Papers by Chukwuemeka Umeh
American Journal of Medical Case Reports
American Journal of Medical Case Reports
Cureus, 2022
Mucormycosis is a life-threatening invasive fungal infection usually seen in immunocompromised pa... more Mucormycosis is a life-threatening invasive fungal infection usually seen in immunocompromised patients and patients with poorly controlled diabetes mellitus with or without diabetic ketoacidosis. We present a rhino-orbito-cerebral mucormycosis (ROCM) case in a coronavirus disease 2019 (COVID-19) patient complicated by the optic nerve and optic tract ischemia with ischemic neuropathy. Both CT and MRI played an essential role in diagnosing ROCM and the accompanying complications in our patient. CT showed sinonasal sinusitis and MRI showed the sinusitis and its progression to ROCM. MRI also showed necrosis involving the bilateral orbits, basal ganglia, thalamus, internal capsule, hypothalamus, optic chiasm, optic nerves, olfactory bulbs, and skull base. ROCM associated with optic nerve ischemia is a rare but life-threatening complication of COVID-19, especially in patients with underlying diabetes and/or those treated with corticosteroids. Physicians should be aware of this complication as early diagnosis may improve the chances of survival in such patients.
Cureus, 2022
Introduction Bradycardia has been reported in the setting of SARS-CoV2 (COVID-19) and appears to ... more Introduction Bradycardia has been reported in the setting of SARS-CoV2 (COVID-19) and appears to be an important cardiac manifestation with an association of mortality. However, the etiology of bradycardia in COVID-19 remains unclear. Therefore, this study aims to retrospectively investigate the potential causes of bradycardia in COVID-19 patients. Method The multicenter retrospective analysis consisted of 1,116 COVID-19 positive patients from March 2020 to March 2021. Bradycardia and severe bradycardia were defined as a sustained heart rate of <60 BPM and <50 BPM, respectively, on two separate occasions, a minimum of four hours apart during the hospitalization. End-of-life bradycardia was excluded from the study. Data were retrieved using a structured query language (SQL) program through the EMR, and data were analyzed using IBM SPSS 27.0 (IBM Corp., Armonk, NY). Logistic regression was used to study the bradycardic event and its association with remdesivir, betablockers, or steroids use during the patient's hospital stay. Result In the multivariate analysis, bradycardia was significantly associated with length of hospital stay (p<0.001), mortality (p=0.022), ventilator use (p=0.001), and steroid use (p=0.001). However, there was no significant association between bradycardia and remdesivir use (p=0.066) or beta-blocker use (p=0.789). Conclusion Our study showed that steroid use was protective against developing bradycardia in COVID-19 patients. Furthermore, remdesivir and the use of beta-blockers were not associated with bradycardia in COVID-19 patients. However, bradycardia was associated with both increased mortality and length of stay in the hospital. Therefore, future studies should focus on the mechanism of bradycardia in COVID-19 patients and the effect of bradycardia on patient outcomes.
The impact of declining vaccination coverage on measles control: a case study of Abia
Cureus, 2022
Возможности флеш-мониторирования гликемии как метода непрерывного измерения уровня глюкозы у паци... more Возможности флеш-мониторирования гликемии как метода непрерывного измерения уровня глюкозы у пациентов с сахарным диабетом в клинической практике атабаева х.в., демидова т.ю., титова в.в. Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации, 117997, г. Москва, Российская Федерация Контроль гликемического профиля -важнейшая составляющая терапии сахарного диабета. И в настоящее время активно внедряются инновационные методики непрерывного мониторирования глюкозы (НМГ). В статье описаны результаты опыта применения системы флеш-мониторирования гликемии (ФМГ) для контроля глюкозы крови у пациентов с сахарным диабетом как 1-го, так и 2-го типа, изучения роли ФМГ в оценке основных параметров гликемического профиля в сравнении с самоконтролем глюкозы крови по глюкометру, а также отражены основные преимущества НМГ как инновационного метода контроля гликемии в сравнении с традиционном контролем глюкозы крови по глюкометру. Ключевые слова: FreeStyle Libre, сахарный диабет, гликемический контроль, флеш-мониторирование гликемии, непрерывный мониторинг глюкозы, глюкометр, вариабельность глюкозы Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
American Journal of Medical Case Reports, 2021
Thirty-Three states in the US have passed laws to legalize marijuana usage, increasing its preval... more Thirty-Three states in the US have passed laws to legalize marijuana usage, increasing its prevalence by 50% within the last year. Though society generally regards cannabis as safe, the exponential increase in users can evince dangerous side effects in patients presenting to physicians, such as the case presented below. A 37-year-old female presented to the ED with chest pain and an initial troponin of 24 that peaked at 29. The coronary arteries were found to be angiographically normal. She was discharged without any definitive diagnosis. Now 38, she again presented with complaints of crushing, substernal chest pain radiating down her left arm, unrelieved by nitro. Since the onset of pain, she progressively developed shortness of breath, nausea, diaphoresis, and anxiety, stating that she felt like she “was going to die.” Her presentation and impending sense of doom were ominous harbingers for a myocardial infarction; concerns that were validated with an initial troponin of 11.4. EKG...
