form of therapeutic intervention with drugs such as warfarin, apixaban, and aspirin being some of the choice anticoagulants. The ARISTOTLE study found apixaban to be more effective than warfarin with a major bleeding rate of 2.13% annually compared to 3.09% respectively. The AVERROES trial found that warfarin use made it harder to maintain INR values compared to apixaban. This presence, severity, and duration of AF in ESRD patients was also found to correlate with structural abnormalities of the heart that significantly increased the risk for ischemic hand hemorrhagic strokes as well as mortality. This risk of stroke was found to be higher in CKD patients compared to the general population. Age, diabetes, hyperlipidemia, and gout were also confirmed as core factors influencing the development of AF in ESRD patients, as well as risk factors for stroke occurrence and mortality. High blood pressure and anticoagulation complications were further identified as causative factors for mortality among ESRD patients with AF. AF incidence is more prevalent among ESRD patients compared to the general population. This incidence and prevalence is also associated with more significant risk of stroke and mortality among said ESRD patients compared to the general population. However, more studies and trials need to be conducted on the prevalence of AF in the general population to fully understand the linkages between AF and ESRD.

Blood, Dec 7, 2017

Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increas... more Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increased risk of bleeding and obstetric complications during pregnancy. This study was undertaken to determine the risk of complications occurring during pregnancy for women with vWD using Nationwide Inpatient Sample (NIS) Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality(AHRQ). Method: We queried the NIS database for the years 2003- 2011, to identify all pregnancy-related discharges for women between 18-50 years of age. The pregnancy-related discharge records were identified by using the International Classification of Diseases Ninth Revision (ICD-9) and were classified as to whether they were an admission during pregnancy or postpartum. ICD 9 code used for vWD was 286.4. Binary logistic regression was used to compute adjusted odds ratio with 95% confidence interval(CI) after adjusting for potential confounders such as age, race, primary payer, hospital location, teaching status and patient comorbidities. Results: There were 15,258 pregnant women with vWD among 40,617,511 pregnancy related discharges. Women with vWD were slightly older than those without (28.01±6.08 vs 27.95±5.98, p Conclusion: Pregnant women with vWD have increased risk of bleeding complications, hypertensive disorder and need of transfusion. High incidence of cesarean section in patients with vWD could likely be explained by planned cesarean section in this high-risk group. There was no increased risk of fetal or maternal mortality in women with vWD. This cross sectional study would help to understand the magnitude of these complications so that they could be managed optimally during antenatal period. Further prospective studies are needed to confirm these findings. Disclosures No relevant conflicts of interest to declare.

The internet journal of public health, 2010

BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and h... more BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and half of this occurs in developing countries. In the sphere of cancer control, much would be achieved if breast cancer were to be detected early. Since a large proportion of patients in India present with advanced disease, any down-staging due to early detection will considerably reduce treatment cost as well as morbidity even if mortality is unaffected. This can be achieved by breast health awareness and adherence to screening practices. OBJECTIVE: The aims of this cross-sectional study were to determine the level of knowledge regarding breast cancer and to measure breast self-examination (BSE) performance in a group of 80 women aged 40 years and above. Additionally we also intended to demonstrate the correct method of BSE performance to each woman included in our study individually and privately. METHODS: This was a cross sectional study conducted over a period of two months commencing on August 1 st 2009 and ending on 30 th September 2009. 80 women were interviewed by means of a structured questionnaire (after obtaining written informed consent) in the surgical outpatient department of the K.J.Somaiya Medical College, Sion, Mumbai. The questionnaire consisted of socio-demographic variables, breast cancer risk factors and protective factors and knowledge and practice of BSE. Further, attitude towards BSE was also evaluated. The data were analyzed by descriptive studies, chi square test and analysis of variance in order to find out the P value. The interview was followed by an interactive session where each woman was individually and privately educated on breast self-examination by the investigators themselves in the presence of a nurse. RESULTS: Breast cancer awareness was found to be 52% in this group of women even though 95% women claimed to have heard of the disease. Only 12% of all women had received information about breast cancer from health professionals while a majority (60%) stated their source of information to be family and friends. Level of breast cancer knowledge was significantly associated with age (younger women more aware than older), income (women belonging to higher income group found to be more aware than those who were economically deprived), literacy (graduates and post graduates more knowledgeable), parity (women bearing lesser number of children being more aware), occupation (teachers and businesswomen being the most aware versus farmers who were the least aware). 38% women had never heard of BSE and among those that had heard of it, 15% were regular while 23% were irregular performers. Thus performance of BSE was found to be inadequate in this group. Not knowing the correct method was the most frequently reported reason for non performance.

