Browsing by Author "Kumar, Vinod"

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    A Case of Autoimmune Hemolytic Anemia after the First Dose of COVID-19 mRNA-1273 Vaccine with Undetected Pernicious Anemia
    (Hindawi, 2022-01-29) Jaydev, Fnu; Kumar, Vinod; Khatri, Jaikumar; Shahani, Shobha; Beganovic, Sead; Medicine, School of Medicine
    By this time, multiple vaccines have been approved to limit the spread of SARS-CoV-2 worldwide. These include new-generation vaccines that contain mRNA of the target organism. Some common side effects were identified and reported during phase 3 clinical trials of vaccination, but more rare adverse events were reported in the literature. One such concern is autoimmune conditions that SARS-CoV-2 viral antigens could have possibly incited. We are presenting here a case of a young female with no known autoimmune diseases, diagnosed with autoimmune hemolytic anemia about a week after receiving her first dose of the COVID-19 mRNA vaccine. We discuss the possible culprit for precipitation of autoimmune hemolytic anemia after the SARS-CoV-2 mRNA vaccine, which encodes virus spike protein. This case highlights the importance of being vigilant for identifying rare adverse events that could appear during mass vaccination.
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    Discharges against medical advice: time to take another look. A retrospective review of discharges against medical advice focused on prevention
    (Taylor & Francis, 2023) Jaydev, Fnu; Gavin, Warren; Russ, Jason; Holmes, Emily; Kumar, Vinod; Sadowski, Joshua; Kara, Areeba; Medicine, School of Medicine
    Background Discharges against medical advice (DAMA) increase the risk of death. Methods We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021. Results DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed. Conclusions Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.
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    Effect of the COVID-19 pandemic on colorectal cancer screening in two university-affiliated health care systems
    (Public Library of Science, 2025-01-06) Kumar, Vinod; Golzarri-Arroyo, Lilian; Roth, Sarah; Imperiale, Thomas F.; Medicine, School of Medicine
    Objectives: In two large university affiliated healthcare systems, we examined trends in colorectal cancer (CRC) screening both prior to and during the COVID-19 pandemic to compare the trends in non-invasive screening tests and colonoscopy. Materials and methods: In this retrospective time-trend analysis, we obtained the numbers of colonoscopies and non-invasive tests performed monthly during the pandemic and the year prior to it. We obtained colonoscopy data from five endoscopy units with the indication determined by dual independent review. Monthly numbers of completed fecal immunochemical (FIT) and FIT-DNA tests were obtained from the electronic medical records of both health systems. Trends in testing, numbers, and stage of incident CRCs diagnosed during the 30-month interval were examined using Poisson regression and logistic regression, respectively. Results: From January 2019 to June 2021, we identified 16,939 FIT tests, 2,942 FIT-DNA tests, and 38,332 colonoscopies from the two health systems, and 368 colorectal cancers (105 early stage, 263 advanced stage) from the private hospital system. Overall colonoscopy volume declined by 18.7% (from 16,483 to 13,393) in 2020 compared to 2019 in both health systems, returning to baseline in 2021. Non-invasive tests declined by 21.9% in 2020, but increased in 2021 due to greater use of FIT/DNA. Compared to 2019, incident CRCs declined in 2020 but rebounded in 2021, with no difference in early versus late-stage cancers. Conclusions: These trends in CRC screening tests may be useful for modeling the effects of the pandemic on the longer-term outcomes of CRC incidence and mortality.
