All Publications

  • Life-Threatening Hemoptysis. Seminars in respiratory and critical care medicine Deshwal, H., Sinha, A., Mehta, A. C. 2021; 42 (1): 145-159


    Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.

    View details for DOI 10.1055/s-0040-1714386

    View details for PubMedID 32862418

  • Subacute Aspergillosis "Fungal Balls" Complicating COVID-19. Journal of investigative medicine high impact case reports Patti, R. K., Dalsania, N. R., Somal, N., Sinha, A., Mehta, S., Ghitan, M., Seneviratne, C., Kupfer, Y. 2020; 8: 2324709620966475


    Severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), commonly known as COVID-19 (coronavirus disease-2019), began in the Wuhan District of Hubei Province, China. It is regarded as one of the worst pandemics, which has consumed both human lives and the world economy. COVID-19 infection mainly affects the lungs triggering severe hypoxemic respiratory failure, also providing a nidus for superimposed bacterial and fungal infections. We report the case of a 73-year-old male who presented with progressive dyspnea; diagnosed with SARS-CoV-2-related severe acute respiratory distress syndrome and complicated with lung cavitations growing Aspergillus sp. COVID-19, to our knowledge, has rarely been associated with subacute invasive pulmonary aspergillosis with aspergillomas. Subacute invasive pulmonary aspergillosis as a superimposed infection in patients with SARS-CoV-2 is a rare entity. By reporting this case, we would like to make the readers aware of this association.

    View details for DOI 10.1177/2324709620966475

    View details for PubMedID 33054445

    View details for PubMedCentralID PMC7570291

  • Andexanet Alfa for Bleeding with Factor Xa Inhibitors. The New England journal of medicine Ponnusamy, V., Sinha, A., Kupfer, Y. 2019; 381 (2): 191-192

    View details for DOI 10.1056/NEJMc1906058

    View details for PubMedID 31291533

  • An Intensive Care Unit Outbreak of Acute Respiratory Distress Syndrome due to Human Metapneumo Virus Infection. Journal of investigative medicine high impact case reports Sinha, A., Ponnusamy, V., Gupta, S. S., Raheja, H., Patti, R., Soni, P., Malhan, N., Lin, Y. S., Kupfer, Y. 2019; 7: 2324709619860549


    Human metapneumo virus is an emerging cause of upper and lower respiratory tract illness with increasing reports of a varied spectrum of disease over all age groups. We report an outbreak of 6 cases of human metapneumo virus infection in the intensive care unit of a metropolitan tertiary care center over 6 weeks, leading to severe acute respiratory distress syndrome. We report the subsequent favorable outcomes due to the institution of extracorporeal membrane oxygenation.

    View details for DOI 10.1177/2324709619860549

    View details for PubMedID 31271048

    View details for PubMedCentralID PMC6611009

  • Losartan-induced Severe Hepatic Injury: A Case Report and Literature Review. Cureus Patti, R., Sinha, A., Sharma, S., Yoon, T. S., Kupfer, Y. 2019; 11 (5): e4769


    Medications have been known to cause adverse drug reactions that affect various organs; these are mostly reversible reactions that improve with the cessation of the culprit medication. Losartan is an angiotensin-one receptor blocker which has been approved by the Food and Drug Administration (FDA) for the treatment of arterial hypertension. Fatigue, anemia, weakness, and cough are some of the common adverse effects of losartan. Acute hepatic injury has rarely been reported as an adverse effect of losartan. We report a case of a 61-year-old female with severe hepatic injury secondary to losartan use. None of the cases reported so far had such a high elevation of liver enzymes as seen in our patient.

    View details for DOI 10.7759/cureus.4769

    View details for PubMedID 31363450

    View details for PubMedCentralID PMC6663042

  • Oral Care and Ventilator-Associated Pneumonia. American journal of therapeutics Malhan, N., Usman, M., Trehan, N., Sinha, A., Settecase, V. A., Fried, A. D., Kupfer, Y. Y., Kamholz, S. L. 2019; 26 (5): 604-607

    View details for DOI 10.1097/MJT.0000000000000878

    View details for PubMedID 30855286

  • Severe Thrombocytopenia Due to Intravenous Tirofiban Therapy. American journal of therapeutics Patti, R., Sinha, A., Rodriguez, D., Khanijao, S., Topi, B., Somal, N. 2019; 26 (4): e534-e537

