Browsing by Author "Montalvan-Sanchez, Eleazar"

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    Health literacy and cumulative social disadvantage are associated with survival and transplant in patients with hepatocellular carcinoma: a prospective study
    (BMJ, 2024-10-02) Nephew, Lauren D.; Rawl, Susan M.; Carter, Allie; Garcia, Nicole; Monahan, Patrick O.; Holden, John; Ghabril, Marwan; Montalvan-Sanchez, Eleazar; Patidar, Kavish; Desai, Archita P.; Orman, Eric; Chalasani, Naga; Medicine, School of Medicine
    Objective: To investigate how individual social determinants of health (SDOH) and cumulative social disadvantage (CSD) affect survival and receipt of liver transplant (LT) in patients with hepatocellular carcinoma (HCC). Methods: We enrolled 139 adult patients from two Indianapolis hospital systems between June 2019 and April 2022. Structured questionnaires collected SDOH and social risk factor data. We compared SDOH and CSD by race, gender and disease aetiology, assigning one point per adverse SDOH. Multivariable competing risk survival analysis assessed associations between SDOH, CSD, survival and LT receipt. Results: Black patients experienced higher CSD than white patients in the cohort (5.4±2.5 vs 3.2±2.1, p<0.001). Black patients were significantly more likely to have household incomes
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    High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America
    (Ainosco Press, 2023) Montalvan-Sanchez, Eleazar; Chambergo-Michilot, Diego; Rodriguez-Murillo, Aida A.; Brooks, Alexandra E.; Palacios-Argenal, Dairy; Rivera-Pineda, Shery; Ordonez-Montes, Jose; Estevez-Ramirez, Rosa; Riva-Moscoso, Adrian; Norwood, Dalton A.; Calderon-Rodriguez, Alex; Pineda-SanMartin, Elizabeth; Giron, Roberto; Rivera-Corrales, Luis; Carcamo-Murillo, Balduino; Garner, Orlando; Medicine, School of Medicine
    To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.
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    Prevalence of small intestinal bacterial overgrowth in patients with gastroparesis: a systematic review and meta-analysis
    (Research Institute for Gastroenterology and Liver Diseases, 2023) Beas, Renato; Riva-Moscoso, Adrian; Montalvan-Sanchez, Eleazar; Príncipe-Meneses, Fortunato S.; Aljaras, Rawan; Ramirez, Mirian; Izquierdo-Veraza, Diego; Calderon, Gerardo; Medicine, School of Medicine
    Aim: We performed a systematic review and meta-analysis to identify the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gastroparesis. Background: Several studies have suggested an association between SIBO and gastroparesis, which is characterized by delayed gastric emptying in the absence of mechanical obstruction. Methods: A comprehensive search was performed using MEDLINE, EMBASE, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) through January, 2022 for randomized controlled trials and observational studies reporting the prevalence of SIBO in gastroparesis. Pooled prevalence was estimated using a random effects model. Heterogeneity was assessed by using the inconsistency index (I2). Results: Among the 976 articles identified, 43 studies were selected for full text review. Six studies, with 385 patients, were deemed eligible for inclusion, with a perfect agreement between investigators (kappa=1.0). Overall, 379 patients were diagnosed with gastroparesis by gastric emptying scintigraphy and six were diagnosed with a wireless motility capsule. The pooled prevalence of SIBO was 41% (95% confidence interval 0.23-0.58). SIBO was diagnosed using jejunal aspirate cultures (N=15, 8.4%), lactulose breath test (N=80, 44.7%), glucose breath test (N=30, 16.8%), D-xylose breath test (N=52, 29.1%), and hydrogen breath test (N=2, 1.1%). Heterogeneity was significant and noted to be high at 91%. Only one study reported SIBO diagnosis in controls, therefore no pooled odds ratio was calculated. Conclusion: SIBO was present in almost half of the patients with gastroparesis. Future studies should examine and identify the association between SIBO and gastroparesis.