Neev Patel

All Publications

• Outcomes with inpatient use of midodrine in patients with heart failure and kidney failure on maintenance dialysis. Acta cardiologica Patel, N., Alvarez Concejo, B., Lo, K. B., Mishra, M., Kattubadi, A., Rangaswami, J. 2024: 1-4

  Abstract

  Midodrine, an FDA-approved medication for orthostatic hypotension, is also used off-label to manage hypotension in dialysis patients, including those with heart failure. However, in patients with reduced ejection fraction (HFrEF) and/or right heart failure, midodrine is potentially harmful. No known studies examine the safety of midodrine in hospitalised kidney failure patients with HF.The TriNetX database was queried for hospitalised kidney failure patients with HFrEF and/or right heart failure who experienced hypotension (SBP < 110 mm Hg or MAP < 70 mm Hg). Excluding those needing critical care or vasopressors, we compared cohorts based on midodrine use, matching for comorbidities.Analysis showed patients on midodrine had a higher 6-month mortality risk ratio (RR 1.53, 95% CI 1.037 to 2.246) and Hazard Ratio (HR 1.54, 95% CI 1.022 to 2.317) compared to those not on midodrine, indicating an association with increased mortality.This study illuminates the complexities in treating hospitalised patients with kidney failure and HF. Our findings, drawn from an exploratory analysis, indicate that inpatient midodrine use is associated with increased 6-month mortality. This may reflect deleterious effects from vasoconstriction and/or unmeasured confounders in this vulnerable population. This investigation, utilising TriNetX, was limited by access to deidentified aggregate data, preventing detailed exploration of specifics such as timing, dosage, and indications for midodrine use. Moreover, given its observational nature, cause-effect relationship cannot be established. Our findings indicate an increased mortality associated with midodrine use for hypotension, underscoring the need for further research and consideration of alternative strategies.

  View details for DOI 10.1080/00015385.2024.2365608

  View details for PubMedID 38860595

• A subtle presentation of acute interstitial nephritis with a peculiar etiology. Clinical nephrology Adisa, O., Patel, N., Morisetti, P., Sulaiman, K. 2023; 100 (5): 240-242

  View details for DOI 10.5414/CN111215

  View details for PubMedID 37548466

• Novel multiple sclerosis agents-associated cardiotoxicity: A real-world pharmacovigilance study. International journal of cardiology Al-Yafeai, Z., Carvajal-González, A., Abduljabar, H., Arvas, M., Patel, S., Patel, N. 2022; 362: 153-157

  Abstract

  Emerging novel therapeutics have been developed to hamper the progression of multiple sclerosis (MS). However, the adverse events related to these new agents remain largely unknown. Therefore, we sought to investigate the cardiovascular complications of these drugs.Utilizing data from the U.S. food and drug administration (FDA) adverse events reporting system (FAERS), we comprehensively evaluated the cardiovascular complications of the newly FDA-approved anti-MS modifying therapies approved since 2015. Disproportionality signal analysis was conducted by measuring reporting odds ratio (ROR) with a 95% confidence interval of all cardiovascular adverse events since approval till 2021.After vetting the newly approved agents for MS, CD20 and CD25 inhibitors and sphingosine-1-phosphate receptors agonists were the latest approved medications for MS since 2015. Two CD20 (ocrelizumab, ofatumumab) and one CD25 inhibitors (daclizumab) were significantly associated with multiple cardiovascular adverse events. Among all the cardiotoxic events; coronary artery disease, cardiac failure and atrial fibrillation were the most predominant among CD20 or CD25 blockers. Interestingly, sphingosine-1-phosphate receptors (S1PR) agonists showed much fewer reported cardiac adverse events. However, fingolimod and siponimod were associated with significant AV block and bradycardia.Our data revealed the new MS agents are associated with various undefined cardiovascular complications. These findings potentially instigate further studies to personalize prescribing these agents for MS based on patient's cardiovascular profile.

  View details for DOI 10.1016/j.ijcard.2022.05.052

  View details for PubMedID 35643216

• Aortic Stenosis Patients With Transcatheter Aortic Valve Replacement: Caution Recommended With Renal Failure During Hospitalization. Cureus Kaur, P., Ajibawo, T., Yomi, T., Patel, N., Baksh, M., Okotcha, E., Kataria, S., Patel, R. S. 2020; 12 (7): e9384