    View details for DOI 10.1097/MJT.0000000000000756

    View details for PubMedID 30839319

  • Myocardial Infarction After Accidental Minoxidil Poisoning. American journal of therapeutics Sinha, A., Raheja, H., Kupfer, Y. 2018; 25 (2): e279-e281

    View details for DOI 10.1097/MJT.0000000000000536

    View details for PubMedID 27875370

  • Atezolizumab-Induced New Onset Diabetes Mellitus With Ketoacidosis. American journal of therapeutics Patti, R., Malhotra, S., Sinha, A., Singh, P., Marcelin, M., Saxena, A. 2018; 25 (5): e565-e568

    View details for DOI 10.1097/MJT.0000000000000644

    View details for PubMedID 28953510

  • Abiraterone-Associated Fulminant Liver Failure. American journal of therapeutics Singh, P., Sinha, A., Lama Tamang, T. G., Chandra, A. B., Huang, Y. J. 2018; 25 (4): e505-e506

    View details for DOI 10.1097/MJT.0000000000000597

    View details for PubMedID 28452846

  • Dronabinol-Induced Acute Altered Mental Status in an Elderly Patient. American journal of therapeutics Sinha, A., Singh, P., Kupfer, Y. 2018; 25 (4): e502-e503

    View details for DOI 10.1097/MJT.0000000000000593

    View details for PubMedID 28452845

  • Severe Pulmonary Hypertension Due to Adult-Onset Still's Disease. Journal of investigative medicine high impact case reports Sinha, A., Patti, R., Ambesh, P., Obiagwu, C., Malhan, N., Chawla, K. 2018; 6: 2324709618757260


    A 29-year-old female with adult-onset Still's disease (AOSD) presented with progressive shortness of breath both on rest and on exertion, increased abdominal girth, and swelling in both legs. She was on oral prednisone and was recently started on canakinumab (interleukin-1 antagonist) for joint pain and rash of AOSD. Echocardiogram showed severely dilated right ventricle, dilated pulmonary artery, moderately reduced right ventricular systolic function, but with normal left ventricular systolic function. Computed tomography with contrast ruled out pulmonary embolism. Blood tests ruled out other rheumatologic diseases. The patient was diagnosed with right-sided heart failure likely secondary to AOSD. Right heart catheterization was needed but could not be performed because of severely dilated pulmonary artery. The patient was transferred to a higher center for further management and possible cardiopulmonary transplant.

    View details for DOI 10.1177/2324709618757260

    View details for PubMedID 29468168

    View details for PubMedCentralID PMC5815417

  • Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review. The open cardiovascular medicine journal Raheja, H., Namana, V., Chopra, K., Sinha, A., Gupta, S. S., Kamholz, S., Moskovits, N., Shani, J., Hollander, G. 2018; 12: 1-6


    Acute alcohol intoxication has been associated with cardiac arrhythmias but the electrocardiogram (ECG) changes associated with acute alcohol intoxication are not well defined in the literature.Highlight the best evidence regarding the ECG changes associated with acute alcohol intoxication in otherwise healthy patients and the pathophysiology of the changes.A literature search was carried out; 4 studies relating to ECG changes with acute alcohol intoxication were included in this review.Of the total 141 patients included in the review, 90 (63.8%) patients had P-wave prolongation, 80 (56%) patients had QTc prolongation, 19 (13.5%) patients developed T-wave abnormalities, 10 (7%) patients had QRS complex prolongation, 3 (2.12%) patients developed ST-segment depressions.The most common ECG changes associated with acute alcohol intoxication are (in decreasing order of frequency) P-wave and QTc prolongation, followed by T-wave abnormalities and QRS complex prolongation. Mostly, these changes are completely reversible.

    View details for DOI 10.2174/1874192401812010001

    View details for PubMedID 29541259

    View details for PubMedCentralID PMC5838641

  • Mixed Adenoneuroendocrine Carcinoma of the Gastroesophageal Junction: A Rare Find. Journal of investigative medicine high impact case reports Ambesh, P., Weissbrot, J., Ratner, S., Sinha, A., Patti, R., Balderacchi, J., Marcelin, M., Wolf, L., Kamholz, S. 2017; 5 (4): 2324709617750180


    Neoplastic lesions that demonstrate neuroendocrine features are rare. However, esophageal tumors containing both adenocarcinomatous and neuroendocrine components are exceedingly rare. Mixed adenoneuroendocrine carcinomas (MANECs) are gastrointestinal tumors with both adenocarcinomatous and neuroendocrine differentiation. They have a tendency for early metastases but clinically manifest relatively late. Imaging studies are often nonspecific with regard to tumor type, and a histopathologic study of biopsy material is required for definitive diagnosis. The overall prognosis is poor. The current report describes a rare case of gastroesophageal MANEC tumor, with approximately 60% neuroendocrine and 40% adenocarcinomatous components. Since there is a dearth of concrete management guidelines for MANECs, we present possible management options to add to the existing literature.