American Journal of Medical Case Reports, 2020
Iliopsoas hematoma is a rare complication in patients on warfarin and usually presents as lower a... more Iliopsoas hematoma is a rare complication in patients on warfarin and usually presents as lower abdominal, groin or thigh pain. The author presents a case of spontaneous iliopsoas hematoma in an 89-year-old female that was initially suspected to be a hip fracture. A review of 12 case reports on iliopsoas hematoma in patients on warfarin shows that the mean age of reported cases was 72 years. Patients present with lower abdominal, groin, flank or thigh pain (100%), lower extremity weakness and/or difficulty in walking (50%) and loss of or abnormal sensation in the lower extremity (17%). Forty two percent of the hematoma cases were in patients with therapeutic or sub-therapeutic international normalized ratio (INR). Iliopsoas hematoma should be considered in elderly patients on warfarin who present with lower abdominal or groin pain, even in patients with therapeutic or sub-therapeutic INR.
INTRODUCTION A wide range of study designs have been utilized in evaluations of home telemonitori... more INTRODUCTION A wide range of study designs have been utilized in evaluations of home telemonitoring and these studies have produced conflicting outcomes over the years. While some of the research has shown that telemonitoring is beneficial in reducing all-cause mortality, hospital admission, length of stay in hospital and emergency room visits, other studies have not shown such benefits. This study, therefore, aims to examine several home telemonitoring study designs and the influence of study design on study outcomes. METHOD Articles were obtained by searching PubMed database with the term heart failure combined with the following terms: telemonitoring, telehealth, home monitoring, and remote monitoring. Searches were limited to randomized controlled trial conducted between year January 1, 2000 and February 6, 2021. The characteristics of the study designs and study outcomes were extracted and analyzed. RESULT Our review of 34 randomized controlled trials of heart failure telemonit...
Statement of the problem While non-governmental organizations (NGOs) play an important role in pr... more Statement of the problem While non-governmental organizations (NGOs) play an important role in providing services, care and support to vulnerable populations, often small and medium sized NGOs in developing countries lack the capacity (i.e., systems and structures) to effectively carry out their functions. Many capacity-building interventions (e.g., staff training and technical assistance) are resource intensive, and not affordable to small and medium NGOs. The objective of this study is to assess the effectiveness of online capacity building resources, a non-conventional and less resource intensive capacity building method, in helping small and medium sized Nigerian NGOs build capacity. Method We conducted a mixed-methods evaluation using a two-arm cluster randomized controlled trial with 72 NGOs across five states in Nigeria. All NGOs received a baseline organizational capacity assessment, using the Measuring Organizational Development and Effectiveness (MODE) tool. Organizational capacity was scored on a scale between 0 ix and 100, where the higher value indicates higher capacity. The treatment group received written recommendations and online resources on capacity building; the comparison group received only written recommendations. The outcome of interest was the change in the organizational capacity of the NGOs after six months measured using the MODE tool. Also, we conducted in-depth interviews of 25 NGO directors. Result At baseline, young (age ≤ 10 years), and less resourced (annual budget <$25,000) NGOs had weaker organizational capacity. At endline, there was significant improvement in organizational capacity score for NGOs in both the experiment group (15.4 percentage points increase (p<0.0001)) and comparison group (19.1 percentage points increase (p<0.0001)). However, multilevel regression analysis showed no statistically significant difference in organizational capacity improvement between the two groups (p=0.09). Improvement in organizational capacity was inversely associated with baseline organizational capacity (p<0.0001). Qualitative data showed that peer networking, engagement of stakeholders in organizations' capacity building decision making, and internal task sharing bolstered organizations' ability to improve capacity. Conclusion Capacity assessment and provision of written capacity building recommendations to NGOs
American Journal of Medical Case Reports, 2020
Hypothyroidism is characterized by a broad clinical spectrum ranging from asymptomatic or subclin... more Hypothyroidism is characterized by a broad clinical spectrum ranging from asymptomatic or subclinical hypothyroidism to overt myxedema and multisystem failure. Pericardial effusion occurs frequently in myxedema but is rare in other stages of hypothyroidism because of the timeliness in which hypothyroidism is nowadays detected and treated. The author reports a case of progressively worsening pericardial effusion from refractory hypothyroidism secondary to autoimmune atrophic gastritis. The approach to managing pericardial effusion complicating refractory hypothyroidism is discussed.
