Oleg Sostin

Danbury Hospital

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José L. Méndez

Universidad Nacional Autónoma de México

John Chronakos

Danbury Hospital

Akash Shah

Sardar Vallabhbhai National Institute of Technology Surat

Tien‐Chan Hsieh

University of Massachusetts Chan Medical School

Dorothy Wakefield

Trinity Health

Joann Petrini

Danbury Hospital

Rima Pai

Danbury Hospital

Douglas Kahn

Covance (United States)

Sambhawana Bhandari

Washington University in St. Louis

Nataliya Sostin

Yale University

Cooperative Institutions

Danbury Hospital

University of Vermont

Western Connecticut Health Network

Yale University

Oregon Health & Science University

Norwalk Hospital

Covance (United States)

Brigham and Women's Hospital

Biomedical Research Institute

American University of the Caribbean School of Medicine

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Octreotide as a Novel Agent for the Management of Bronchorrhea in Mechanically Ventilated Patients: A Case Series and Review of Literature

Sambhawana Bhandari Oleg Sostin Akash Shah John Chronakos Douglas Kahn

Excessive bronchial secretions pose a challenge in mechanically-ventilated patients and may prolong the time to extubation, increasing the risk for pneumonia. Octreotide, a somatostatin analogue, has been used to decrease bronchial secretions especially for the symptomatic management of patients with lung cancer. We describe three patients in the form of a case series and discuss effect of octretotide on bronchial secretions and management of bronchorrhea in the intensive care unit. Similar to reports of its utilization in palliative care in patients with lung cancer, we observed a clinically significant decrease in the rate of bronchial secretions.

10.2139/ssrn.4446308

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Sickle Cell Trait As a Risk Factor for Leukemia: A Nationwide Study

Blood (2023)

Oleg Sostin Rima Pai Mehndi Dandwani Christian Espana-Schmidt

10.1182/blood-2023-178275

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A Unique Case of Gastric Calcinosis Secondary to Complete Hypoparathyroidism

The American Journal of Gastroenterology (2017)

Oleg Sostin Nataliya Sostin Clifford Appel Hani El-Fanek

Introduction: Gastric mucosal calcinosis (GMC) is a rare disorder typically encountered incidentally on routine biopsy or autopsy. Patients may present with dyspepsia and gastrointestinal bleeding. Most cases were reported in end-stage renal disease (ESRD) patients. We present a case of GMC in a patient with iatrogenic hypoparathyroidism. Case Report: A 70 year old female with a history of total thyroidectomy complicated by complete hypoparathyroidism at the age of 22, osteoporosis, hypercalciuria, recurrent nephrolithiasis, and chronic kidney disease (CKD) stage 3 presented to the office with chronic epigastric pain. CKD was attributed to nephrocalcinosis in the setting of hypercalciuria. Her pertinent medications included levothyroxine, calcium supplementation (1.8 g/day), calcitriol, vitamin D3, HCTZ, potassium chloride, and alendronate. She denied alcohol use. Physical exam revealed a hemodynamically stable woman of normal weight, with mild epigastric tenderness and guaiac negative stool. Review of lab results over the previous 5 years was notable for chronic hyperphosphatemia (average, 5.6 mg/dL) and frequent episodes of hypocalcemia; blood creatinine level was 1.4 mg/dL. Endoscopy showed pangastric erythema, a sessile gastric polyp, and a superficial ulcer in the gastric body. Biopsies revealed chronic gastritis (negative for H. Pylori), reactive gastropathy, a hyperplastic polyp, and associated patchy interstitial dystrophic calcifications, consistent with GMC (Figure 1).FigureDiscussion: In ESRD, decreased renal phosphorus excretion leads to hyperphosphatemia, secondary hyperparathyroidism, and hypercalcemia. Ca x PO4 product precipitates in tissues with high intracellular pH, such as gastric epithelium, causing GMC. In contrast, our patient had hypoparathyroidism-related hyperphosphatemia with hypocalcemia. Elevated intraluminal and intraepithelial calcium concentration, created by high-dose oral calcium supplementation, could be the cause of elevated Ca x PO4 product formation in the gastric epithelium. Furthermore, chronic inflammation predisposed gastric mucosa to precipitation of calcium salts, consistent with the known mechanism of dystrophic GMC. While many of the reported cases occurred in the setting of hypercalcemia, we described GMC in a patient with post-surgical hypoparathyroidism and hypocalcemia managed with aggressive oral calcium supplementation. The etiology of GMC remains unclear in many cases.