    View details for DOI 10.1177/2324709617750180

    View details for PubMedID 29318164

    View details for PubMedCentralID PMC5753953

  • Very Severe Aplastic Anemia During Treatment With Doxycycline. American journal of therapeutics Singh, P., Sinha, A., Kamath, A., Malhotra, S. 2017; 24 (4): e492

    View details for DOI 10.1097/MJT.0000000000000516

    View details for PubMedID 27763888

  • A Diagnostic Surprise: Primary Hodgkin's Lymphoma of the Lung. Journal of investigative medicine high impact case reports Sinha, A., Patti, R., Singh, P., Solomon, W., Kupfer, Y. 2017; 5 (4): 2324709617734247


    An 81-year-old male presented to the emergency room with a 3-month history of progressive shortness of breath, productive cough with white sputum, and generalized weakness with 10-pound weight loss in 2 months. On presentation, the patient was afebrile, with blood pressure of 93/55 mm Hg and oxy-hemoglobin saturation of 92% on 2 liters of oxygen via nasal cannula. Complete blood count with differential was significant for white count of 12 400/mL. Brain natriuretic peptide level was 454 ng/mL. Postero-anterior chest radiograph showed multiple round opacities in the lung fields. Computed tomography scan of the chest confirmed multiple round densities in both the lung fields along with mild mediastinal lymphadenopathy. Core needle biopsy was performed. Immunohistochemical stains were positive for CD30 and CD15 in a population of large atypical cells amid a background of CD3-positive nonneoplastic cells. These results were in support of the diagnosis of classical Hodgkin's lymphoma of the lung with histological appearance confirming nodular sclerosis type. The patient was started on chemotherapy but was readmitted in 20 days for acute respiratory distress and suffered cardiac arrest and subsequently died. This case highlights the fact that although primary pulmonary Hodgkin's lymphoma of the lung is a rare entity, it should be thought of as a differential while evaluating lung masses. In these cases, definite diagnosis can only be made by biopsy and histology. Early commencement of chemotherapy and regular follow-up with oncology is essential.

    View details for DOI 10.1177/2324709617734247

    View details for PubMedID 29051894

    View details for PubMedCentralID PMC5637979

  • Blocking the Flow: Secondary Syringomyelia Due to an Cervical Intramedullary Ependymoma Sinha, A., Gupta, S., Kupfer, Y. ELSEVIER SCIENCE BV. 2017: 354A
  • Rare Case of Spinal Cord Compression as Initial Presentation of Thymic Carcinoma. World journal of oncology Singh, P., Sinha, A., Malhotra, S., Chandra, A. B., Solomon, W., Huang, Y. 2017; 8 (4): 122-125


    Thymic carcinomas are rare aggressive cancers with limited clinical trial data. Its usual treatment is surgical resection with variable response to chemotherapy and radiation. It usually presents as anterior mediastinal mass with late sequela of metastases to the lymph nodes, pleura and bones. We present of thymic carcinoma with a rare initial presentation of vertebral metastases causing spinal cord compression.

    View details for DOI 10.14740/wjon1053w

    View details for PubMedID 29147447

    View details for PubMedCentralID PMC5650009

  • Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis. Case reports in nephrology Janga, K. C., Sinha, A., Wengrofsky, P., Oo, P., Greenberg, S., Tarkovsky, R., Sharma, K. 2017; 2017: 7240156


    A 43-year-old male patient with past medical history of diabetes mellitus (DM), end stage renal disease (ESRD) on hemodialysis (HD), congestive heart failure (CHF), obstructive sleep apnea (OSA), and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT) of the thigh revealed evidence of edema with no evidence of a focal collection or gas formation noted. The patient's clinical symptoms persisted and he underwent magnetic resonance imaging (MRI) of his thigh which was reported to show small areas of muscle necrosis with fluid collection. These findings in the acute setting concerned necrotizing fasciitis. After careful discussion following a multidisciplinary approach, a decision was made to perform a fasciotomy with tissue debridement. The patient was treated with IV antibiotics and discharged with a vacuum assisted wound drain. The surgical pathology revealed evidence of muscle edema with necrosis. Seven weeks later the patient presented with similar complaints on the other thigh (right thigh). MRI of the thighs revealed worsening edema with features suggestive of myositis and possible muscle infarction. A CT guided biopsy of the right quadriceps muscle revealed fibrotic interstitial connective tissue and no evidence of necrosis. This favored a diagnosis of diabetic muscle infarction. The disease was managed with pain control, strict diabetes management, and aggressive dialysis.

