Saroj Lohani's research while affiliated with Reading Health System and other places

Publications (29)

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Background: Clozapine is a second-generation antipsychotic used in refractory schizophrenia. Clozapine can lead to pulmonary embolism (PE) by various mechanisms including immobility, weight gain and increased platelet aggregation. Objectives: We performed a systematic review on published cases of PE associated with clozapine. Methods: Comprehensive...
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A 20 year old male with past medical history of Type 1 Diabetes and Hypothyroidism presented to our hospital with severe hypocalcemia. His calcium was 5.8 mg/dl (normal range 8.6–10.3 mg/dl). He had been complaining of generalized weakness for weeks. Vital signs were within normal limits. Physical exam was significant for positive Chvostek sign. Ot...
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Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are diffe...
Article
Introduction: Cosmetic injections with silicone and polymethylmethacrylate are not FDA approved for augmentation of body parts such as breast, buttock or legs, but they have been widely used for decades. Cosmetic injections can cause foreign body granulomas and occasionally severe and life-threatening hypercalcemia. We aimed to systematically anal...
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A 41-year-old female presented to the hospital with sore throat and shortness of breath. She was hypoxic with an oxygen saturation of 87% in room air. Physical examination revealed swollen uvula with exudates. She had been started on topiramate for treatment of migraine few months ago. The dose of topiramate was increased to 100 mg twice daily 2 we...
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Background: Statins are a group of drugs that reduce the levels of triglycerides and cholesterol in blood by inhibiting HMG-CoA reductase, an enzyme involved in rate limiting step in cholesterol synthesis. About 2-20% patients on statins develop toxic myopathies, which usually resolve on discontinuation of statin. More recently, an immune-mediated...
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Background: Antiphospholipid antibody syndrome (APS) is a disorder associated with both arterial and venous thromboembolic disease, including acute myocardial infarction (AMI). Given that management with anticoagulants is critical and differs from usual AMI care, identification of key discriminators of patients with AMI with APS is important. Met...
Article
Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-ye...
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We describe a case of 40-year-old woman who presented to our hospital with symptoms of non-radiating epigastric pain for 4–5 days associated with nausea and vomiting. Her history was significant for asthma with recurrent exacerbations, polyneuropathy and recurrent sinus infections. Liver function tests revealed cholestasis. Antinuclear antibody and...
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Thrombosis is a frequent cause of morbidity and mortality in patients with nephrotic syndrome (NS). Though venous thromboses are common in NS, arterial thromboses are relatively rare. Commonly involved arteries include coronary, iliac, femoral, renal, cerebral, pulmonary, mesenteric, and axillary arteries, and the aorta. Arterial thromboses are ass...
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Pylephlebitis or infective suppurative thrombosis of the portal mesenteric venous system is an uncommon condition that can potentially be deadly if not recognized and treated early. Although most commonly associated with pancreatitis and diverticulitis, any intra-abdominal or pelvic infection occurring in the region drained by the portal venous sys...
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Disseminated mucormycosis endocarditis is extremely rare, and only a few cases have actually been reported in the literature. It is almost universally fatal despite aggressive surgical and medical management. In this article, we present the case of a 48-year-old immunocompromised male with mucormycosis endocarditis, who presented with acute bilater...
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Epiploic appendagitis (EA) is an uncommon cause of abdominal pain. It is a benign condition but may mimic other serious causes of acute abdomen such as appendicitis, diverticulitis, and gynecological emergency in severe cases. Knowledge of this condition in the differential diagnosis of abdominal pain can save unnecessary hospital admission, antibi...
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Background: Takotsubo cardiomyopathy is a syndrome of transient cardiac dysfunction that is frequently associated with sudden emotional or physical stress. Epinephrine use has been implicated in precipitating Takotsubo cardiomyopathy in multiple case reports and case series. We sought to systematically review the current English literature on this...
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Isolated pulmonary valve endocarditis in intravenous drug users is a rarely reported phenomenon. We present the case of a 25-year-old male with history of intravenous drug use who presented with respiratory symptoms after failing outpatient treatment for community-acquired pneumonia. Further investigations identified multiple lung lesions with earl...
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Generalized pruritic rash in Hodgkin's disease is most commonly due to paraneoplastic manifestation. It can sometimes precede other manifestations of Hodgkin's disease by weeks or months. Hence, if other possible causes have been ruled out, Hodgkin's disease should be considered a possible cause of generalized pruritic rash. Consideration of Hodgki...
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Glioblastoma is a highly aggressive and generally lethal brain tumor despite aggressive treatment. Treatment to ensure prolonged survival while maintaining quality of life has always been challenging, as glioblastoma occurs mostly in elderly population who already have multiple comorbidities. We present the case of a 75-year-old male who was evalua...
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Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis. Most cases are asymptomatic; however, symptomatic patients may present with a wide range of non-specific cutaneous, pulmonary, or gastrointestinal symptoms posing a diagnostic dilemma and delay in diagnosis. We report a case of a 58-year-old female who presented with m...
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Gonococcus typically affects the mucosal surfaces but in rare cases can spread to bloodstream causing disseminated gonococcal infection (DGI). The usual presentation of DGI is rash, polyarthralgia, and tenosynovitis. We present the case of a 23-year-old female who presented to our hospital with pustular rash and tenosynovitis of hand and was sent h...
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We report a case of a 37-year-old woman who presented to our hospital with retrosternal chest pain following intramuscular administration of epinephrine due to presumed anaphylaxis. On arrival, she was found to have ST segment depression in the anterolateral leads on ECG and elevated cardiac troponins. She was diagnosed with stress cardiomyopathy b...
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Vertebral osteomyelitis due to Streptococcus viridans following a dental procedure is a rarely reported phenomenon. We discuss the case of a 67-year-old immunocompetent woman who presented with low back pain of 3 weeks duration associated with subjective fever and chills. On admission, the MRI of the lumbar spine showed L5-S1 vertebral osteomyeliti...

