Papers by Keyvan Ravakhah
Journal of Clinical Oncology
3597 Background: Metastatic disease at the time of diagnosis of gastrointestinal (GI) malignancie... more 3597 Background: Metastatic disease at the time of diagnosis of gastrointestinal (GI) malignancies is a strong predictor of poor outcomes. Differences in metastatic patterns among Caucasians (C) and African-Americans (AA) needs further elucidation. In this study, we analyzed the patterns of metastasis in C and AA in colorectal cancer (CRC), pancreatic cancer (PC), gastric cancer (GC), and liver cancer (LC). Methods: We identified patients with CRC, PC, GC, and LC from the Surveillance, Epidemiology, and End Results Program (SEER) database from 2010-2018. We obtained metastasis data to lungs, liver, bone, and brain at the time of diagnosis. We calculated the relative risk (RR), confidence interval (CI), and standard error with the use of SPSS software, 28.0 (IBM). Results: The most common metastasis site was the liver being highest at 39% in AA with PC. Brain metastasis was the least common. Significant racial disparities were noted. In CRC, AA had a 35-37% increased risk of metastas...
Cureus, 2021
Coronavirus disease 2019 (COVID-19) induces a dysregulated immune response, leading to a drastic ... more Coronavirus disease 2019 (COVID-19) induces a dysregulated immune response, leading to a drastic elevation of proinflammatory cytokines. This cytokine storm has the potential to aggravate any prior ongoing inflammation. Moreover, acute pancreatitis can cause local necrosis, thereby causing extensive abdominal inflammation. This condition increases the risk of abdominal compartment syndrome (ACS) and its deleterious consequences. We report the case of a 37-year-old male with a past medical history of chronic pancreatitis and alcohol use disorder who presented to the emergency department complaining of abdominal pain. Physical examination revealed a tender abdomen. Initial workup showed elevated amylase and lipase, a positive COVID-19 polymerase chain reaction (PCR) test, and elevated inflammatory markers. The patient denied any respiratory symptoms. Initial abdominal CT scan revealed mild pancreatic inflammation. The patient was admitted to the respiratory ICU and managed with fluid resuscitation and pain control. However, the patient had increasing oxygen requirements, leukocytosis, and worsening kidney function. A trans-bladder measurement of intra-abdominal pressure revealed severe ACS. Broad-spectrum antibiotics were started; however, after 72 hours of treatment, the patient had a cardiopulmonary arrest. He returned to spontaneous circulation after advanced cardiovascular life support (ACLS) protocol and intubation. A repeat CT scan of the abdomen showed necrotizing pancreatitis with a largevolume hemoperitoneum. Urgent pancreatic necrosectomy was performed with drainage of the hemoperitoneum. The patient was transferred to a long-term acute care facility for extended antibiotic therapy where he eventually recovered. This case illustrates the catastrophic consequences of necrotizing pancreatitis complicated by sepsis and ACS in a COVID-19-positive patient.
Cureus, 2021
Zonisamide is a new-generation anticonvulsant that works by altering the sodium and T-type calciu... more Zonisamide is a new-generation anticonvulsant that works by altering the sodium and T-type calcium channels in the brain. It is currently approved for partial seizures, and trials are ongoing to evaluate the effectiveness against mania and chronic pain in adults. Psychosis is a rare side effect with an incidence of 2%. Our patient, a 52-year-old female with a past medical history of osteoarthritis and chronic pain only relieved by zonisamide is brought to the emergency department (ED) after a two-day history of altered mental status, agitation and visual hallucinations. One month prior, she had undergone total knee arthroplasty complicated with right knee cellulitis managed by IV (intravenous) long-term antibiotics of vancomycin and ertapenem. Physical examination was remarkable for disorientation to person, place, and time with intact remainder of the neurological exam. Initial laboratory work was unremarkable and a computerized tomography (CT) scan of the brain showed no acute int...