Neuro-Oncology, 2012

Primary Leptomeningeal Anaplastic Oligodendroglioma (PLAO) is a very rare tumor that grows in the... more Primary Leptomeningeal Anaplastic Oligodendroglioma (PLAO) is a very rare tumor that grows in the subarachnoid space with no obvious findings of intraparenchymal mass lesion. Here we report an 11-year-old girl who was diagnosed as PLAO with temporal bone invasion. She has a history of shunted hydrocephalus of unknown etiology since the age of 8. Computed tomography (CT) scan had showed bifrontal subdural hygroma without intracranial or extracranial mass lesion until she developed right exophthalmos at the age of 11. CT scan and magnetic resonance imaging (MRI) revealed temporal bone tumor extending right orbital bone and diffuse leptomeningeal thickening. The biopsy was performed and histopathology revealed anaplastic oligodendroglioma. Combination chemotherapy with CDDP, CY and VP16 was started, and decreased the size of the tumor and improved her exophthalmos. After 5 cycles of the chemotherapy, TMZ was given for maintenance therapy. However, she developed leg paralysis and urinary incontinence 6 months later due to the worsening of leptomeningeal thickening throughout the spinal canal and intracranial space. Whole brain/spine radiotherapy was given, which decreased the tumor size and improved her neurological symptoms. A few months after cessation of chemotherapy, subcutaneous tumor was noted along the scar of LP shunt catheter. The subcutaneous tumor was surgically resected. Histopathology showed anaplastic oligodendroglioma and G-banding analysis showed the presence of i(1)(q10). Bone marrow metastasis was also noted at this time. Chemotherapy using IFO, CBDCA and VP16 was restarted. In response to treatment, serum LDH increased to 6.000 and then returned to normal. Tumor cells in the bone marrow almost disappeared after one cycle of chemotherapy. She has been stable without recurrence of the tumor for three months since then. PLAO is relatively slowly progressive and treatment using multiple modalities seems to be effective for this tumor.

Blood, Nov 29, 2018

Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data f... more Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 the prevalence of folic acid deficiency in the United States has decreased from 16% to 0.5% since the dietary folic acid fortification program started in the late 1990s. Routine testing for folic acid deficiency remains quite common in the workup of anemia, dementia, alcoholism and other high risk populations. The objective for this study were to determine the prevalence of folic acid deficiency in order to analyze whether routine testing for deficiency should be discouraged or targeted to specific patient populations. In addition to this, we want to assess the economic burden that folic acid level testing adds to the high cost of care of our health system. Methods Cross sectional chart review of all adults tested for folic acid level from March 2014 to March 2015 from the Hospital and Ambulatory Care Center of the Community Hospital was undertaken. Folic acid deficiency was defined as ≤4ng/dl. Folic acid level were further classified as low (≤10ng/dl ), intermediate (10-20ng/dl) and high (>20ng/dl). Age, race, body mass index, hemoglobin, mean corpuscular volume levels and billing details were recorded of all patients and information was also collected regarding known conditions correlated to the folic acid levels including Vitamin B12 deficiency( <300 ng/dl), dementia, alcoholism, pregnancy malabsorption, sickle cell disease, bariatric surgery, inflammatory bowel syndrome, and drug therapy with HAART (Highly Active Anti-Retroviral Therapy) , TMP-SMX(Trimethoprim/sulfamethoxazole), phenytoin, valproic acid and/or methotrexate (Table 1). Statistical testing using t-test, logistic / linear regressions with α level at 0.05 was used for analysis of data. Results A total of 957 charts of patients who were tested for folic acid between March 2014 to March 2015 at our Heath- Care System were reviewed. 413 (43%) patients were male and 544 (57%) were female. There were 394 (41 %) Hispanics, 325 (34%) African American, 202 (21%) Caucasian and 36 (4%) were from other ethnicity. The mean age was 59.7 years and a mean Hb was 11. 6 g/ dl. Mean folic acid level was 14.5 ng/dl. 16 patients from total of 957 (2 %) had folic acid deficiency with value ≤4ng/dl . Additional results from the study are described in Table 1, Table 2 and Table 3. Conclusion The prevalence of folic acid deficiency was 2%, About 33,000 dollars per year were used to identify such a low prevalent disease which can be treated at a low cost (2 cents/day) by oral supplementation. Low levels of folic acid were statistically associated with male sex, African American race, dementia and coexistence of vitamin B12 deficiency. Empiric supplementation of folic acid and possibly limiting testing for folic acid level to this group of patients may represent a more cost effective strategy. Disclosures No relevant conflicts of interest to declare.

