Lapatinib impact on pulmonary hypertension.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 160-160
Author(s):  
Yaser Alkhatib ◽  
Derar Albashaireh ◽  
Tameem Abdul Hamid Al-Aqtash ◽  
Rana Awdish ◽  
Amr S. Hanbali
Keyword(s):  
Heart Disease ◽  
Chart Review ◽  
Kinase Inhibitors ◽  
Retrospective Chart Review ◽  
Selective Inhibition ◽  
Right Heart Catheterization ◽  
Pulmonary Vasculature ◽  
Heart Catheterization ◽  
Before And After ◽  
The Impact

160 Background: Pulmonary Arterial Hypertension (PAH) and cancer share growth factor and protein kinase signaling pathways that result in smooth muscle cell proliferation and vasculopathy. A number of tyrosine kinase inhibitors (TKI) have been developed for the treatment of cancer, and some of these like Imatinib have been investigated in PAH. There is little known about the impact of other TKI on the pulmonary vasculature. After reporting a case of lapatinib-induced PAH that reversed after withdrawal of the drug, we investigated the association of lapatinib with the development of PAH in our institution. Methods: A retrospective chart review was conducted, in accordance with IRB protocol, of all patients treated with lapatinib over the past five years at our institution. Patients who had undergone 2-D echocardiogram both prior to and after treatment were included in the analysis. Systolic Pulmonary Artery Pressures (PASP), right-sided chamber dilation and function, TAPSE were each evaluated. Through chart review, patients were evaluated in terms of risk factors for non-Group 1 PAH. A Wilcoxon signed-rank sum test was used to compare the changes in PASP before and after the initiation of lapatinib. Results: A total of 27 patients were found to have 2-D echo done before and after starting treatment with lapatinib. All patients had normal PASP before starting treatment. Eight patients developed elevated PASP following treatment. Two patients had evidence of left-sided heart disease felt to contribute to their elevated pressures, while the remaining 6 patients had no evidence for Group 2 (associated with left heart disease), 3 (associated with lung disease or hypoxemia) or chronic thromboembolic PAH. Right heart catheterization was available in one patient, confirming the diagnosis of PAH. The median pre-treatment and post treatment PASP in those 6 patients was 29.5 mmHg and 65.5 mmHg respectively (N=6; p = 0.03). Conclusions: Lapatinib is a TKI with a selective inhibition to EGFR and HER2, approved by FDA in 2007 as a second line agent in advanced breast cancer. Given the potential of TKIs as anti-proliferative agents in PAH, a number are currently under study, but little is yet known. This is the first study in the literature to show that PAH is a potential side effect of lapatinib.

Abstract WMP89: Stroke Code De-escalation: Safety and Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jessica Jarnot ◽  
Christopher Streib ◽  
Angela Heyer ◽  
Amy Reichert ◽  
David Anderson ◽  
...  
Keyword(s):  
Chart Review ◽  
Healthcare Providers ◽  
Retrospective Chart Review ◽  
Before And After ◽  
Chi Squared ◽  
Cost Implications ◽  
The Impact ◽  
Timely Treatment ◽  
Iv Tpa ◽  
Missed Opportunity

Introduction: “Stroke codes” (SCs) facilitate the timely treatment of acute ischemic stroke (AIS) with IV tPA or intra-arterial thrombectomy (IAT), but are inherently resource-intensive and can expose patients to unnecessary and potentially harmful interventions. While all healthcare providers are encouraged to activate SCs, this might lead to low SC-to-treatment-ratios (SCTR). We examined the impact of de-escalation of stroke codes (DSCs) on SCTR. Methods: DSCs were initiated in our institution in January 2015. All DSCs were reviewed for the patient’s eligibility for IV tPA or IAT, and reason for de-escalation. We reviewed all stroke codes 12 months before and after the initiation of this process and compared the SCTR by chi-squared testing. Results: In 2014, prior to DSCs, 253 SCs resulted in 22 AIS interventions (22 IV tPA) for a SCTR of 8.7%. In 2015, 348 SCs were activated with 64 subsequent DSCs (18.4%) and 45 AIS interventions (38 IV tPA, 7 IAT, 7 both), for a SCTR of 15.8%. The improvement in SCTR after introducing DSCs was statistically significant (p=0.012). When restricting the analysis to IV tPA interventions alone, there remained a trend (p=0.068) towards improvement in SCTR. Retrospective chart review did not reveal any DSC cases that resulted in missed opportunity for IV TPA or IAT treatment. No DSCs were due to an acute ICH. Justifications for de-escalations are summarized in figure 1. Conclusions: The introduction of DSCs resulted in a statistically significant absolute improvement in SCTR of 7.1%. Importantly, DSCs did not result in any eligible AIS patient forgoing IV tPA or IAT, nor missed ICH. More research is needed to increase the yield of stroke codes, refine the criteria for both activating and de-escalating them, and quantify the resource and cost implications of such de-escalations.

Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emma M Loebel ◽  
Mary Rojas ◽  
Connor Mensching ◽  
Danielle Wheelwright ◽  
Laura K Stein
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Mount Sinai Hospital ◽  
Index Admission ◽  
Negative Consequences ◽  
Medical Comorbidities ◽  
Post Stroke ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

scholarly journals The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaron Burnett ◽  
Dolly Panchal ◽  
Bjorn Peterson ◽  
Eric Ernest ◽  
Kent Griffith ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
T Test ◽  
Medical Services ◽  
Demographic Differences ◽  
Chemical Restraint ◽  
Emergency Medical ◽  
Clinically Significant ◽  
The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints.  Haloperidol is employed for chemical restraint in many EMS services.  Recently, ketamine has been introduced as an alternate option for prehospital sedation.  On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review.  On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups.  On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.  

scholarly journals Low-Dose Aminophylline for the Treatment of Neonatal Non-Oliguric Renal Failure—Case Series and Review of the Literature

2008 ◽  
Vol 13 (2) ◽  
pp. 80-87
Author(s):  
Bethany A. Lynch ◽  
Peter Gal ◽  
J. Laurence Ransom ◽  
Rita Q. Carlos ◽  
Mary Ann V.T. Dimaguila ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Chart Review ◽  
Low Dose ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Review Of The Literature ◽  
Oliguric Renal Failure ◽  
The Impact

OBJECTIVE Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. MATERIALS AND METHODS This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. RESULTS Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. CONCLUSIONS Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.

scholarly journals Effect of abnormal right heart structures on the diagnosis of pulmonary hypertension

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401877305 ◽  
Author(s):  
Batool AbuHalimeh ◽  
Milind Y. Desai ◽  
Adriano R. Tonelli
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Heart Catheterization ◽  
The Other ◽  
Heart Catheterization ◽  
Right Heart ◽  
Cardiac Lesions ◽  
The Right ◽  
The Impact ◽  
Heart Lesions

The diagnosis of pulmonary hypertension (PH) requires a right heart catheterization (RHC) that reveals a mean pulmonary artery pressure ≥ 25 mmHg. The pulmonary artery catheter traverse the right atrium and ventricle on its way to the pulmonary artery. The presence of abnormal right heart structures, i.e. thrombus, vegetation, benign or malignant cardiac lesions, can lead to complications during this procedure. On the other hand, avoidance of RHC delays the diagnosis and treatment of PH, an approach that might be associated with worse outcomes. This paper discusses the impact of right heart lesions on the diagnosis of PH and suggests an approach on how to manage this association.

Retrospective Chart Review of Cryopreserved Amniotic Membrane for Knee Pain

2020 ◽  
Author(s):  
Ruben Berrocal Timmons
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Amniotic Membrane ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Mean Values ◽  
Number Of Patients ◽  
The Impact

Objective: Treatment of joint pain with an injection of the amniotic membrane has not been adequately studied. This study retrospectively reviewed Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic usage data from patients treated with the injection of cryopreserved amniotic membrane (CAM) in their knees to determine the impact of treatment on patients’ pain, quality of life, and analgesic usage. Methods: Chart review was conducted on 40 patients. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. The membrane was utilized as per the FDA guidance of 21CFR1271. Retrospective data, including demographics, medical history, pain score, quality of life score, analgesic usage and adverse events, were collected from their medical records for each consenting patient through 6 months after CAM injection. Results: A total of 40 patients were considered in the final analysis. Mean VAS for pain level improved from 7.0 to 2.6 (p<0.001). WOMAC daily activity function score improved from a mean score of 52 to 28 (p<0.001). Opioid and non-steroidal anti-inflammatory drug (NSAID) usage decreased from 97% to 25% (p<0.001). No adverse events were reported. Conclusion: Mean values for VAS and WOMAC scores significantly improved at all time points and the number of patients who used analgesics decreased as compared to baseline. CAM injection into painful knee joints decreases pain, improves physical function, and decreases the use of analgesics in the absence of adverse events.

scholarly journals Pulmonary Vascular Underperfusion Score in Premature Infants with Bronchopulmonary Dysplasia and Pulmonary Hypertension