    View details for DOI 10.1155/2017/7240156

    View details for PubMedID 28529812

    View details for PubMedCentralID PMC5424164

  • Nephrologists Hate the Dialysis Catheters: A Systemic Review of Dialysis Catheter Associated Infective Endocarditis. Case reports in nephrology Janga, K. C., Sinha, A., Greenberg, S., Sharma, K. 2017; 2017: 9460671


    A 53-year-old Egyptian female with end stage renal disease, one month after start of hemodialysis via an internal jugular catheter, presented with fever and shortness of breath. She developed desquamating vesiculobullous lesions, widespread on her body. She was in profound septic shock and broad spectrum antibiotics were started with appropriate fluid replenishment. An echocardiogram revealed bulky leaflets of the mitral valve with a highly mobile vegetation about 2.3 cm long attached to the anterior leaflet. CT scan of the chest, abdomen, and pelvis showed bilateral pleural effusions in the chest, with triangular opacities in the lungs suggestive of infarcts. There was splenomegaly with triangular hypodensities consistent with splenic infarcts. Blood cultures repeatedly grew Candida albicans. Despite parenteral antifungal therapy, the patient deteriorated over the course of 5 days. She died due to a subsequent cardiac arrest. Systemic review of literature revealed that the rate of infection varies amongst the various types of accesses, and it is well documented that AV fistulas have a much less rate of infection in comparison to temporary catheters. All dialysis units should strive to make a multidisciplinary effort to have a referral process early on, for access creation, and to avoid catheters associated morbidity.

    View details for DOI 10.1155/2017/9460671

    View details for PubMedID 28409042

    View details for PubMedCentralID PMC5376949

  • Adult Onset Dysphagia: Right Sided Aortic Arch, Ductus Diverticulum, and Retroesophageal Ligamentum Arteriosum Comprising an Obstructing Vascular Ring. Case reports in cardiology Sinha, A., Raheja, H., Namana, V., Abrol, S., Kamholz, S., Shetty, V. 2017; 2017: 9614835


    A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient's symptoms.

    View details for DOI 10.1155/2017/9614835

    View details for PubMedID 28396805

    View details for PubMedCentralID PMC5370493

  • Cryptococcal Meningitis Masquerading as Normal Pressure Hydrocephalus in an Immune-competent Adult. Journal of global infectious diseases Raheja, H., Sinha, A., Irukulla, P. K., Kupfer, Y. 2017; 9 (4): 157-159


    We report a case of acute cryptococcal meningitis (CM) masquerading as normal pressure hydrocephalus (NPH) in an immune-competent female. An 85-year-old human immunodeficiency virus-negative female presented to the emergency room for altered mental status and difficulty walking. She was increasingly lethargic, with urinary incontinence and gait instability. A previous computed tomography was reported to have ventricular dilatation out of proportion to the degree of cortical atrophy. Magnetic resonance scan of the brain revealed ventricular dilatation and subtle debris layering the occipital horns of the lateral ventricles. A working diagnosis of NPH had been made considering the clinical symptoms and imaging. She became febrile to 103°F. Lumbar puncture was then performed which showed increased protein, decreased glucose, and mononuclear pleocytosis. India ink preparation of the cerebrospinal fluid was positive for Cryptococcus along with a positive cryptococcal antigen test. The patient was started on treatment for CM, but the patient continued to deteriorate further and died on the same day. Blood cultures subsequently grew Cryptococcus neoformans as well.

    View details for DOI 10.4103/jgid.jgid_2_17

    View details for PubMedID 29302151

    View details for PubMedCentralID PMC5750440

  • Ventricular septal defect. QJM : monthly journal of the Association of Physicians Gupta, S. S., Sinha, A., Sarasam, R., Namana, V. 2016; 109 (10): 691-692

    View details for DOI 10.1093/qjmed/hcw112

    View details for PubMedID 27435668