American Journal of Gastroenterology, 2021
Cureus, 2021
Drug-induced liver injury (DILI) is the leading cause of acute liver failure in the United States... more Drug-induced liver injury (DILI) is the leading cause of acute liver failure in the United States. Azithromycin is a commonly used antibiotic for community-acquired pneumonia that causes liver injury in rare cases. Typically, cholestatic liver injury has been reported for azithromycin, but there have only been a few case reports addressing the association with direct hepatocellular liver injury. This is a case of a 66-year-old man, with no pre-existing liver disease, who was managed for Legionnaires' disease who sustained a hepatocellular pattern of liver injury associated with azithromycin. We report this case to highlight the importance of prompt recognition of these rare side effects associated with azithromycin and the discontinuation of the drug to facilitate rapid recovery.
Endocrine Practice, 2016
MOTYW I PYTANIE BADAWCZE DO NIEGO O tym, że kolumna to jeden "z dwóch ulubionych przez Norwida sk... more MOTYW I PYTANIE BADAWCZE DO NIEGO O tym, że kolumna to jeden "z dwóch ulubionych przez Norwida składników architektury klasycznej" 1 przekonywała praca Kazimierza Wyki z 1948 r. Cyprian Norwid: poeta i sztukmistrz. Niniejszy artykuł dotyczy literackich przedstawień kilku przykładów takiego upodobania: rzymskich kolumn Trajana i Marka Aureliusza oraz przede wszystkim paryskiej kolumny z placu Vendôme 2 , a zatem zabytków, co do których warto przypomnieć rzecz podstawowąsą to kolumny triumfalne. Z szerokiego kręgu znaczeń jednostki słownikowej "kolumna": słup, posąg, pionowa podpora wspierająca część budowli, która służy również jako podstawa pomnika lub pomnik-należy wybrać te synonimiczne do statuy, aby zrozumieć funkcje pełnione przez ten typ elementu architektury miejskiej. Poetycki opis kolumny triumfalnej stanowi bowiem inny rodzaj obrazu niż przedstawienie kolumnady, uwypuklające pluralizm kolumn, a także niekiedy ich rozmieszczenie na planie budynku, które spotykamy np. w przedmowie do Quidama: "do tego kościoła, co w kwadracie kolumn świątyni starożytnej jako gołąb w rozłamanej klatce przestawa" (DW III, 119) lub we fragmencie "dalej kolumn rząd" (PWsz I, 98) z wiersza Z listu (do Włodzimierza Łubieńskiego). Określenie: "klatka", tak jak i "rząd", przywodzi na myśl regularne odstępy między kolumnami. Opozycja wielość-pojedynczość nie wyczerpuje jednak aspektu różnicującego przesłanie kolumny triumfalnej od wymowy
BMJ Case Reports, 2020
Although solitary plasmacytomas may occasionally present as collar bone swellings or fractures, m... more Although solitary plasmacytomas may occasionally present as collar bone swellings or fractures, multiple myeloma involving clavicle is extremely rare. Ten to forty per cent of multiple myeloma cases are asymptomatic and are incidental diagnoses. Our case report describes an entirely benign presentation like chronic shoulder pain masquerading advanced myeloma, thereby posing a significant diagnostic dilemma. We present a 48-year-old man who presented with chronic bilateral shoulder pain with no history of trauma and was eventually diagnosed with advanced multiple myeloma and pathologic fracture of the right clavicle. It is, therefore, evident that a low threshold for suspicion can lead to early diagnosis and initiation of treatment and better survival.