Hypoparathyroidism

Nephrocalcinosis

Calcinosis cutis

10.14309/00000434-201710001-02639

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S1385 First Case of Risperidone-Associated Secondary Sclerosing Cholangitis

The American Journal of Gastroenterology (2020)

Tien‐Chan Hsieh Akash Shah Gagandeep Kaur Hani El-Fanek Gin Yi Lee

INTRODUCTION: Secondary sclerosing cholangitis is a rare form of sclerosing cholangitis, with cholangiography and biopsy findings that are similar to primary sclerosing cholangitis. Early recognition of secondary causes is important to delay disease progression. There has not been any report that identified antipsychotics as a potential cause of secondary sclerosing cholangitis. Herein, we present a unique case of risperidone-associated secondary sclerosing cholangitis. CASE DESCRIPTION/METHODS: A 72-year-old Caucasian female, who had been treated with risperidone for catatonic schizophrenia for six months, presented to the hospital with altered mental status and fever. Pertinent laboratory findings upon arrival were leukocytosis (white blood cell count - 11.5 × 109/L), bacteriuria, pyuria, and transaminitis (alanine aminotransferase - 597 units/L, aspartate aminotransferase - 467 units/L, gamma-glutamyl transferase - 775 units/L, and alkaline phosphatase - 535 units/L). Ultrasound of the abdomen did not show ductal dilation. Risperidone was held. The patient was treated with antibiotics for a urinary tract infection, with resolution of fever and leukocytosis. As transaminitis improved, risperidone was restarted on day 4; however, transaminitis subsequently worsened. Further work-up was negative for viral hepatitis A/B/C and CMV/EBV infection. Liver core biopsy revealed periductal inflammation with onion skinning-like pattern (Figure 1–3), consistent with secondary sclerosing cholangitis. Transaminitis improved following discontinuation of risperidone. Subsequent endoscopic retrograde cholangiopancreatography revealed three stones in the lower common bile duct, with moderate, diffuse duct dilation. DISCUSSION: Risperidone and other antipsychotics have been reported to induce cholestatic hepatitis. Previous case reports have suggested an association of risperidone with drug-induced hepatitis, as evidenced by transaminitis and inflammatory liver parenchymal changes. Our case is the first to suggest a link between risperidone and secondary sclerosing cholangitis. The fibrotic changes of biliary duct, as well as the temporal relationship between risperidone intake and elevation of hepatic enzymes, are suggestive of this diagnosis. The findings of multiple ductal stones and ductal dilation likely represent the chronic inflammatory process.Figure 1.: Hematoxylin & eosin stain demonstrates the characteristic onion-skinning changes in periductal area.Figure 2.: Trichrome stain reveals high collagen content (blue) in the onion-skinning pattern, predominantly in the periductal area, consistent with active fibroblastic proliferation.Figure 3.: Inflammatory cells infiltrate hepatic parenchyma, consistent with non-specific immune response seen in hepatitis.

Primary Sclerosing Cholangitis

10.14309/01.ajg.0000707588.33999.5d

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Upper Airway Complications in COVID-19: A Case Series

Cureus (2023)

Sushmita Shrestha Yong Soon Shin Oleg Sostin Polina Pinkhasova John Chronakos

Prolonged intubation is associated with several complications leading to upper airway obstruction, including tracheal stenosis and tracheomalacia. Tracheostomy may potentially decrease the risk of tracheal injury in patients with upper airway obstruction. The ideal timing to perform tracheostomy remains controversial. Prolonged intubations were particularly common during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to present a series of five cases of upper airway complications in patients who underwent mechanical ventilation in the setting of COVID-19 and discuss their clinical aspects, risk factors, and therapeutic strategies.