The Journal of community and supportive oncology, May 1, 2017

Tumori Journal, Mar 21, 2018

Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia ... more Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia and organ destruction secondary to eosinophilic infiltration. The coexistence of primary B-cell lymphoma and hypereosinophilic syndrome is extremely rare. We present a case of HES that preceded the diagnosis of diffuse large B-cell lymphoma. Case report: A 70-year-old man presented with a 3-month history of diarrhea and 30-pound weight loss. Complete blood count showed a white blood cell count of 7452/µL with eosinophils of 42% (absolute eosinophil count 3130). Colonoscopy showed eosinophilic infiltrate in the lamina propria and muscularis mucosa. Bone marrow biopsy showed elevated myeloid: erythroid ratio (6:1), increased mature and immature eosinophilic infiltration (10% of nucleated cells). Molecular studies were negative for Fip1-like1-platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) translocation and PDGFRB and FGFR mutations, indicating nonclonal eosinophilia. Treatment was initiated with prednisone (1 mg/kg) and hydroxyurea 500 mg twice daily. He responded with complete resolution of symptoms. Five months later, the patient presented with right lower quadrant pain. Abdominal/pelvis computed tomography (CT) showed bulky right inguinal lymphadenopathy and biopsy revealed CD10+ diffuse large B-cell lymphoma (DLBCL). Further staging workup showed the stage to be IIB. He received 6 cycles of chemotherapy and involved field radiation therapy. He achieved complete remission. Conclusion: Reviewing the literature indicates only one case of similar presentation with concomitant HES and DLBCL. Eosinophilia is routinely encountered in clinical practice and as such physicians must be aware of the rarer, more malevolent underlying associations of this condition so as to aid early diagnosis and prompt treatment.

The Journal of community and supportive oncology, May 1, 2016

Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increas... more Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increased risk of bleeding and obstetric complications during pregnancy. This study was undertaken to determine the risk of complications occurring during pregnancy for women with vWD using Nationwide Inpatient Sample (NIS) Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality(AHRQ). Method: We queried the NIS database for the years 2003- 2011, to identify all pregnancy-related discharges for women between 18-50 years of age. The pregnancy-related discharge records were identified by using the International Classification of Diseases Ninth Revision (ICD-9) and were classified as to whether they were an admission during pregnancy or postpartum. ICD 9 code used for vWD was 286.4. Binary logistic regression was used to compute adjusted odds ratio with 95% confidence interval(CI) after adjusting for potential confounders such as age, race, prima...

Blood, 2017

Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospect... more Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospective studies suggest that women with hemophilia have increased risk of bleeding and obstetric complications however the exact burden of this remains unknown. By analyzing the Nationwide Inpatient sample database (NIS) of Healthcare Cost and Utilization Project(AHRQ), we attempted to identify pregnant women with hemophilia A or B and compared their outcome and Obstetric complications with pregnant women who did not have a diagnosis of hemophilia. Method: By using NIS database 2003-2011, we identified the number of obstetric hospitalization, deliveries and caesarean deliveries in women between the age group 18-50 years. Patients hospitalized with Hemophilia A or B were also identified (ICD-9 286.0, 286.1 respectively). We then compared pregnancy related complications for women with and without Hemophilia. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR)....

The Internet Journal of Healthcare Administration, 2010

Tuberculosis has emerged as the greatest danger to India threatening the health of millions. Sinc... more Tuberculosis has emerged as the greatest danger to India threatening the health of millions. Since TB is ubiquitous and contagious, hospital staff and others in close contact with tuberculosis patients run the highest risk of infection. This risk is largely preventable by use of simple inexpensive measures to avoid the contagion to spread via droplets. Even though health care workers are well aware of the mode of spread of tuberculosis , they do not take precautionary measures while dealing with TB patients. Patients too are non compliant with doctors' advise of wearing masks for protection of people in the vicinity. Thus, extensive use of masks enforced by the administration will greatly reduce the transmission of tuberculosis. This may be achieved if disposable masks are made available free of cost from dispensers along with condoms under a national programme thus helping us tackle the two leading diseases of the country.

The Internet Journal of Public Health

BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and h... more BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and half of this occurs in developing countries. In the sphere of cancer control, much would be achieved if breast cancer were to be detected early. Since a large proportion of patients in India present with advanced disease, any down-staging due to early detection will considerably reduce treatment cost as well as morbidity even if mortality is unaffected. This can be achieved by breast health awareness and adherence to screening practices. OBJECTIVE: The aims of this cross-sectional study were to determine the level of knowledge regarding breast cancer and to measure breast self-examination (BSE) performance in a group of 80 women aged 40 years and above. Additionally we also intended to demonstrate the correct method of BSE performance to each woman included in our study individually and privately. METHODS: This was a cross sectional study conducted over a period of two months commencing on August 1 st 2009 and ending on 30 th September 2009. 80 women were interviewed by means of a structured questionnaire (after obtaining written informed consent) in the surgical outpatient department of the K.J.Somaiya Medical College, Sion, Mumbai. The questionnaire consisted of socio-demographic variables, breast cancer risk factors and protective factors and knowledge and practice of BSE. Further, attitude towards BSE was also evaluated. The data were analyzed by descriptive studies, chi square test and analysis of variance in order to find out the P value. The interview was followed by an interactive session where each woman was individually and privately educated on breast self-examination by the investigators themselves in the presence of a nurse. RESULTS: Breast cancer awareness was found to be 52% in this group of women even though 95% women claimed to have heard of the disease. Only 12% of all women had received information about breast cancer from health professionals while a majority (60%) stated their source of information to be family and friends. Level of breast cancer knowledge was significantly associated with age (younger women more aware than older), income (women belonging to higher income group found to be more aware than those who were economically deprived), literacy (graduates and post graduates more knowledgeable), parity (women bearing lesser number of children being more aware), occupation (teachers and businesswomen being the most aware versus farmers who were the least aware). 38% women had never heard of BSE and among those that had heard of it, 15% were regular while 23% were irregular performers. Thus performance of BSE was found to be inadequate in this group. Not knowing the correct method was the most frequently reported reason for non performance.