American Journal of Gastroenterology, 2017
Fish are sensitive to temperature, but the intergenerational consequences of maternal exposure to... more Fish are sensitive to temperature, but the intergenerational consequences of maternal exposure to high temperature on offspring behavioural plasticity and underlying mechanisms are unknown. Here we show that a thermal maternal stress induces impaired emotional and cognitive responses in offspring rainbow trout (Oncorhynchus mykiss). Thermal stress in mothers triggered the inhibition of locomotor fear-related responses upon exposure to a novel environment and decreased spatial learning abilities in progeny. Impaired behavioural phenotypes were associated with the dysregulation of several genes known to play major roles in neurodevelopment, including auts2 (autism susceptibility candidate 2), a key gene for neurodevelopment, more specifically neuronal migration and neurite extension, and critical for the acquisition of neurocognitive function. In addition, our analysis revealed the dysregulation of another neurodevelopment gene (dpysl5) as well as genes associated with human cognitive disorders (arv1, plp2). We observed major differences in maternal mRNA abundance in the eggs following maternal exposure to high temperature indicating that some of the observed intergenerational effects are mediated by maternallyinherited mRNAs accumulated in the egg. Together, our observations shed new light on the intergenerational determinism of fish behaviour and associated underlying mechanisms. They also stress the importance of maternal history on fish behavioural plasticity.
American Journal of Gastroenterology, 2017
Current Trends in Cardiology, 2017
Brugada Syndrome (BrS) is an autosomal dominant genetic disease determined by abnormal electrocar... more Brugada Syndrome (BrS) is an autosomal dominant genetic disease determined by abnormal electrocardiographic (ECG) pattern and causes increased risk of sudden cardiac death. It is characterised by coved-type ST segment elevation in precordial leads V1-V3. There had been many proposed mechanisms explaining the link of sodium channel mutations and its electrophysiology. There are various triggering factors like fever, hypokalemia, ischemia, cocaine abuse and medications which unmask the ECG changes and these changes are usually transient. There is increased possibility of this cardiac rhythm to deteriorate into life threatening arrhythmias. Thus it is essential for the clinician to be aware of the conditions. We present such a scenario in which hyperthermia unmasked our patient's Brugada syndrome.
BMJ Case Reports, 2019
Injudicious use of over-the-counter calcium supplements has resulted in increased incidences of h... more Injudicious use of over-the-counter calcium supplements has resulted in increased incidences of hypercalcaemia and related complications. We present a case of acute pancreatitis in a chronic hypocalcaemic patient of DiGeorge’s syndrome. The patient came into the ED with sepsis syndrome, right upper quadrant and epigastric pain and no obvious source of infection. Lab results and imaging were indicative of acute pancreatitis. There was severe renal dysfunction. The patient needed haemodialysis and had a prolonged stay in intensive care. The medical history was negative for biliary duct pathology or alcohol use. The patient had vomiting and diarrhoea in the nursing home for about a week, but she continued to receive her regular medications that included the calcium supplements and thiazide diuretics. It is likely that a complex interplay between calcium supplementation, dehydration and thiazide diuretics resulted in the development of acute pancreatitis and severe renal dysfunction in ...
Archives of medical science : AMS, 2018
Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type... more Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR-, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. We evaluated a cohort of 348 consecutive patients: 152 h...
Indian Heart Journal, 2017
Background: Peripheral arterial disease (PAD) is an underdiagnosed illness often affecting the el... more Background: Peripheral arterial disease (PAD) is an underdiagnosed illness often affecting the elderly population. Ankle brachial index (ABI) is a good diagnostic tool for PAD in outpatient practice, but remains underused. Materials and methods: Patients were recruited from an outpatient medical camp in rural India, and assessed for symptoms and pre-existing risk factors. Measured ABI 0.9 was considered abnormal and considered PAD. Results: Out of 100 patients recruited, PAD was diagnosed in 57 patients. Associated risk factors were like age >55 years (67%), hypertension (66%), smoking (69%) and diabetes mellitus (35%) were common. Conclusion: PAD is a very common and underdiagnosed illness in rural India. A simple tool like ABI can help diagnosis in underserved areas.