Cureus, 2021
We present a case of refractory hypernatremia in a patient with elevated adrenocorticotropic horm... more We present a case of refractory hypernatremia in a patient with elevated adrenocorticotropic hormone (ACTH) and hypercortisolism. Cortisol's effect in tissues results in various outcomes, from maintaining blood pressure to increasing serum glucose levels. In addition, cortisol, cortisone, and aldosterone activate mineralocorticoid receptors with the same affinity; therefore, the activation of mineralocorticoid receptors by elevated cortisol levels leads to increased sodium reabsorption, increased potassium secretion, and metabolic alkalosis. Hypernatremia in our patient was initially refractory to fluid replacement but was eventually corrected with intravenous fluid and desmopressin. Overall, we suggest that hypercortisolism should be considered a differential diagnosis in hypernatremia refractory to fluids replacement.
Cureus, 2021
Immune thrombocytopenia, also called idiopathic thrombocytopenic purpura, is a common cause of th... more Immune thrombocytopenia, also called idiopathic thrombocytopenic purpura, is a common cause of thrombocytopenia after viral infections. Even in the second year of the coronavirus disease 2019 (COVID-19) pandemic, our body of knowledge regarding the diverse symptoms and complications of the virus continues to grow and evolve. We present a case of a 48-year-old African American male who came into the emergency department with severe left foot pain. A platelet count of 7x10 3 /mL was incidentally found on complete blood count (CBC) during the patient's initial workup. The patient had previously been hospitalized for COVID-19 five weeks prior. Further workup did not support any etiology of his thrombocytopenia. Therefore, we gave a presumed diagnosis of idiopathic thrombocytopenic purpura secondary to COVID-19. The patient was treated with corticosteroid resulting in improvement in his platelet count.
American Journal of Medical Case Reports, 2021
Stroke is a leading cause of disability and death, and the use of tissue plasminogen activator (t... more Stroke is a leading cause of disability and death, and the use of tissue plasminogen activator (tPA) has been shown to improve outcomes in ischemic stroke. However, despite the favorable outcome from the use of tPA, it has been associated with complications, including intracranial hemorrhage, major systemic hemorrhage, and angioedema. Though there are few reports of intracerebral hemorrhage complicating tPA use, pontine hemorrhage, a subset of intracerebral hemorrhage, is rarely reported. We report a case of pontine hemorrhage in an ischemic stroke patient after tPA and discussed the management of this rare complication of tPA.
Cureus, 2021
Acetone is a chemical found naturally in the environment, and acetone poisoning can occur through... more Acetone is a chemical found naturally in the environment, and acetone poisoning can occur through contact with household products that contain acetone, including nail polish removers, paint removers, some polishes, as well as certain detergents and cleaners. Acetone toxicity affects almost all body systems, including the nervous, respiratory, cardiovascular, and endocrine systems. The incidence of life-threatening medical problems from acetone exposure is very rare. However, in this report, we present a case of acetone toxicity resulting in death. Our patient presented with cardiopulmonary arrest, hypotension, tachycardia, hyperglycemia, acute kidney injury (AKI), thrombocytopenia, elevated liver enzymes, and extensive esophageal and gastric erosion with associated upper gastrointestinal bleeding.