Blood

Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data f... more Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 the prevalence of folic acid deficiency in the United States has decreased from 16% to 0.5% since the dietary folic acid fortification program started in the late 1990s. Routine testing for folic acid deficiency remains quite common in the workup of anemia, dementia, alcoholism and other high risk populations. The objective for this study were to determine the prevalence of folic acid deficiency in order to analyze whether routine testing for deficiency should be discouraged or targeted to specific patient populations. In addition to this, we want to assess the economic burden that folic acid level testing adds to the high cost of care of our health system. Methods Cross sectional chart review of all adults tested for folic acid level from March 2014 to March 2015 from the Hospital and Ambulatory Care Center of the Community Hospital was undertaken. Folic acid deficiency wa...

Tumori Journal

Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia ... more Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia and organ destruction secondary to eosinophilic infiltration. The coexistence of primary B-cell lymphoma and hypereosinophilic syndrome is extremely rare. We present a case of HES that preceded the diagnosis of diffuse large B-cell lymphoma. Case report: A 70-year-old man presented with a 3-month history of diarrhea and 30-pound weight loss. Complete blood count showed a white blood cell count of 7452/µL with eosinophils of 42% (absolute eosinophil count 3130). Colonoscopy showed eosinophilic infiltrate in the lamina propria and muscularis mucosa. Bone marrow biopsy showed elevated myeloid: erythroid ratio (6:1), increased mature and immature eosinophilic infiltration (10% of nucleated cells). Molecular studies were negative for Fip1-like1-platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) translocation and PDGFRB and FGFR mutations, indicating nonclonal eosinophilia. Treatmen...

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, Jan 24, 2018

Venous thromboembolism (VTE) is a major cause of mortality and morbidity in hospitalized patients... more Venous thromboembolism (VTE) is a major cause of mortality and morbidity in hospitalized patients with malignancy. Nationwide Inpatient Sample database was analyzed to determine the trends in the rate of hospitalization and mortality from VTE in hospitalized ovarian cancer patients and assess its economic impact and resource utilization. We queried the 2003 to 2011 Nationwide Inpatient Sample database from Healthcare Cost and Utilization project (Agency of Healthcare Research and Quality) to identify all adults (age ≥18 years) ovarian cancer. Patients hospitalized with VTE as one of the top 3 discharge diagnoses were also identified. Demographic characteristics and in-hospital outcomes of this population were compared with ovarian cancer patients without VTE. Binary logistic regression analysis was used to obtain adjusted odds ratios (ORs). A total of 34,249 (3.5%) of a total of 981,386 hospitalized ovarian cancer patients had an accompanying diagnosis of VTE. Mean age of the study ...

Blood, Dec 7, 2017

Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospect... more Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospective studies suggest that women with hemophilia have increased risk of bleeding and obstetric complications however the exact burden of this remains unknown. By analyzing the Nationwide Inpatient sample database (NIS) of Healthcare Cost and Utilization Project(AHRQ), we attempted to identify pregnant women with hemophilia A or B and compared their outcome and Obstetric complications with pregnant women who did not have a diagnosis of hemophilia. Method: By using NIS database 2003-2011, we identified the number of obstetric hospitalization, deliveries and caesarean deliveries in women between the age group 18-50 years. Patients hospitalized with Hemophilia A or B were also identified (ICD-9 286.0, 286.1 respectively). We then compared pregnancy related complications for women with and without Hemophilia. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR). Results: The total number of obstetric hospitalizations was 42.31 million of which 2415 were Hemophilia A or B. After adjusting for potential confounding factors, compared with patients without Hemophilia, those with hemophilia had significantly higher caesarian section rate [37.5% vs 28%, OR 1.44(CI 1.31-1.59)], intrauterine growth retardation [3.2% vs 1.8%, OR 1.66(CI 1.26-2.19)], preterm deliveries [7.9% vs 6.6%, OR 1.22(CI 1.03-1.45)], antepartum hemorrhage [4.5% vs 2%, OR 1.92(CI 1.52-2.42)], postpartum hemorrhage [5% vs 2.6%, OR 1.84(CI 1.49-2.29)] and transfusion rate [4.2% vs 1.1%, OR 3.44(CI 2.68-4.41)] . Conversely, the incidence of premature rupture of membranes in the hemophiliac group was less as compared to the control group. Inpatient fetal and maternal mortality was found to be zero. The frequencies of the above outcomes with Odds Ratio are reported in Table 1. Conclusion: The overall risk of cesarean section, intrauterine growth retardation, preterm deliveries, risk of transfusion and antepartum and postpartum hemorrhage was higher in pregnant women who have hemophilia. This cross sectional study would help to understand the magnitude of these complications so that they could be managed optimally during antenatal period. Further studies are needed to examine these findings in relation to severity of disease, medications used and the presence of other comorbidities. Disclosures No relevant conflicts of interest to declare.