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    Impact of the COVID-19 pandemic on adherence to diagnostic colonoscopy after a positive non-invasive screening test for colorectal cancer in two Indiana healthcare systems
    (Elsevier, 2024-11-26) Richter, Benjamin; Roth, Sarah M.; Golzarri-Arroyo, Lilian; Kumar, Vinod; Tuason, Rick; Imperiale, Thomas F.; Medicine, School of Medicine
    Objective: To describe trends in the use of non-invasive tests (NIST) and the interval between a positive NIST and diagnostic colonoscopy. Methods: Using a retrospective time-trend design, we examined medical records of patients within two large Indiana integrated healthcare systems who had a positive NIST between January 2019 and June 2021 and quantified the proportion of patients who had not completed colonoscopy within 60, 90, and 180 days to determine the interval between NIST result and diagnostic colonoscopy in days. Results: Of 1379 patients with positive NISTs, 930 (68 %) underwent diagnostic colonoscopy during the 30-month study timeframe. Median time to colonoscopy completion was significantly longer in 2020 compared to 2019 (50 vs. 37 days, p < 0.01) and 2021 (46 days, p = 0.06). The proportion of patients completing colonoscopy within 90 days of a positive FIT in 2019, 2020, and 2021 were 79 %, 83 %, and 72 %, respectively (p = 0.63), and were 86 %, 78 %, and 84 %, respectively, after positive FIT/DNA (p = 0.07). Median time to diagnostic colonoscopy completion was significantly longer in 2020, likely due to the COVID-19 pandemic. Conclusions: Studies of outcomes in those who declined or delayed colonoscopy in 2020 are needed to estimate the potential subsequent colorectal cancer disease burden.
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    Safety and efficacy of hot avulsion as an adjunct to endoscopic mucosal resection (with videos)
    (Elsevier, 2019) Kumar, Vinod; Broadley, Heather; Rex, Douglas K.; Medicine, School of Medicine
    Background Excision of all visible neoplastic tissue is the goal of endoscopic mucosal resection (EMR) of colorectal laterally spreading tumors (LSTs). Flat and fibrotic tissue can resist snaring. Ablation of visible polyps is associated with high recurrence rates. Avulsion is a technique to continue resection when snaring fails. Methods We retrospectively analyzed colonic EMRs of 564 consecutive referred polyps between 2015 and 2017. Hot avulsion was used when snaring was unsuccessful. Polyps treated with and without avulsion were compared. Results Hot avulsion was used in 20.9% (n=112) of all resected lesions. The recurrence rates on follow up colonoscopy were 17.52% in avulsion group versus 16.02% in the non-avulsion group (p= 0.76). Hot avulsion was associated with a trend toward higher rates of delayed hemorrhage (5.35% vs 2.58%; p=0.15) and post-coagulation syndrome (1.8% vs 0.47%; p=0.15), but polyps treated with any avulsion were larger than those in which no avulsion was used (p=<0.001). There were an insufficient number of adverse events to perform a multivariable analysis testing the effects of avulsion, size, and location on the risk of overall adverse events. Conclusion Unlike previous reports of using argon plasma coagulation to treat visible polyp during EMR, hot avulsion of visible/fibrotic neoplasia was associated with similar EMR efficacy compared with cases that did not require hot avulsion. The safety profile of hot avulsion appears acceptable.
