Background: According to past studies, recovery and survival following severe vascular events suc... more Background: According to past studies, recovery and survival following severe vascular events such as acute myocardial infarction and stroke are negatively impacted by vitamin D deficiency. However, the national estimate on disability-related burden is unclear. We intend to evaluate the prevalence and outcomes of vitamin D deficiency (VDD) among patients with cardiovascular disease (CVD) and cerebrovascular disorder (CeVD). Methods: We performed a cross-sectional study on the Nationwide Inpatient Sample data (2016–2017) of adult (≥18 years) hospitalizations. We identified patients with a secondary diagnosis of VDD and a primary diagnosis of CVD and CeVD using the 9th revision of the International Classification of Diseases, clinical modification code (ICD-10-CM) codes. A univariate and mixed-effect multivariable survey logistic regression analysis was performed to evaluate the prevalence, disability, and discharge disposition of patients with CVD and CeVD in the presence of VDD. Res...
Introduction: Previous studies had provided evidence that vitamin D deficiency is a strong negati... more Introduction: Previous studies had provided evidence that vitamin D deficiency is a strong negative predictor for survival and recovery after severe vascular events but national estimate on disability related burden is not clear. Hypothesis: We evaluate the prevalence of vitamin D deficiency (VDD) amongst patients with cardiovascular disease (CVD) and cerebrovascular disorders (CeVD) and to find out whether or not CVD and CeVD in the presence of VDD increases the disability. Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample data (years 2016-2017) in adults (≥18 years) hospitalizations. We identified patients with secondary diagnosis of VDD and primary diagnosis of CVD (AFib, CHF, IHD, acute MI, and angina) and CeVD (AIS, TIA, ICeH and SAH) using ICD-10-CM codes. We performed a chi-square test and multivariable survey logistic regression to analyze disability of patients with CVD and CeVD in presence of VDD. Disability/loss of function was investigated...
Background Lambl's excrescence (LE) is a rare thin, mobile, filiform frond on the endocardial sur... more Background Lambl's excrescence (LE) is a rare thin, mobile, filiform frond on the endocardial surface of cardiac valves responsible for recurrent ischemic strokes due to embolic phenomena. Due to nonspecific symptoms, sometimes the diagnosis is challenging. It can be diagnosed by transesophageal echocardiogram (TEE) with increased sensitivity. Several case reports have been published with a strategy to manage LE but there is lack of consensus. We report a case of a 75-year-old patient with the LE arising from aortic valve resulting in recurrent ischemic strokes within a short period and its management. Case A 75-year-old male with multiple vascular risk factors presented with confusion, altered mental status of unknown onset and aphasia. He denied weakness, numbness, or other focal neurological deficits. National Institute of Health Stroke Scale was 5. IV tPA was not given due to the unknown onset of symptoms. The magnetic resonance imaging (MRI) revealed acute/subacute left thalamic lacunar infarct. TEE demonstrated a 7-mm linear fibrinous mass on the valve. The patient was on aspirin which was changed to clopidogrel. After 2 weeks, the patient readmitted with similar presentation. MRI showed subacute right parietal cortical infarct. The patient was advised to proceed with surgical resection of LE. Due to refusal for surgery, he was kept on 30 days cardiac monitor and had given anticoagulant therapy for secondary prevention of stroke. Conclusion Although wide range from single or dual antiplatelet therapy to full dose anticoagulation have been tried, surgical intervention should be considered in case of multiple ischemic strokes to mitigate the risk of embolism.
Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is one of the ra... more Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is one of the rare early childhood intractable epileptic encephalopathies associated with pleomorphic seizure activity, cognitive decline, motor, and behavioral abnormalities. The convulsive seizure is the most common type seen in DS. After the first episode of seizure-like activity, behavioral disorders and cognitive decline are progressive and long-lasting. The most common etiology identified in patients with DS is a de-novo genetic mutation alpha-1 subunit of voltage-gated calcium channel gene (SCN1A). DS is diagnosed clinically and if unclear, genetic testing is recommended. DS treatment options include anti-epileptic drugs and cannabinoids; ketogenic diet therapy and surgical options such as the deep brain and vagal nerve stimulation. Due to drug-refractory epilepsy in DS, many more therapies are being investigated to increase the longevity of patients.