Journal of Cardiovascular Diseases & Diagnosis, 2017
Takotsubo cardiomyopathy (TCM) is a reversible disorder characterized by left ventricular wall ap... more Takotsubo cardiomyopathy (TCM) is a reversible disorder characterized by left ventricular wall apical ballooning precipitated by stressful event. Clinical presentation of this disorder mimics acute coronary syndrome (ACS). We are presenting a case of TCM, which is unique as rhabdomyolysis being the triggering factor. Although, our patient presented with features of NSTEMI on EKG and elevated troponins, diagnosis of TCM was made by echocardiography which showed left ventricular apical wall hypokinesis with Left ventriculogram showing the apical ballooning. The unique feature of the case was the triggering factor being rhabdomyolysis.
Vessel Plus, 2017
Leriche's syndrome is an aortic occlusive disease, which is due to obliteration of distal aorta a... more Leriche's syndrome is an aortic occlusive disease, which is due to obliteration of distal aorta above the site of bifurcation of common iliac arteries. The classic triad of symptoms include claudication, impotence, and absent or decreased femoral pulses. It may be acute or chronic in onset. Most of the cases are chronic in nature due to baseline pathophysiology involving atherosclerotic changes in the aorta. There are many causes of acute leriche's syndrome like surgical manipulation, trauma, thromboembolic disease, hypercoagulability, atrial fibrillation, neoplasm, intraplaque hemorrhage in an aneurysm. Post-surgical Leriche's syndrome is rare and needs a strong index of suspicion to diagnose. The authors highlight a case of Leriche's syndrome, as a post-surgical complication and its clinical importance.
Cardiovascular Therapeutics, 2016
Heart failure continues to be a widely prevalent disease across the world, affecting millions of ... more Heart failure continues to be a widely prevalent disease across the world, affecting millions of Americans annually. Acute heart failure (AHF) has a substantial effect on rising healthcare costs and is one of the major causes of morbidity and mortality. The search for new drugs for symptom relief and to improve long-term outcomes in heart failure has led to development of serelaxin, a recombinant human relaxin-2 hormone. Relaxin was discovered in pregnancy, but eventually found to have a number of other physiological actions, not only in pregnancy, but also in nonpregnant women and men. The actions of serelaxin are primarily via nitric oxide, leading to the observed vasodilatory effects, and increase in renal plasma flow. It has also been found to increase expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)-2 and MMP-9. The antifibrotic and antiinflammatory effects of the drug also play a role in heart failure. In Phase II studies, serelaxin has shown reduction in pulmonary arterial pressure, pulmonary capillary wedge pressure, and NT-proBNP. The recently published results of the RELAX-AHF, a phase III clinical trial on serelaxin, has opened new avenues into our understanding of its effects in heart failure. The trial showed improvement in short-term dyspnea scores and 180-day mortality, but, interestingly, failed to show any improvement of the secondary endpoints of death or readmission at 60 days. Ongoing Phase III trials like RELAX-AHF-2 and RELAX-AHF-ASIA would explain these data better and improve understanding of the use of serelaxin in clinical practice. This article summarizes the most updated published preclinical and clinical study data on serelaxin, including pharmacokinetic, pharmacodynamic, safety studies in hepatic, renal impaired patients, Phase II and Phase III trials.
Australasian Medical Journal, 2015
number: 528 Case Presentation: We report a case of 48 year old male with no significant past medi... more number: 528 Case Presentation: We report a case of 48 year old male with no significant past medical history, presented to hospital with complaint of left arm weakness and dysarthria that started 2-3 hours before. He had an episode of left leg weakness for 15-20 minutes, 2 weeks ago which completely resolved. Review of system was negative for palpitation, chest pain, shortness of breath, headache, blurred vision, dysphagia and facial deviation. His neurological exam was completely benign on presentation. Cardiovascular, pulmonary and extremities examinations were also unremarkable. The patient was approached as a possible case of transient ischemic attack (TIA). ECG, Echo, carotid US and non contrast CT of brain were all normal. CBCD showed WBC 8.0, Hb of 13.0, Platelets 1092, large and giant platelets but absence of teardrop cell, immature blasts and nucleated RBC in peripheral smear. Patient denied any crush injury, infection, recent surgery, acute blood loss and splenectomy. Coag...
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Papers by Keyvan Ravakhah