Cureus, 2021
The majority of patients infected with coronavirus disease 2019 (COVID-19) recover from the illne... more The majority of patients infected with coronavirus disease 2019 (COVID-19) recover from the illness after suffering mild to moderate symptoms, while approximately 20% progress to severe or critical disease, which may result in death. Understanding the predictors of severe disease and mortality in COVID-19 patients will help to risk stratify patients and improve clinical decision making. US data to inform this understanding are, however, scarce. We studied predictors of COVID-19 mortality in a cohort of 1,116 hospitalized patients in Southern California in the United States. Methods We conducted a retrospective cohort study of COVID-19 patients admitted at two hospitals in Southern California United States between March 2020 and March 2021. Bivariate and multivariate analyses of the relationship between mortality and other variables such as demographics, comorbidities, and laboratory values were performed, with a p-value of 0.05 considered as significant. Results The analysis involved 1,116 COVID-19 patients, of which 51.5% were males and 48.5% were females. Of the 1,116 patients, 81.6% were whites, 7.2% were blacks, and 11.2% were other races. After adjusting for covariables, age (p<0.001), admission to intensive care unit (p< 0.001), use of remdesivir (p=0.018), C-reactive protein (CRP) levels (p<0.001), and lactate dehydrogenase (LDH) levels (p=0.039) were independently associated with mortality in our study. Gender, race, body mass index, presence of co-morbidities such as diabetes and hypertension, and use of steroid, statin, calcium channel blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were not associated with mortality in the multivariate analysis. Conclusion In the cohort we studied, admission to intensive care unit was associated with decreased mortality while older age, use of remdesivir, and high levels of CRP and LDH were associated with increased mortality in COVID-19 patients.
American Journal of Medical Case Reports, 2020
Background: Neurogenic pulmonary edema (NPE) is a rare pulmonary edema that develops rapidly afte... more Background: Neurogenic pulmonary edema (NPE) is a rare pulmonary edema that develops rapidly after an acute central nervous system injury. The mechanism by which neurological insult leads to pulmonary edema is not well understood. The clinical presentation of NPE varies widely and ranges from asymptomatic cases to fulminant cases. Clinical signs in pure NPE are usually those of acute pulmonary edema, without signs of left ventricular failure. Case Report: The author presents a case of NPE is a young female patient with a brief epileptic seizure in which NPE resolved within 48 hours. Patient had no respiratory symptoms but was initially placed on antibiotics because her chest x-ray showed bilateral lung patchy opacifications in a perihilar distribution suggestive of pulmonary edema and/or multifocal pneumonia. Antibiotics was discontinued when the pulmonary edema resolved. Conclusion: There is need for physicians to be aware of NPE to avoid unnecessary antibiotics in asymptomatic patients who present with bilateral pulmonary infiltrates following an epileptic seizure.
American Journal of Medical Case Reports, 2020
Background: Lung cancer can be present with lung abscess in up to a third of lung abscess cases. ... more Background: Lung cancer can be present with lung abscess in up to a third of lung abscess cases. However, lung cancer is often overlooked as an underlying condition while making a diagnosis of lung abscess. Case report: The authors present a case of a 69-year-old male that experienced a syncopal episode, accompanied by productive cough and shortness of breath. Lung abscess was diagnosed, and the patient was placed on antibiotics with no improvement in the cough after a week. Additional tests were performed, and latent squamous cell carcinoma was discovered. Conclusion: Since lung cancer can masquerade as lung abscess, physicians should have a high suspicion for lung cancer whenever there is a radiographic diagnosis of lung abscess, especially in patients with risk factors for lung cancer.
Bhutan Health Journal, 2016
Introduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmissio... more Introduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmission. This study explored the multiple sexual partnering and its predictors among people who visited public social venues (bars, restaurants, hotels, lodges, cafes, karaokes and discos) in Bhutan’s two largest townships of Thimphu and Phuntsholing. Methods: We interviewed 755 sexually active venue patrons from 102 randomly selected venues (56 in Thimphu, 46 in Phuntsholing) from a list of all venues identified as having sex workers or patrons seeking sexual partners. Both bivariate and multivariate analyses were carried out to characterize the predictors of multiple sexual partnering among 755 respondents who had previously had sex. Results: Of the 755 patrons, 46.09% had one sexual partner while the remaining 54.91% had multiple sex partners (greater than or equal to 2 sexual partners) in the 12 months preceding the study. Overall, 6.23% of respondents had received payment from someone at ...
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Papers by Chukwuemeka Umeh