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 359
Author(s):  
Das ◽  
Jadotte ◽  
Chan
Keyword(s):  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Imaging Modality ◽  
Pulmonary Angiography ◽  
Right Heart Catheterization ◽  
Pulmonary Vasculature ◽  
Heart Catheterization ◽  
Vascular Changes ◽  
Cardiac Hemodynamics ◽  
Underlying Pathophysiology

Pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD). The underlying pathophysiology of BPD-associated PH is complex and poorly understood. Echocardiogram may underestimate the severity of pulmonary hypertensive vascular disease in severe BPD. Digital subtraction pulmonary angiography (DSPA) is a potentially useful imaging modality for evaluating changes in the pulmonary vasculature of BPD-associated PH. In this study, we objectively quantified the pulmonary hypertensive vascular changes demonstrated by DSPA using a novel pulmonary vascular underperfusion score (PVUS) and correlated the scoring system with echocardiography parameters and cardiac hemodynamics by right heart catheterization.

scholarly journals 2532. Identifying Educational Needs and Improving Provider Knowledge Regarding the Management of Febrile Neutropenia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S880-S880
Author(s):  
Amy Chang ◽  
Stan Deresinski ◽  
Aruna Subramanian ◽  
Bruno Medeiros ◽  
Emily Mui, PharmD ◽  
...  
Keyword(s):  
Medical Students ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Empiric Therapy ◽  
Myelogenous Leukemia ◽  
Front Line ◽  
National Guidelines ◽  
Gram Positive ◽  
The Impact

Abstract Background In a retrospective chart review of 211 first episodes of febrile neutropenia (FN) in in-patients with acute myelogenous leukemia evaluating rates of appropriate vs. inappropriate management, we identified frequent noncompliance with national guidelines for the management of FN. We utilized these data to develop an educational intervention targeting front-line providers. Methods Based on findings from our chart review, we developed and implemented an interactive, case-based didactic session for advanced practice providers (APPs) and medical students/residents rotating on hematology, targeting inappropriate antibiotic use. Pretest questions were embedded into the lecture, preceding content related to each learning objective. Lecture material included content from national guidelines, literature addressing misconceptions (e.g., vancomycin usage for persistent fever), and data from our institutional antibiogram (Figure 1). A post-test was given directly after the lecture to evaluate knowledge gained. Results Five inappropriate behaviors were identified (Figure 2): (1) changing empiric therapy despite clinical stability, (2) misunderstanding piperacillin/tazobactam’s spectrum of activity, (3) inappropriate initiation of antibiotics active against resistant Gram-positive organisms; (4) failure to de-escalate therapy at 72 hours and (5) failure to add Gram-positive coverage when using aztreonam. Lectures were provided to 13 APPs and 17 medical students/residents over 6 sessions. An improvement in knowledge was noted for most learning objectives except for the third, for which misconceptions remained, especially regarding need for vancomycin in the setting of mucositis (Figures 3 and 4). Higher baseline knowledge was noted for medical students/residents than APPs. 93% of learners rated the lecture very/extremely helpful. Learners recommended future content focus on antifungal therapy. Conclusion We utilized local practice data to develop educational content for front-line providers. We will convert this lecture into a video-format to be incorporated into hematology rotations to reinforce key concepts. A prospective cohort study to evaluate the impact on prescribing behavior is underway. Disclosures All authors: No reported disclosures.

scholarly journals Pulmonary hypertension with dasatinib and other tyrosine kinase inhibitors

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401986570 ◽  
Author(s):  
Ashraf El-Dabh ◽  
Deepak Acharya
Keyword(s):  
Pulmonary Hypertension ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Kinase Inhibitors ◽  
Right Heart Catheterization ◽  
Myelogenous Leukemia ◽  
Heart Catheterization ◽  
Early Therapy ◽  
Pulmonary Vasodilators ◽  
Small Series

Dasatinib and other tyrosine kinase inhibitors are commonly utilized in the management of chronic myelogenous leukemia. Pulmonary hypertension is an important adverse event associated with dasatinib. Mechanisms for pulmonary hypertension include pulmonary endothelial injury, apoptosis, and increased susceptibility to other triggers for pulmonary hypertension. The diagnosis is suspected based on symptoms, suggested by echocardiographic findings, and confirmed with right heart catheterization. Management includes discontinuation of dasatinib and initiation of pulmonary vasodilators. Persistent pulmonary hypertension is present in up to one third of patients after cessation of dasatinib. Other tyrosine kinase inhibitors, including bosutinib, lapatinib, and ponatinib have also been implicated in pulmonary hypertension in small series, although evidence for causation is less robust. A high index of suspicion, continued vigilance for pulmonary hypertension with long-term use, and early therapy are important in optimizing outcomes in this population.

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