2016 AUA Grad Publishes Book: Case Study on Hepatotoxicity
Some students are lucky enough to have research opportunities during med school. Others are even luckier and get to publish research articles as med students. Dr. Nickul Shah conducted research during Clinical Sciences that just resulted in the publication of his first book.
The 2016 AUA graduate is the author of Hepatitis C Infection and Adverse Hepatic Complications to Anesthesia (Scholars’ Press). The book grew from a case that Dr. Shah observed during a surgical rotation at Northside Medical Center in Youngstown, Ohio.
He was working under Dr. Peter Devito, a surgeon, and Dr. Samuel Wilson, an anesthesiologist. A man in his early 50s was admitted for a simple hernia procedure. Before the operation, which was conducted on a Friday night, he told the staff that he had hepatitis C. He attributed the infection to a tattoo he had gotten decades earlier. When they began the procedure, the patient’s liver had a normal red-tan color with regular borders. Six hours after the hernia operation, on Saturday, his blood pressure began to drop and he went into shock. His body temperature was dropping too, and his heart rate was elevated. They administered fluid support and took other measures to bring his blood pressure back up, but it continued to fall through Sunday. On Monday, as they had originally planned, they reopened him at the site of the hernia to check for bleeding or any sort of internal hemorrhage and discovered that his liver had become completely black with irregular nodules. Dr. Wilson asked Dr. Shah what he thought the problem was. Dr. Shah said he didn’t know but thought maybe it had something to do with the hepatitis, while Dr. Wilson told him he suspected it was “anesthesia-induced.” He told him to look into it and try to find out what had gone wrong. The patient would later go into organ failure, and then cardiac arrest twice before expiring.
The medical examiner would eventually report that the patient had a cirrhotic liver on autopsy, but did not list a cause for the cirrhosis. “After extensive research, the anesthesiologist and I determined that the anesthetic may have exacerbated his cirrhosis, with the underlying hepatitis C infection,” Dr. Shah said, adding that while cirrhosis is cumulative, necrosis can result in cirrhosis in an acute manner after drastic organ injury. In this case, it can be said that necrosis was the initial state, and over time cirrhosis occurred.” In the book, Dr. Shah explains the descriptions of key terminology used in the study and the differences between acute injury from fulminant hepatic injury and cirrhosis in the book.
An article he wrote about the case appeared in Internal Medicine (“Hepatotoxicity after Sevoflurane Exposure in a Patient with Chronic Hepatitis C”) in 2015. This year, he published an article about an unrelated case in Consultant (“A Case of Squamous Cell Carcinoma of the Scalp in an African Man”). Scholars’ Press noticed the Internal Medicine article and approached him seven months ago about writing a full-length book about the patient he operated on at Northside Medical Center during rotations. When he sat down to write it, he decided to explore the case through the lenses of anatomy, physiology, biochemistry, immunology, and serology. The target audiences are health professionals who want to read something off-the-beaten path, and general readers. He recommends it to anyone interested in learning more about hepatitis and virology.
Writing a book is definitely something Dr. Shah would do again. He is also interested in teaching, but his most immediate and main goal is to pursue a career as a clinical pathologist.