Case reports in endocrinology, 2018

Aim. To present a case of Graves' disease complicated by methimazole induced agranulocytosis trea... more Aim. To present a case of Graves' disease complicated by methimazole induced agranulocytosis treated with therapeutic plasma exchange (TPE) and review of the literature. Case Presentation. A 21-year-old patient with a history of Graves' disease presented to the endocrine clinic. His history was significant for heat intolerance, weight loss, and tremors. Upon examination he had tachycardia, smooth goiter, thyroid bruit, and hyperactive reflexes. He was started on methimazole and metoprolol and thyroidectomy was to be done once his thyroid function tests normalized. On follow-up, the patient symptoms persisted. Complete blood count done showed a white blood cell count of 2100 (4000-11,000 cells/cu mm) with a neutrophil count of 400 cells/cu mm, consistent with neutropenia. He was admitted to the hospital and underwent 3 cycles of TPE and was also given filgrastim. He improved clinically and his thyroxine (T4) levels also came down. Thyroidectomy was done. He was discharged on levothyroxine for postsurgical hypothyroidism. Conclusion. Plasmapheresis may be useful in the treatment of hyperthyroidism. It works by removing protein bound hormones and also possibly inflammatory cytokines. Further studies are needed to clarify the role of various modalities of TPE in the treatment of hyperthyroidism.

SM journal of nephrology and therapeutics, 2017

End Stage Renal Disease (ESRD) patients have been found to exhibit high prevalence of Atrial Fibr... more End Stage Renal Disease (ESRD) patients have been found to exhibit high prevalence of Atrial Fibrillation (AF), which demonstrates the possibility of a relationship of causality between the two conditions. The increased risk of stroke and mortality among ESRD patients with AF has also prompted a desire to understand the exact linkages between these different conditions. We conducted extensive reviews of relevant literature and established that indeed ESRD patients with AF exhibited higher risks for mortality and stroke occurrence compared to individuals with AF that did not suffer from ESRD. We also established that anticoagulation is regularly used as a form of therapeutic intervention with drugs such as warfarin, apixaban, and aspirin being some of the choice anticoagulants. The ARISTOTLE study found apixaban to be more effective than warfarin with a major bleeding rate of 2.13% annually compared to 3.09% respectively. The AVERROES trial found that warfarin use made it harder to maintain INR values compared to apixaban. This presence, severity, and duration of AF in ESRD patients was also found to correlate with structural abnormalities of the heart that significantly increased the risk for ischemic hand hemorrhagic strokes as well as mortality. This risk of stroke was found to be higher in CKD patients compared to the general population. Age, diabetes, hyperlipidemia, and gout were also confirmed as core factors influencing the development of AF in ESRD patients, as well as risk factors for stroke occurrence and mortality. High blood pressure and anticoagulation complications were further identified as causative factors for mortality among ESRD patients with AF. AF incidence is more prevalent among ESRD patients compared to the general population. This incidence and prevalence is also associated with more significant risk of stroke and mortality among said ESRD patients compared to the general population. However, more studies and trials need to be conducted on the prevalence of AF in the general population to fully understand the linkages between AF and ESRD.

Blood, Dec 7, 2017

Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increas... more Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increased risk of bleeding and obstetric complications during pregnancy. This study was undertaken to determine the risk of complications occurring during pregnancy for women with vWD using Nationwide Inpatient Sample (NIS) Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality(AHRQ). Method: We queried the NIS database for the years 2003- 2011, to identify all pregnancy-related discharges for women between 18-50 years of age. The pregnancy-related discharge records were identified by using the International Classification of Diseases Ninth Revision (ICD-9) and were classified as to whether they were an admission during pregnancy or postpartum. ICD 9 code used for vWD was 286.4. Binary logistic regression was used to compute adjusted odds ratio with 95% confidence interval(CI) after adjusting for potential confounders such as age, race, primary payer, hospital location, teaching status and patient comorbidities. Results: There were 15,258 pregnant women with vWD among 40,617,511 pregnancy related discharges. Women with vWD were slightly older than those without (28.01±6.08 vs 27.95±5.98, p Conclusion: Pregnant women with vWD have increased risk of bleeding complications, hypertensive disorder and need of transfusion. High incidence of cesarean section in patients with vWD could likely be explained by planned cesarean section in this high-risk group. There was no increased risk of fetal or maternal mortality in women with vWD. This cross sectional study would help to understand the magnitude of these complications so that they could be managed optimally during antenatal period. Further prospective studies are needed to confirm these findings. Disclosures No relevant conflicts of interest to declare.