  Abstract

  Objective Our study aimed to assess the risk of in-patient mortality due to renal failure and other comorbidities in aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a cross-sectional study using a Nationwide Inpatient Sample (NIS, January 2010 to December 2014) from the United States and included 33,325 patients with a primary diagnosis of AS. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in AS by comorbidities including renal failure. Results The prevalence of renal failure in AS patients is 29.2%, and a higher proportion were males (60.1%) and non-white (14.1%). Major loss of function (96.6%) and in-hospital mortality (5.1%) were also proportionally higher in prevalence. Female patients (OR 1.35, 95% CI 1.20-1.51) had higher odds of in-patient mortality in AS patients. Race was a non-significant predictor for mortality risk. Patients with comorbid coagulopathy (OR 2.02, 95% CI 1.79-2.27) and heart failure (OR 1.62, 95% CI 1.39-1.89) have increased mortality in AS inpatients. After controlling confounders, renal failure was significantly associated with increased in-hospital mortality (OR 1.43, 95% CI 1.28-1.61) in AS patients. Conclusion Renal failure was prevalent in AS patients and was an independent factor that increases the risk of in-hospital mortality by 43%. Due to worse outcomes, more studies are required to evaluate risk-benefit ratio and strategies to improve health-related quality of life in post-TAVR patients with renal failure, and optimally decrease inpatient mortality.

  View details for DOI 10.7759/cureus.9384

  View details for PubMedID 32850251

  View details for PubMedCentralID PMC7445110

• Clinical Perspective on 2019 Novel Coronavirus Pneumonia: A Systematic Review of Published Case Reports. Cureus Patel, R. S., Patel, N., Baksh, M., Zaidi, A., Patel, J. 2020; 12 (6): e8488

  Abstract

  The ongoing pandemic of 2019 novel coronavirus (2019-nCoV), which originated from Wuhan, China, has led to 68,279 deaths due to 2019-nCoV pneumonia as of May 5, 2020. We conducted a systematic review and included 16 case reports to summarize the transmission and pathology of 2019-nCoV, and clinical presentation, laboratory and imaging findings, and treatment in 2019-nCoV pneumonia. The disease is mild in most people; in some, it may progress to severe pneumonia with acute respiratory distress syndrome (ARDS). Patients with mild illness usually recover at home, with supportive care and isolation in accordance with guidelines. Patients who have moderate to severe pneumonia are usually monitored in the hospital. Although there is no definitive treatment for 2019-nCoV pneumonia so far, some antiviral drugs have shown promising results. The use of lopinavir/ritonavir and remdesivir was associated with significant clinical improvement in severe pneumonia. Nonetheless, we need more randomized clinical trials (RCTs) and treatment guidelines for developing effective management of the 2019-nCoV and improve patient outcomes by reducing mortality in high-risk patients. We also need more clinical trials and management guidelines for the effective management of 2019-nCoV pneumonia.

  View details for DOI 10.7759/cureus.8488

  View details for PubMedID 32656006

  View details for PubMedCentralID PMC7343316

• Causative agents of urinary tract infections and their antimicrobial susceptibility patterns at a referral center in Western India: An audit to help clinicians prevent antibiotic misuse. Journal of family medicine and primary care Patel, H. B., Soni, S. T., Bhagyalaxmi, A., Patel, N. M. 2019; 8 (1): 154-159

  Abstract

  Urinary tract infections (UTIs) remain one of the most common infections in community and susceptibility of uropathogens to commonly used antimicrobials has declined over years. It is important to periodically study susceptibility patterns of uropathogens, so that empiric treatment can be determined using recent data, helping improve patient outcomes.Urine samples received by the laboratory for culture and susceptibility testing over a period of 3 months were analyzed and included in this study. Antimicrobial susceptibility testing was done on cultured isolates.Of total 3,151 urine samples received, 3,066 were processed, and organisms were isolated from 1,401 (45.69%) samples. Isolation rate from male and female urine samples was 45.29% and 46.32%, respectively. The most commonly isolated organism was Escherichia coli (36.11%), followed by Candida spp. (18.56%), and Klebsiella spp. (18.06%). E. coli was most susceptible to meropenem (91.89%) and imipenem (91.69%). Klebsiella spp. was most susceptible to imipenem(75.89%) and meropenem(75.49%). Susceptibility of E. coli and Klebsiella spp. to nitrofurantoin, cotrimoxazole, and ciprofloxacin was 72.33%, 32.02%, and 18.97%, and 51.77%, 27.27%, and 22.13%, respectively. Candida spp. was most susceptible to amphotericin B (97.30%).Treatment for UTIs should be determined based on current local antimicrobial susceptibility patterns of uropathogens to minimise therapeutic failures and prevent antibiotic misuse.

  View details for DOI 10.4103/jfmpc.jfmpc_203_18

  View details for PubMedID 30911498

  View details for PubMedCentralID PMC6396617