Tracheomalacia

Airway obstruction

Subglottic stenosis

10.7759/cureus.37163

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Octreotide as a novel agent for the management of bronchorrhea in mechanically ventilated patients: A case series and review of literature

Respiratory Medicine Case Reports (2023)

Sambhawana Bhandari Oleg Sostin Akash Shah John Chronakos Douglas Kahn

Excessive bronchial secretions pose a challenge in mechanically-ventilated patients and may prolong the time to extubation, increasing the risk for pneumonia. Octreotide, a somatostatin analog, has been used to decrease bronchial secretions especially for the symptomatic management of patients with lung cancer. We describe three patients in the form of a case series and discuss effect of octretotide on bronchial secretions and management of bronchorrhea in the intensive care unit. Similar to reports of its utilization in palliative care in patients with lung cancer, we observed a clinically significant decrease in the rate of bronchial secretions.

Somatostatin Analogue

10.1016/j.rmcr.2023.101891

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Outcomes of Transcatheter Mitral Valve Repair in Patients With Rheumatoid Arthritis – A Retrospective Study from the National Inpatient Sample Database

Research Square (Research Square) (2023)

Amr Abdelradi Rima Pai Cynthia Feher Oleg Sostin

Abstract Introduction: Transcatheter mitral valve repair (TMVR) with the MitraClip device is a widely performed procedure for both primary and secondary mitral regurgitation. Several studies have assessed outcomes of TMVR in subpopulations with different comorbidities. However, there is no data on the safety and outcomes of TMVR in patients with rheumatoid arthritis (RA), which is a known independent risk factor for cardiovascular disease. Methods: We performed a retrospective analysis using data from the Nationwide Inpatient Sample (NIS) database from 2016-2019 to assess the outcomes of TMVR in patients with RA vs. without RA. Our primary outcome was in-hospital mortality following TMVR. Our secondary outcomes included the association of pre-specified comorbidities with in-hospital mortality and rates of post-procedural complications between RA vs. without RA groups. Results: A total of 4,176 patients were included in analysis (85 with RA, 4091 without RA). Our results showed no significant difference in mortality between patients with versus without RA (OR 0.798, p = 0.825). Patients with underlying diabetes had significantly increased mortality following TMVR (OR 1.843, p = 0.027). Patients with underlying CABG had significantly lower mortality following TMVR (OR 0.439, p = 0.047). Multivariate regression analysis of in-hospital complications showed no significant difference in complications between the RA vs. without RA groups. Conclusion: Our data shows no increased risk of in-hospital mortality or complications in patients with RA following TMVR.

10.21203/rs.3.rs-2901699/v1

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OCTREOTIDE AS A NOVEL AGENT FOR MANAGEMENT OF BRONCHORRHEA IN MECHANICALLY VENTILATED PATIENTS

CHEST Journal (2020)

Akash Shah John Chronakos Oleg Sostin Douglas Kahn José L. Méndez

PURPOSE:In mechanically-ventilated (MV) patients, excessive bronchial secretion may prolong time to extubation, increasing the risk for pneumonia and other serious complications.Bronchorrhea, production of sputum of >100 mL/24 hr, results from a combination of multiple pathophysiological processes.Effectiveness of the current standard of care interventions for management of bronchorrhea remains limited.As somatostatin receptors play a role in regulation of bronchial secretions, we studied use of octreotide, a somatostatin receptor agonist, in management of bronchorrhea in the ICU, which is a novel use of this agent METHODS:In this open-label, single-center, randomized trial, MV patients with the bronchial secretion rate of > 200 ml/24 hours were included.Subjects in the control group received standard of care interventions for management of bronchial secretions.In the intervention group, octreotide drip was administered for up to 72 hours (at a rate of 12-25 mcg/hour), in addition to the standard of care.The primary outcome was a change in the bronchial secretions rate, measured every 12 hours and compared to the baseline.Due to the low prevalence of bronchorrhea in the ICU patients in our community hospital, we report our results as a case series.RESULTS: Patient 1: 58-year-old male with a history of COPD and smoking, who presented with abdominal hematoma complicated by hemorrhagic shock requiring massive transfusion, complicated by TRALI and bacterial pneumonia requiring MV for respiratory failure, complicated by bronchorrhea.His baseline secretion rate of 310 mL decreased to 10 mL/12 hours, after 60 hours on octreotide.Patient 2: 61-year-old male, non-smoker, who presented with pneumonia, septic shock, AKI, and ARDS.The MV, required for acute respiratory failure, was complicated by bronchorrhea.His baseline secretion was 200 mL, which reduced to140 cc by the end of the octreotide course.He was successfully extubated.Patient 3:54-year-old male with a history of COPD and smoking, admitted with acute respiratory failure in the setting of COPD exacerbation and pneumonia.His baseline secretion rate of 300 mL decreased to < 50 ml after 48 hours on octreotide drip.The patient was successfully extubated. CONCLUSIONS:We observed a clinically significant decrease in bronchial secretion rate in bronchorrhea when octreotide drip was used.Octreotide is a safe and inexpensive agent.It's effectiveness in ICU patients with excessive bronchial secretions should be further investigated in randomized controlled trials.CLINICAL IMPLICATIONS: Octreotride demonstrates efficacy in bronchorrhea and warrants further investigations.