The internet journal of public health, 2010

BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and h... more BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and half of this occurs in developing countries. In the sphere of cancer control, much would be achieved if breast cancer were to be detected early. Since a large proportion of patients in India present with advanced disease, any down-staging due to early detection will considerably reduce treatment cost as well as morbidity even if mortality is unaffected. This can be achieved by breast health awareness and adherence to screening practices. OBJECTIVE: The aims of this cross-sectional study were to determine the level of knowledge regarding breast cancer and to measure breast self-examination (BSE) performance in a group of 80 women aged 40 years and above. Additionally we also intended to demonstrate the correct method of BSE performance to each woman included in our study individually and privately. METHODS: This was a cross sectional study conducted over a period of two months commencing on August 1 st 2009 and ending on 30 th September 2009. 80 women were interviewed by means of a structured questionnaire (after obtaining written informed consent) in the surgical outpatient department of the K.J.Somaiya Medical College, Sion, Mumbai. The questionnaire consisted of socio-demographic variables, breast cancer risk factors and protective factors and knowledge and practice of BSE. Further, attitude towards BSE was also evaluated. The data were analyzed by descriptive studies, chi square test and analysis of variance in order to find out the P value. The interview was followed by an interactive session where each woman was individually and privately educated on breast self-examination by the investigators themselves in the presence of a nurse. RESULTS: Breast cancer awareness was found to be 52% in this group of women even though 95% women claimed to have heard of the disease. Only 12% of all women had received information about breast cancer from health professionals while a majority (60%) stated their source of information to be family and friends. Level of breast cancer knowledge was significantly associated with age (younger women more aware than older), income (women belonging to higher income group found to be more aware than those who were economically deprived), literacy (graduates and post graduates more knowledgeable), parity (women bearing lesser number of children being more aware), occupation (teachers and businesswomen being the most aware versus farmers who were the least aware). 38% women had never heard of BSE and among those that had heard of it, 15% were regular while 23% were irregular performers. Thus performance of BSE was found to be inadequate in this group. Not knowing the correct method was the most frequently reported reason for non performance.

Neuro-Oncology, 2012

Primary Leptomeningeal Anaplastic Oligodendroglioma (PLAO) is a very rare tumor that grows in the... more Primary Leptomeningeal Anaplastic Oligodendroglioma (PLAO) is a very rare tumor that grows in the subarachnoid space with no obvious findings of intraparenchymal mass lesion. Here we report an 11-year-old girl who was diagnosed as PLAO with temporal bone invasion. She has a history of shunted hydrocephalus of unknown etiology since the age of 8. Computed tomography (CT) scan had showed bifrontal subdural hygroma without intracranial or extracranial mass lesion until she developed right exophthalmos at the age of 11. CT scan and magnetic resonance imaging (MRI) revealed temporal bone tumor extending right orbital bone and diffuse leptomeningeal thickening. The biopsy was performed and histopathology revealed anaplastic oligodendroglioma. Combination chemotherapy with CDDP, CY and VP16 was started, and decreased the size of the tumor and improved her exophthalmos. After 5 cycles of the chemotherapy, TMZ was given for maintenance therapy. However, she developed leg paralysis and urinary incontinence 6 months later due to the worsening of leptomeningeal thickening throughout the spinal canal and intracranial space. Whole brain/spine radiotherapy was given, which decreased the tumor size and improved her neurological symptoms. A few months after cessation of chemotherapy, subcutaneous tumor was noted along the scar of LP shunt catheter. The subcutaneous tumor was surgically resected. Histopathology showed anaplastic oligodendroglioma and G-banding analysis showed the presence of i(1)(q10). Bone marrow metastasis was also noted at this time. Chemotherapy using IFO, CBDCA and VP16 was restarted. In response to treatment, serum LDH increased to 6.000 and then returned to normal. Tumor cells in the bone marrow almost disappeared after one cycle of chemotherapy. She has been stable without recurrence of the tumor for three months since then. PLAO is relatively slowly progressive and treatment using multiple modalities seems to be effective for this tumor.

Blood, Nov 29, 2018

Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data f... more Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 the prevalence of folic acid deficiency in the United States has decreased from 16% to 0.5% since the dietary folic acid fortification program started in the late 1990s. Routine testing for folic acid deficiency remains quite common in the workup of anemia, dementia, alcoholism and other high risk populations. The objective for this study were to determine the prevalence of folic acid deficiency in order to analyze whether routine testing for deficiency should be discouraged or targeted to specific patient populations. In addition to this, we want to assess the economic burden that folic acid level testing adds to the high cost of care of our health system. Methods Cross sectional chart review of all adults tested for folic acid level from March 2014 to March 2015 from the Hospital and Ambulatory Care Center of the Community Hospital was undertaken. Folic acid deficiency was defined as ≤4ng/dl. Folic acid level were further classified as low (≤10ng/dl ), intermediate (10-20ng/dl) and high (>20ng/dl). Age, race, body mass index, hemoglobin, mean corpuscular volume levels and billing details were recorded of all patients and information was also collected regarding known conditions correlated to the folic acid levels including Vitamin B12 deficiency( <300 ng/dl), dementia, alcoholism, pregnancy malabsorption, sickle cell disease, bariatric surgery, inflammatory bowel syndrome, and drug therapy with HAART (Highly Active Anti-Retroviral Therapy) , TMP-SMX(Trimethoprim/sulfamethoxazole), phenytoin, valproic acid and/or methotrexate (Table 1). Statistical testing using t-test, logistic / linear regressions with α level at 0.05 was used for analysis of data. Results A total of 957 charts of patients who were tested for folic acid between March 2014 to March 2015 at our Heath- Care System were reviewed. 413 (43%) patients were male and 544 (57%) were female. There were 394 (41 %) Hispanics, 325 (34%) African American, 202 (21%) Caucasian and 36 (4%) were from other ethnicity. The mean age was 59.7 years and a mean Hb was 11. 6 g/ dl. Mean folic acid level was 14.5 ng/dl. 16 patients from total of 957 (2 %) had folic acid deficiency with value ≤4ng/dl . Additional results from the study are described in Table 1, Table 2 and Table 3. Conclusion The prevalence of folic acid deficiency was 2%, About 33,000 dollars per year were used to identify such a low prevalent disease which can be treated at a low cost (2 cents/day) by oral supplementation. Low levels of folic acid were statistically associated with male sex, African American race, dementia and coexistence of vitamin B12 deficiency. Empiric supplementation of folic acid and possibly limiting testing for folic acid level to this group of patients may represent a more cost effective strategy. Disclosures No relevant conflicts of interest to declare.

