Bio

Clinical Focus


  • Internal Medicine
  • Perioperative Medicine

Academic Appointments


Professional Education


  • Residency:St Vincent Charity Hospital (2009) OH
  • Master of Science, University of Texas Health Science Center at Houston, Epidemiology and Biostatistics (2006)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2009)
  • Medical Education:Maulana Azad Medical College (2002) India

Research & Scholarship

Current Research and Scholarly Interests


Quality metrics in Perioperative Medicine

Publications

Journal Articles


  • Eptifibatide overdose INTERNATIONAL JOURNAL OF CARDIOLOGY Parakh, S., Naik, N., Rohatgi, N., Bhat, U., Parakh, K. 2009; 131 (3): 430-432

    Abstract

    Eptifibatide is a glycoprotein (GP) IIb/IIIa inhibitor used globally, but there is little information on overdose. We report a case of eptifibatide overdose with no consequence to the patient.We searched for eptifibatide overdose on PubMed, British National Formulary, Thomson Micromedex, EudraPharm, Toxbase, and the Medicines and Healthcare products Regulatory Agency and Food and Drug Administration websites.In clinical trials, overdose occurred in 17 cases with no adverse events including bleeding. In case reports, prolonged infusions of eptifibatide were associated with gastrointestinal bleeding and thrombocytopenia. In animal studies, eptifibatide was not lethal but induced dyspnea, ptosis, cerebellar dysfunction, hypotonia and petechial hemorrhages. Eptifibatide side effects including chest pain, bradycardia, angioedema and hypotension may occur in patients with overdose. Alveolar hemorrhage should be suspected in patients with hemoptysis, dyspnea or new infiltrates on chest X-ray. Management of overdose requires discontinuation of eptifibatide, monitoring for bleeding and waiting for clearance (primarily renal). Normalization of hemostasis occurs rapidly and coronary bypass surgery performed within 2 hours of eptifibatide discontinuation did not have excess bleeding. Eptifibatide clearance is delayed in renal failure and in one report hemodialysis normalized hemostasis. Platelet transfusion is appropriate in cases of acute thrombocytopenia, a side effect of eptifibatide. If the platelet count is normal, transfusion of platelets does not help as drug molecules overwhelmingly outnumber GP IIb/IIIa receptors. Desmopressin reversed platelet dysfunction caused by eptifibatide in healthy volunteers but is untested in patients.Available data suggest that eptifibatide overdose is rare and can be managed conservatively.

    View details for DOI 10.1016/j.ijcard.2007.07.132

    View details for Web of Science ID 000262328700029

    View details for PubMedID 18023892

  • Fatal cytomegalovirus pneumonia in patients with haematological malignancies: an autopsy-based case-control study CLINICAL MICROBIOLOGY AND INFECTION Torres, H. A., Aguilera, E., Safdar, A., Rohatgi, N., Raad, I. I., SEPULVEDA, C., Luna, M., Kontoyiannis, D. P., Chemaly, R. F. 2008; 14 (12): 1160-1166

    Abstract

    Cytomegalovirus (CMV) pneumonia is a life-threatening infection in patients with haematological malignancies (HMs) or in haematopoietic stem cell transplant (HSCT) recipients. To assess the incidence and risk factors for developing fatal CMV pneumonia in these patients, a case-control study based on 999 autopsies was performed at The University of Texas M. D. Anderson Cancer Center, Houston, Texas (January 1990 to December 2004). Twenty-five cases (patients who died with CMV pneumonia) were matched with 34 controls (patients who died without CMV pneumonia) by type of HM or HSCT, year of autopsy, age and gender. The incidence of CMV pneumonia declined between January 1990 to June /1997 and July 1997 to December 2004 (CMV pneumonia rates were 22/620 and 3/379 autopsies, respectively; p 0.006). Logistic regression analysis identified complete remission and sustained lymphopenia as independent predictors of CMV pneumonia (all p <0.05). The incidence of fatal CMV pneumonia has decreased over the last 15 years, which might reflect earlier diagnosis or the use of pre-emptive therapy or more effective preventive strategies. Complete remission of an HM does not preclude the development of CMV pneumonia among patients with prolonged lymphopenia.

    View details for DOI 10.1111/j.1469-0691.2008.02106.x

    View details for Web of Science ID 000261627200009

    View details for PubMedID 19046167

  • Chemotherapy and survival for patients with multiple myeloma - Findings from a large nationwide and population-based cohort AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS Rohatgi, N., Du, X. L., Coker, A. L., Moye, L. A., Wang, M., Fang, S. 2007; 30 (5): 540-548