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    Serum amylase and lipase levels in healthy volunteers assessed by multiple commercial analyzers: Variability with established reference values
    (Journal of Gastroenterology Research and Practice, 2021) Kumar, Vinod; Gromski, Mark A.; Kwon, Chang-Il; Zimmerman, Michelle K.; McNulty, Gail M.; Korc, Paul; Choi, Eun Kwang; Easler, Jeffrey J.; Watkins, James; Fogel, Evan L.; Sherman, Stuart; Lehman, Glen A.; Medicine, School of Medicine
    Background/Aims: Although serum pancreatic enzyme measurements for amylase and lipase are the most widely used biochemical tests for the diagnosis of pancreatitis, limitations for their interpretation of pancreatic disease do exist. An international reference method or an evidence-based cut-off value of serum pancreatic enzyme levels has not been established to facilitate standardization. Therefore, different analytic methods for serum pancreatic enzyme levels have verified their own Reference Ranges (RR) as normal values. The aim of this study is to evaluate the frequency of serum pancreatic enzyme values outside of the RR in healthy volunteers, using 5 different pancreatic enzyme analyzers to determine variability of values between analyzers. Methods: Healthy volunteers were screened to exclude a history of pancreatic disease or pancreatic surgery, severe gastrointestinal disease, excess alcohol intake, tobacco use, amongst other conditions. Volunteers were prospectively enrolled and blood samples from a single draw were analyzed for serum pancreatic enzyme levels on five different automated chemistry analyzer platforms. Whether or not the results were within each analyzer's institutional RR was evaluated. Results: Among screened healthy volunteers, 180 participants were enrolled who met the inclusion criteria. Serum amylase results were outside the RR in 8 (4.4%), 11 (7.2%), 19 (10.5%), 6 (3.3%) and 7 (3.9%) subjects, respectively, based on the 5 separate analyzers. Serum lipase results were not within the RR in 3 (1.7%), 20 (13.2%), 13 (7.2%), 1 (0.6%) and 2 (1.1%) subjects, respectively. Among all 22 (12.2%) subjects that were outliers of the serum amylase level, 10 (5.6%) of those subjects were outside of the RR for two or more analyzers. In contrast, among all 32 (17.8%) subjects who were outliers of serum lipase level, only four subjects (2.2%) were outside of the RR for two or more analyzers. Conclusion: Although there was slight variability in test results for serum amylase and lipase between different commonly available testing systems in healthy subjects, no values exceeded three times the upper limit of normal. There was a small group of healthy volunteers that fell outside of the reference range on two or more analyzers. If there is clinical ambiguity due to an abnormal serum pancreatic enzyme, further diagnostic testing can be pursued. Standardization amongst pancreas enzyme analyzers with a unified reference methodology and standard would be beneficial.
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    An Unusual Case of Acute Carpal Tunnel Syndrome
    (Cureus, 2021-12-31) Singh, Simranjit; Sanna, Fnu; Singh, Natasha; Adhikari, Ramesh; Kumar, Vinod; Medicine, School of Medicine
    Acute atraumatic carpal tunnel syndrome (CTS) that results from a hematoma as a complication of oral anticoagulation use is a highly uncommon presentation. CTS is a common type of peripheral compression neuropathy, with CTS's acute presentation being less common than chronic. The acute type is commonly caused either by recent trauma, including fractures of the distal radius and carpal dislocations, atraumatic etiologies like infections, or inflammatory conditions that increase the pressure in the carpal tunnel. Timely diagnosis of acute CTS is essential, as often surgical decompression is required if symptoms do not improve within hours. A 79-year-old female presented to the ED with a past medical history significant for stroke, paroxysmal atrial fibrillation on rivaroxaban, and hypertension. She complained of a one-day history of left wrist pain, swelling, and restricted range of motion, associated with numbness in the median nerve distribution and weakening of the handgrip. The patient denied any trauma or unusual physical activity. CCT imaging of the left upper extremity showed soft tissue expansion around the flexor pollicis longus proximal to and just distal to the carpal tunnel consistent with dissecting hematoma within the flexor compartment. The orthopedics hand team evaluated the patient. Her rivaroxaban was held, and she was monitored for 24 hours in the hospital. The next day, she almost had a complete resolution of her symptoms. She was discharged home with a close follow-up. There are various atraumatic causes of acute CTS. Spontaneous atraumatic hematoma occurring in the forearm's flexor compartment and resulting in acute CTS is extremely uncommon. In contrast to chronic CTS, acute CTS requires urgent carpal tunnel release to prevent irreversible median nerve damage. Anticoagulants in such cases increase the bleeding risk. This case highlights the importance of considering CTS into the differential diagnosis of someone on an anticoagulant and presenting with acute wrist swelling and pain. Despite the absence of any direct trauma, timely diagnosis of this condition is prudent and greatly affects the outcomes.