Browsing by Author "Bhatt, Harshil"

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    A 64-Year-Old Man with Low Back Pain Due to Clostridium perfringens Lumbar Discitis
    (International Scientific Information, 2021-01-22) Bhatt, Harshil; Singh, Sandeep; Medicine, School of Medicine
    Lumbar discitis caused by Clostridium perfringens is extremely rare. There have only been 7 published cases of confirmed discitis caused by Clostridium perfringens. We write this report to underscore this unusual relationship by discussing an additional case and providing a review of the previously published cases so clinicians can adequately evaluate and treat patients presenting with discitis. CASE REPORT A 64-year-old morbidly obese man presented with an acute onset of worsening back pain and generalized weakness after incurring physical trauma related to falling. Additionally, he also developed fever and chills before the presentation. Based on the clinical presentation and elevated serum levels of inflammatory markers, magnetic resonance imaging was ordered, which showed L5-S1 discitis with extension of infection into the epidural space. Fluoroscopy-guided aspiration of the L5-S1 epidural space facilitated the detection of Clostridium perfringens as the involved pathogen. Based on the antibiotic susceptibility report, the patient was treated with intravenous ampicillin for 8 weeks, after which his symptoms resolved. CONCLUSIONS Diagnosis of discitis can be very challenging due to its ambiguous clinical presentation, especially in the elderly population due to the presence of underlying degenerative changes. Even though Clostridium perfringens remains a rare cause of lumbar discitis, it should be considered as a pathogen capable of causing infection of the vertebrae and intervertebral discs, thus allowing clinicians to make necessary diagnostic evaluations to provide appropriate targeted treatment to patients presenting with discitis.
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    A Case of Systemic Toxicity Related to Intravesical Bacillus Calmette-Guerin for the Treatment of Bladder Cancer
    (Cureus, 2021-05-29) Gupta, Sachin; Singh, Balraj; Bhatt, Harshil; Singh, Sandeep; Gupta, Sorab; Medicine, School of Medicine
    Intravesical administration of Bacillus Calmette-Guerin (BCG) has been utilized for the treatment of superficial bladder cancer for the past several decades. Though this treatment is well tolerated in general, both local and systematic side effects have been reported. We present a case of a patient who presented with systemic symptoms of fever with chills associated with leucopenia, thrombocytopenia, abnormal liver function tests (LFTs), and splenomegaly a few weeks after an episode of traumatic instillation of intravesical BCG. Though the mycobacterial cultures were negative, he was started on an anti-mycobacterial regimen empirically to which he responded and ultimately fully recovered.
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    Improving influenza vaccination rates during COVID-19 pandemic - the need of the hour
    (International Society of Global Health, 2021) Bhatt, Harshil; Medicine, School of Medicine
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    Leukocytosis and Spurious Hypoxemia
    (Cureus, 2021-06-26) Gupta, Sachin; Medikayala, Sushma; Singh, Balraj; Bhatt, Harshil; Singh, Sandeep; Medicine, School of Medicine
    Abnormally low pO2 and oxygen saturations on arterial blood gases (ABGs) test have been reported in the patients who have very high WBC and platelet counts; generally in the setting of hematological malignancies. This is presumably related to the consumption of oxygen by the active cellular elements in the arterial blood sample during the process of ABG analysis. This phenomenon which is also known as "spurious hypoxemia" or "oxygen steal" or "leukocyte/platelet larceny" is suspected when there is no other obvious explanation for hypoxemia on ABG, especially in the setting of normal oxygen saturations by the pulse oximetry. It is important for medical professionals to be aware of this condition so that appropriate workup and triage can be performed on such patients, which may otherwise lead to unnecessary hospitalization and escalation of care.
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    Should COVID-19 Mother Breastfeed her Newborn Child? A Literature Review on the Safety of Breastfeeding for Pregnant Women with COVID-19
    (Springer, 2021) Bhatt, Harshil; Medicine, School of Medicine
    Purpose of Review Breastfeeding is beneficial to both the newborn and the mother. During the COVID-19 pandemic, concerns have been raised on whether the SARS-CoV-2 virus could be transmitted from COVID-19 positive mother to the newborn through breastmilk. The purpose of this review is to examine the available evidence on the risks of transmission of infection from COVID-19 mothers to their newborns through breastfeeding. Recent Findings Data is very limited in this regard, with only a few smaller case series, and case reports have been published so far. In most of the studies, breastmilk samples from COVID-19 mothers tested negative for the virus. In the case reports where the virus was detected in breastmilk and the infants were diagnosed with COVID-19, it remained unclear whether the disease was transmitted through breastmilk or direct contact or through delivery. Another hypothesis is that the viral antibodies could pass to the newborn passively through breastmilk of COVID-19 positive mothers and give immunity to the child, but data is minimal. Summary Based on the currently available limited evidence and recognizing the benefits of breastfeeding, it may be concluded that if the health of the mother and her newborn allows, direct breastfeeding or extracted breastmilk should be encouraged by the healthcare providers after a careful discussion of the risks of vertical transmission to the mother and her family. Preventive measures should be taken by COVID-19 mothers to prevent droplet transmission of infection to the infants while breastfeeding.
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    Usage of Direct Acting Oral Anticoagulants in Cirrhotic and Non-Cirrhotic Portal Vein Thrombosis: A Systematic Review
    (Cureus, 2021-08-05) Gupta, Sachin; Hidalgo, Jessica; Singh, Balraj; Iyer, Aditya; Yang, Yang; Short, Alexandra; Singh, Sandeep; Bhatt, Harshil; Gupta, Sorab; Medicine, School of Medicine
    Thrombosis of the portal vein (PVT) is generally seen in the setting of liver cirrhosis and to a lesser extent in the absence of cirrhosis. There is no clear guidance in relation to approaching treatment with anticoagulation in this condition. The professional societies and guidelines recommend treatment with traditional anticoagulation like low-molecular-weight heparin and vitamin-K antagonists in patients presenting with acute portal vein thrombosis. There is no clarity in relation to treatment in the setting of chronic PVT and in patients with cirrhosis. Also, the role of direct-acting oral anticoagulants (DOACs) that are becoming a preferred choice for anticoagulation for various other indications is not clear in the case of PVT. There are a very few studies in the medical literature that have investigated the role of DOACs in patients with PVT in different settings. Thus, we performed a systematic review of the literature to study the use of DOACs in PVT in patients with and without cirrhosis. The results of the available studies show that DOACS appears to be a promising choice for the treatment of patients with PVT. The availability of more data in the future along with better availability of the approved reversal agents for various DOACs is expected to make DOACS a preferred choice for the clinicians to treat patients with PVT.