The Journal of community and supportive oncology, May 1, 2017

Tumori Journal, Mar 21, 2018

Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia ... more Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia and organ destruction secondary to eosinophilic infiltration. The coexistence of primary B-cell lymphoma and hypereosinophilic syndrome is extremely rare. We present a case of HES that preceded the diagnosis of diffuse large B-cell lymphoma. Case report: A 70-year-old man presented with a 3-month history of diarrhea and 30-pound weight loss. Complete blood count showed a white blood cell count of 7452/µL with eosinophils of 42% (absolute eosinophil count 3130). Colonoscopy showed eosinophilic infiltrate in the lamina propria and muscularis mucosa. Bone marrow biopsy showed elevated myeloid: erythroid ratio (6:1), increased mature and immature eosinophilic infiltration (10% of nucleated cells). Molecular studies were negative for Fip1-like1-platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) translocation and PDGFRB and FGFR mutations, indicating nonclonal eosinophilia. Treatment was initiated with prednisone (1 mg/kg) and hydroxyurea 500 mg twice daily. He responded with complete resolution of symptoms. Five months later, the patient presented with right lower quadrant pain. Abdominal/pelvis computed tomography (CT) showed bulky right inguinal lymphadenopathy and biopsy revealed CD10+ diffuse large B-cell lymphoma (DLBCL). Further staging workup showed the stage to be IIB. He received 6 cycles of chemotherapy and involved field radiation therapy. He achieved complete remission. Conclusion: Reviewing the literature indicates only one case of similar presentation with concomitant HES and DLBCL. Eosinophilia is routinely encountered in clinical practice and as such physicians must be aware of the rarer, more malevolent underlying associations of this condition so as to aid early diagnosis and prompt treatment.

The Journal of community and supportive oncology, May 1, 2016

Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increas... more Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increased risk of bleeding and obstetric complications during pregnancy. This study was undertaken to determine the risk of complications occurring during pregnancy for women with vWD using Nationwide Inpatient Sample (NIS) Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality(AHRQ). Method: We queried the NIS database for the years 2003- 2011, to identify all pregnancy-related discharges for women between 18-50 years of age. The pregnancy-related discharge records were identified by using the International Classification of Diseases Ninth Revision (ICD-9) and were classified as to whether they were an admission during pregnancy or postpartum. ICD 9 code used for vWD was 286.4. Binary logistic regression was used to compute adjusted odds ratio with 95% confidence interval(CI) after adjusting for potential confounders such as age, race, prima...

Blood, 2017

Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospect... more Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospective studies suggest that women with hemophilia have increased risk of bleeding and obstetric complications however the exact burden of this remains unknown. By analyzing the Nationwide Inpatient sample database (NIS) of Healthcare Cost and Utilization Project(AHRQ), we attempted to identify pregnant women with hemophilia A or B and compared their outcome and Obstetric complications with pregnant women who did not have a diagnosis of hemophilia. Method: By using NIS database 2003-2011, we identified the number of obstetric hospitalization, deliveries and caesarean deliveries in women between the age group 18-50 years. Patients hospitalized with Hemophilia A or B were also identified (ICD-9 286.0, 286.1 respectively). We then compared pregnancy related complications for women with and without Hemophilia. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR)....

The Internet Journal of Healthcare Administration, 2010

Tuberculosis has emerged as the greatest danger to India threatening the health of millions. Sinc... more Tuberculosis has emerged as the greatest danger to India threatening the health of millions. Since TB is ubiquitous and contagious, hospital staff and others in close contact with tuberculosis patients run the highest risk of infection. This risk is largely preventable by use of simple inexpensive measures to avoid the contagion to spread via droplets. Even though health care workers are well aware of the mode of spread of tuberculosis , they do not take precautionary measures while dealing with TB patients. Patients too are non compliant with doctors' advise of wearing masks for protection of people in the vicinity. Thus, extensive use of masks enforced by the administration will greatly reduce the transmission of tuberculosis. This may be achieved if disposable masks are made available free of cost from dispensers along with condoms under a national programme thus helping us tackle the two leading diseases of the country.