10.1016/j.chest.2020.08.1938

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CHARACTERISTICS OF PATIENTS WITH FREQUENT EXACERBATOR PHENOTYPE OF COPD AND ROLE OF INHALED CORTICOSTEROID THERAPY

CHEST Journal (2020)

Sushmita Shrestha Uladzislau Valynets Manish Gupta Prajay Rathore Oleg Sostin

Medical record

Obstructive lung disease

10.1016/j.chest.2020.08.1563

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Comparison of the Microbiome Composition of Rectal Stool vs Laxative-purged Liquid Stool in Patients Undergoing Screening Colonoscopy

The American Journal of Gastroenterology (2016)

Oleg Sostin L Arrigo Deep Pandya Adam B. Gorelick Anna-Marie Dufresne

Introduction: Recent studies have generated new insights on the effects of gut microbiome on human health. As a result, diagnostic strategies that focus on analysis of an individual's microbiota are being developed. Traditionally, rectal stool samples have been used to characterize taxonomic composition of gut microbiome. However, the environment of the small intestine and colon is different from the rectum and supports different microbial communities. Analysis of solid rectal stool may not provide complete information about gut microbiome. The purpose of this study was to determine if significant differences in microbiome composition can be detected between laxative-purged liquid stool, which may reflect right colon microbiota, and solid rectal stool. Methods: Twenty subjects with no history of gastrointestinal disorders or recent antibiotic use were recruited prior to undergoing screening colonoscopy. Solid stool samples were collected before starting preparation with Colyte (S1) and in two months after colonoscopy (S2). Liquid stool samples (L1, L2, and L3) were consecutively collected at different times during the preparation. Metagenomics libraries were prepared targeting the V3-V4 variable region of the 16s rRNA gene from the samples. A reference database was used for bioinformatics analysis to identify microbiome composition, which was compared between the sample groups. Results: Sequencing resulted in 20.5 M reads in total. Distribution of Actinobacteria, Bacteroidetes, and Firmicutes phyla was significantly different between solid and liquid groups (Wilcoxon test, p < 0.05). Our initial analysis focused on comparing S1 and L2 sample groups. Adonis group significance test showed a marked difference in overall bacterial abundance (p < 0.001). A nonparametric Wilcoxon test was carried out to compare absolute abundance of all phyla; Euryarchaeota, Actinobacteria, Bacteroidetes, Cyanobacteria, Tenericutes, and Verrucomicrobia phyla showed significant difference (p < 0.05). Wilcoxon sign rank test for paired samples of S1 and L2 was performed at the genus level and showed significant difference in 50% of subjects (p < 0.05). Conclusion: Initial analysis revealed significant differences in microbiome composition between solid rectal stool and liquid stool. Our study suggests that analysis of both solid and liquid stool samples should be performed to characterize individual's gut microbiome. This may lead to new insights regarding etiology of some disease processes.

10.14309/00000434-201610001-00174

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