In today's era, solid waste management is the thrust area. Out of this various waste material... more In today's era, solid waste management is the thrust area. Out of this various waste materials, plastic waste, tire waste and municipal solid waste are of great concern. Aim of our present work is helping to solve Solid waste management of this tire waste and to investigate the alternate coarse aggregate to reduce cost of structure and reduce environment pollution. Different combinations of crumb rubber with traditional coarse aggregate were evaluated based on compression strength and flexural strength tests were conducted according to Indian Standards. Tests were also carried out to determine workability of concrete. The study pointed out that the increased in percentage of Crumb Rubber in Concrete reduces the effective Compressive strength and Flexural strength but increases workability of concrete. Increases of Crumb rubber percentage in concrete it makes more economical if we consider it to point of environment protection.
Breath testing could provide a rational tool for radiation biodosimetry because radiation causes ... more Breath testing could provide a rational tool for radiation biodosimetry because radiation causes distinct stress-producing molecular damage, notably an increased production of reactive oxygen species. The resulting oxidative stress accelerates lipid peroxidation of polyunsaturated fatty acids, liberating alkanes and alkane metabolites that are excreted in the breath as volatile organic compounds (VOCs). Breath tests were performed before and after radiation therapy over five days in 31 subjects receiving daily fractionated doses: 180-400 cGy d(-1) standard radiotherapy (n = 26), or 700-1200 cGy d(-1) high-dose stereotactic body radiotherapy (n = 5). Breath VOCs were assayed using comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry. Multiple Monte Carlo simulations identified approximately 50 VOCs as greater-than-chance biomarkers of radiation on all five days of the study. A consistent subset of 15 VOCs was observed at all time points. A radiation respo...
Background: According to past studies, recovery and survival following severe vascular events suc... more Background: According to past studies, recovery and survival following severe vascular events such as acute myocardial infarction and stroke are negatively impacted by vitamin D deficiency. However, the national estimate on disability-related burden is unclear. We intend to evaluate the prevalence and outcomes of vitamin D deficiency (VDD) among patients with cardiovascular disease (CVD) and cerebrovascular disorder (CeVD). Methods: We performed a cross-sectional study on the Nationwide Inpatient Sample data (2016–2017) of adult (≥18 years) hospitalizations. We identified patients with a secondary diagnosis of VDD and a primary diagnosis of CVD and CeVD using the 9th revision of the International Classification of Diseases, clinical modification code (ICD-10-CM) codes. A univariate and mixed-effect multivariable survey logistic regression analysis was performed to evaluate the prevalence, disability, and discharge disposition of patients with CVD and CeVD in the presence of VDD. Res...
Introduction: Previous studies had provided evidence that vitamin D deficiency is a strong negati... more Introduction: Previous studies had provided evidence that vitamin D deficiency is a strong negative predictor for survival and recovery after severe vascular events but national estimate on disability related burden is not clear. Hypothesis: We evaluate the prevalence of vitamin D deficiency (VDD) amongst patients with cardiovascular disease (CVD) and cerebrovascular disorders (CeVD) and to find out whether or not CVD and CeVD in the presence of VDD increases the disability. Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample data (years 2016-2017) in adults (≥18 years) hospitalizations. We identified patients with secondary diagnosis of VDD and primary diagnosis of CVD (AFib, CHF, IHD, acute MI, and angina) and CeVD (AIS, TIA, ICeH and SAH) using ICD-10-CM codes. We performed a chi-square test and multivariable survey logistic regression to analyze disability of patients with CVD and CeVD in presence of VDD. Disability/loss of function was investigated...