    Abstract

    To assess the patterns of chemotherapy use for patients with multiple myeloma and to determine if chemotherapy is effective in prolonging survival outside the clinical trial settings.We studied a nationwide and population-based retrospective cohort of 4902 patients > or =65 years of age with stage II or III multiple myeloma from 1992 to 1999, identified from the Surveillance, Epidemiology, and End-Results-Medicare data. Multivariate logistic regression was used to estimate the odds ratio of receiving chemotherapy and Cox proportional hazard model was used to estimate the hazard ratio of mortality associated with chemotherapy.Of 4902 patients with stage II or III multiple myeloma, 52.0% received chemotherapy during the course of the disease. The receipt of chemotherapy decreased significantly with age from 65.7% in the 65- to 69-year age group to 34.3% in those > or =80 years. Blacks (47.6%) were less likely to receive chemotherapy than whites (52.8%). Use of chemotherapy decreased significantly with comorbidity scores and increased over time. Risk of all-cause mortality was significantly reduced in patients who received chemotherapy compared with those who did not (adjusted hazard ratio = 0.65; 95% confidence interval = 0.61-0.69). A similar pattern as observed for myeloma-specific mortality (0.61; 0.56-0.67). Survival benefit increased with increasing cycles of chemotherapy (P < 0.001 for trend) and was significant across different age groups, gender, ethnic groups, and comorbidity scores.Chemotherapy was significantly associated with increased survival in patients with multiple myeloma outside the clinical trial settings. This survival benefit was significant across different groups by age, gender, race, and comorbidity. A substantial number of patients with multiple myeloma did not receive chemotherapy.

    View details for DOI 10.1097/COC.0b013e3180592a30

    View details for Web of Science ID 000250023100014

    View details for PubMedID 17921717

  • Characteristics and outcome of respiratory syncytial virus infection in patients with leukemia HAEMATOLOGICA-THE HEMATOLOGY JOURNAL Torres, H. A., Aguilera, E. A., Mattiuzzi, G. N., Cabanillas, M. E., Rohatgi, N., Sepulveda, C. A., Kantarjian, H. M., Jiang, Y., Safdar, A., Raad, I. I., Chemaly, R. F. 2007; 92 (9): 1216-1223

    Abstract

    Little is known about respiratory syncytial virus (RSV) infection in patients with leukemia. The aim of this study was to determine the characteristics, and the outcome of RSV infection with or without therapy with aerosolized ribavirin in leukemia patients.We reviewed the records of 52 leukemia patients with RSV infection seen at our institution between October 2000 and March 2005.The median age of the patients was 47 years (range, 1-83 years). Most patients were male (65%) and had acute leukemia (65%); 46% had received salvage chemotherapy and 62% corticosteroids before RSV infection. Compared to the 25 patients with upper respiratory tract infection (URI), the 27 patients with pneumonia had a higher median APACHE II score at the time of the first assessment at the hospital for respiratory symptoms (11 vs 16), and a higher rate of corticosteroid treatment in the month preceding the infection (48% vs 74%) (all p < or =0.05). Twenty-four (46%) patients received aerosolized ribavirin. Patients who presented with URI and were treated with ribavirin were less likely than non-treated patients to develop pneumonia (68% vs 96%, p<0.01) and possibly die of pneumonia (6% vs 36%, p=0.1). Multiple logistic regression analysis identified high APACHE II score and lack of ribavirin treatment as independent predictors of progression to pneumonia (p=0.01). Five patients (10%) died within 30 days of RSV infection; all had pneumonia.RSV infection is associated with significant morbidity and mortality in leukemia patients; treatment with aerosolized ribavirin at the stage of URI may prevent pneumonia in some subsets of patients.

    View details for DOI 10.3324/haematol.11300

    View details for Web of Science ID 000249402100010

    View details for PubMedID 17666367

  • Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients - A retrospective study at a major cancer center MEDICINE Chemaly, R. F., Ghosh, S., Bodey, G. P., Rohatgi, N., Safdar, A., Keating, M. J., Champlin, R. E., Aguilera, E. A., Tarrand, J. J., Raad, I. I. 2006; 85 (5): 278-287

    Abstract

    Community respiratory viruses (CRVs) have been recognized as a potential cause of pneumonia and death among hematopoietic stem cell transplantation (HSCT) recipients and patients with hematologic malignancies. We reviewed the Microbiology Laboratory records dated from July 1, 2000, to June 30, 2002, to identify patients who had respiratory specimens positive for influenza, parainfluenza, respiratory syncytial virus, or picornavirus. We identified 343 infections among patients with underlying hematologic malignancies and HSCT. We collected data on type of disease, age, sex, type of infection, neutrophil and lymphocyte counts, therapy, and outcome. Influenza, parainfluenza, and respiratory syncytial virus accounted for most cases and were approximately equal in frequency. Most infections occurred predominantly among recipients of allogeneic transplants. Infection progressed to pneumonia in 119 patients (35%) and occurred with similar frequency for the 3 viruses. Patients at greatest risk for developing pneumonia included those with leukemia, those aged more than 65 years, and those with severe neutropenia or lymphopenia. Lack of respiratory syncytial virus-directed antiviral therapy (p=0.025) and age (p=0.042) were associated with development of respiratory syncytial virus pneumonia, and an absolute lymphocyte count

    View details for DOI 10.1097/01.md.0000232560.22098.4e

    View details for Web of Science ID 000240661300003

    View details for PubMedID 16974212

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