Citations

... 6 Established risk factors for VTE include advanced age, inherited coagulation abnormalities, acute medical illnesses, recent surgery, underlying malignancy, pregnancy, and estrogen containing medications. 6 A growing number of studies have described an association between antipsychotic therapy, particularly clozapine, [7][8][9] and an increased risk of VTEs. [10][11][12][13][14][15][16] Several mechanisms have been proposed, such as venous stasis secondary to sedation and reduced mobility, 17,18 increased platelet adhesion and aggregation, 19,20 and elevated serum IgM antiphospholipid antibodies. ...
... Further to severe dehydration, the patient may present with neuromuscular weakness, cardiac arrhythmias, metabolic acidosis, seizures, ataxia, coagulopathy and acute kidney injury [6]. It may arise in patients with poor compliance to GFD or it may be the onset of CD [8]. It is often precipitated by stress factors like surgery or infection [9] but in our case no such precipitant could be found. ...
... Following the promising developments in TAVR devices, some of the earliest and common TMVI procedures were done using TAVR devices (e.g., Sapien M3, Sapien XT) via valve-invalve (VIV) approach in degenerated bioprostheses or severe MAC patients (63)(64)(65)(66). This is especially since redo surgery for the degenerated bioprosthetic mitral valve in elderly patients with impaired left ventricular dysfunction and previous cardiac surgery is not ideal (67). ...
... For patients with annuloplasty ring failure and severe MAC, further studies are needed in view of the high short-term morbidity and mortality feasibility. Transseptal TMVR, which eliminates the need for extracorporeal circulation and naturally reduces the risk, is considered a safer route to perform repeat valve surgery [19,41]. It has the advantages of less invasiveness, does not require opening the chest and avoids trauma to the left ventricle. ...
... So, the vitamins within compound 'ADE' may not be the only factors responsible for hypercalcaemia. The use of cosmetic injections consisting of silicone, paraffin and polymethyl methacrylate have been associated with the development of hypercalcaemia [11,55,70]. These agents support the formation of granulomas that increase the 1-α-hydroxylase activity, thus promoting formation of 1,25-OH-D. ...
... Often, the etiology is not due to a single cause but rather a combination of electrolyte derangements. Several cases in the literature describe the development of tetany in young females with malabsorption due to inflammatory bowel disease, celiac disease, or bulimia, who are found to have multiple electrolyte abnormalities [1][2][3]. The majority of published cases of tetany describe non-life-threatening symptoms. ...
... Venous thrombotic complications have frequently been observed (2). Arterial complications are rare and may lead to serious and life-threatening complications depending on the vessels involved and associated with poor prognosis (2)(3)(4)(5). ...
... Although it is a relatively safe drug, it can rarely cause serious adverse events like rhabdomyolysis, hepatotoxicity, diabetes, and haemorrhagic strokes (1). Statin-induced autoimmune necrotizing myopathy (SIANM) is an extremely rare side effect with an incidence of 2 cases per million per year (2). It is characterized by the presence of autoantibodies against 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. ...
... The commonly identified antiphospholipid antibodies are LAA, anticardiolipin IgG or IgM, and anti-B2glycoprotein I IgG (aB2GPI). These pathogenic antibodies deposit on valvular or vascular endothelium, activating an inflammatory cascade that leads to valvular dysfunction, microvascular injury, and premature accelerated atherosclerosis [3,4]. Yet, reports of acute myocardial infarction associated with APS are all characteristically acute thrombotic events [3]. ...
... Occasionally, patients have been subjected to extensive and expensive neurologic investigations and prolonged hospitalization prior to the discovery of TPP. 15,58 A key feature to note is that the attacks may recur, but there is always a complete recovery between the episodes of muscle weakness. About half of the patients had suffered at least one attack before the correct diagnosis was made in one hospital where TPP was seen. ...