Background Lambl's excrescence (LE) is a rare thin, mobile, filiform frond on the endocardial sur... more Background Lambl's excrescence (LE) is a rare thin, mobile, filiform frond on the endocardial surface of cardiac valves responsible for recurrent ischemic strokes due to embolic phenomena. Due to nonspecific symptoms, sometimes the diagnosis is challenging. It can be diagnosed by transesophageal echocardiogram (TEE) with increased sensitivity. Several case reports have been published with a strategy to manage LE but there is lack of consensus. We report a case of a 75-year-old patient with the LE arising from aortic valve resulting in recurrent ischemic strokes within a short period and its management. Case A 75-year-old male with multiple vascular risk factors presented with confusion, altered mental status of unknown onset and aphasia. He denied weakness, numbness, or other focal neurological deficits. National Institute of Health Stroke Scale was 5. IV tPA was not given due to the unknown onset of symptoms. The magnetic resonance imaging (MRI) revealed acute/subacute left thalamic lacunar infarct. TEE demonstrated a 7-mm linear fibrinous mass on the valve. The patient was on aspirin which was changed to clopidogrel. After 2 weeks, the patient readmitted with similar presentation. MRI showed subacute right parietal cortical infarct. The patient was advised to proceed with surgical resection of LE. Due to refusal for surgery, he was kept on 30 days cardiac monitor and had given anticoagulant therapy for secondary prevention of stroke. Conclusion Although wide range from single or dual antiplatelet therapy to full dose anticoagulation have been tried, surgical intervention should be considered in case of multiple ischemic strokes to mitigate the risk of embolism.
Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is one of the ra... more Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is one of the rare early childhood intractable epileptic encephalopathies associated with pleomorphic seizure activity, cognitive decline, motor, and behavioral abnormalities. The convulsive seizure is the most common type seen in DS. After the first episode of seizure-like activity, behavioral disorders and cognitive decline are progressive and long-lasting. The most common etiology identified in patients with DS is a de-novo genetic mutation alpha-1 subunit of voltage-gated calcium channel gene (SCN1A). DS is diagnosed clinically and if unclear, genetic testing is recommended. DS treatment options include anti-epileptic drugs and cannabinoids; ketogenic diet therapy and surgical options such as the deep brain and vagal nerve stimulation. Due to drug-refractory epilepsy in DS, many more therapies are being investigated to increase the longevity of patients.
In today's era, solid waste management is the thrust area. Out of this various waste material... more In today's era, solid waste management is the thrust area. Out of this various waste materials, plastic waste, tire waste and municipal solid waste are of great concern. Aim of our present work is helping to solve Solid waste management of this tire waste and to investigate the alternate coarse aggregate to reduce cost of structure and reduce environment pollution. Different combinations of crumb rubber with traditional coarse aggregate were evaluated based on compression strength and flexural strength tests were conducted according to Indian Standards. Tests were also carried out to determine workability of concrete. The study pointed out that the increased in percentage of Crumb Rubber in Concrete reduces the effective Compressive strength and Flexural strength but increases workability of concrete. Increases of Crumb rubber percentage in concrete it makes more economical if we consider it to point of environment protection.
Breath testing could provide a rational tool for radiation biodosimetry because radiation causes ... more Breath testing could provide a rational tool for radiation biodosimetry because radiation causes distinct stress-producing molecular damage, notably an increased production of reactive oxygen species. The resulting oxidative stress accelerates lipid peroxidation of polyunsaturated fatty acids, liberating alkanes and alkane metabolites that are excreted in the breath as volatile organic compounds (VOCs). Breath tests were performed before and after radiation therapy over five days in 31 subjects receiving daily fractionated doses: 180-400 cGy d(-1) standard radiotherapy (n = 26), or 700-1200 cGy d(-1) high-dose stereotactic body radiotherapy (n = 5). Breath VOCs were assayed using comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry. Multiple Monte Carlo simulations identified approximately 50 VOCs as greater-than-chance biomarkers of radiation on all five days of the study. A consistent subset of 15 VOCs was observed at all time points. A radiation respo...
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Papers by Urvish Patel