The Internet Journal of Public Health

BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and h... more BACKGROUND: Breast cancer is responsible for 10.4% of the global burden of cancers in women and half of this occurs in developing countries. In the sphere of cancer control, much would be achieved if breast cancer were to be detected early. Since a large proportion of patients in India present with advanced disease, any down-staging due to early detection will considerably reduce treatment cost as well as morbidity even if mortality is unaffected. This can be achieved by breast health awareness and adherence to screening practices. OBJECTIVE: The aims of this cross-sectional study were to determine the level of knowledge regarding breast cancer and to measure breast self-examination (BSE) performance in a group of 80 women aged 40 years and above. Additionally we also intended to demonstrate the correct method of BSE performance to each woman included in our study individually and privately. METHODS: This was a cross sectional study conducted over a period of two months commencing on August 1 st 2009 and ending on 30 th September 2009. 80 women were interviewed by means of a structured questionnaire (after obtaining written informed consent) in the surgical outpatient department of the K.J.Somaiya Medical College, Sion, Mumbai. The questionnaire consisted of socio-demographic variables, breast cancer risk factors and protective factors and knowledge and practice of BSE. Further, attitude towards BSE was also evaluated. The data were analyzed by descriptive studies, chi square test and analysis of variance in order to find out the P value. The interview was followed by an interactive session where each woman was individually and privately educated on breast self-examination by the investigators themselves in the presence of a nurse. RESULTS: Breast cancer awareness was found to be 52% in this group of women even though 95% women claimed to have heard of the disease. Only 12% of all women had received information about breast cancer from health professionals while a majority (60%) stated their source of information to be family and friends. Level of breast cancer knowledge was significantly associated with age (younger women more aware than older), income (women belonging to higher income group found to be more aware than those who were economically deprived), literacy (graduates and post graduates more knowledgeable), parity (women bearing lesser number of children being more aware), occupation (teachers and businesswomen being the most aware versus farmers who were the least aware). 38% women had never heard of BSE and among those that had heard of it, 15% were regular while 23% were irregular performers. Thus performance of BSE was found to be inadequate in this group. Not knowing the correct method was the most frequently reported reason for non performance.

Blood

Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data f... more Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 the prevalence of folic acid deficiency in the United States has decreased from 16% to 0.5% since the dietary folic acid fortification program started in the late 1990s. Routine testing for folic acid deficiency remains quite common in the workup of anemia, dementia, alcoholism and other high risk populations. The objective for this study were to determine the prevalence of folic acid deficiency in order to analyze whether routine testing for deficiency should be discouraged or targeted to specific patient populations. In addition to this, we want to assess the economic burden that folic acid level testing adds to the high cost of care of our health system. Methods Cross sectional chart review of all adults tested for folic acid level from March 2014 to March 2015 from the Hospital and Ambulatory Care Center of the Community Hospital was undertaken. Folic acid deficiency wa...

Tumori Journal

Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia ... more Introduction: Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia and organ destruction secondary to eosinophilic infiltration. The coexistence of primary B-cell lymphoma and hypereosinophilic syndrome is extremely rare. We present a case of HES that preceded the diagnosis of diffuse large B-cell lymphoma. Case report: A 70-year-old man presented with a 3-month history of diarrhea and 30-pound weight loss. Complete blood count showed a white blood cell count of 7452/µL with eosinophils of 42% (absolute eosinophil count 3130). Colonoscopy showed eosinophilic infiltrate in the lamina propria and muscularis mucosa. Bone marrow biopsy showed elevated myeloid: erythroid ratio (6:1), increased mature and immature eosinophilic infiltration (10% of nucleated cells). Molecular studies were negative for Fip1-like1-platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) translocation and PDGFRB and FGFR mutations, indicating nonclonal eosinophilia. Treatmen...

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, Jan 24, 2018

Venous thromboembolism (VTE) is a major cause of mortality and morbidity in hospitalized patients... more Venous thromboembolism (VTE) is a major cause of mortality and morbidity in hospitalized patients with malignancy. Nationwide Inpatient Sample database was analyzed to determine the trends in the rate of hospitalization and mortality from VTE in hospitalized ovarian cancer patients and assess its economic impact and resource utilization. We queried the 2003 to 2011 Nationwide Inpatient Sample database from Healthcare Cost and Utilization project (Agency of Healthcare Research and Quality) to identify all adults (age ≥18 years) ovarian cancer. Patients hospitalized with VTE as one of the top 3 discharge diagnoses were also identified. Demographic characteristics and in-hospital outcomes of this population were compared with ovarian cancer patients without VTE. Binary logistic regression analysis was used to obtain adjusted odds ratios (ORs). A total of 34,249 (3.5%) of a total of 981,386 hospitalized ovarian cancer patients had an accompanying diagnosis of VTE. Mean age of the study ...