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Amyotrophic Lateral Sclerosis Presenting As Chronic Cough, Marjorie Friedman, MD 2018 Thomas Jefferson University

Amyotrophic Lateral Sclerosis Presenting As Chronic Cough, Marjorie Friedman, Md

The Medicine Forum

INTRODUCTION

Amyotrophic Lateral Sclerosis (ALS) is a debilitating, uniformly fatal disease. While it most commonly presents with limb weakness, patients may also present with neurocognitive, respiratory, or bulbar symptoms. Despite its poor prognosis, an early diagnosis can save patients from unnecessary and expensive testing, lead to interventions that improve quality of life, and give patients and family time for advanced planning.1 This case highlights an unusual presentation of ALS.

KEY POINTS

  • Our patient presented with chronic cough and restrictive lung disease and after extensive workup was diagnosed with ALS.
  • Bulbar and respiratory symptoms are uncommon initial presentations of ALS ...


Use Of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture, Rajiv Kabadi, MD 2018 Thomas Jefferson University

Use Of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture, Rajiv Kabadi, Md

The Medicine Forum

INTRODUCTION

Iatrogenic tracheal rupture is a rare complication of endotracheal intubation and has a high risk of morbidity and mortality. Risk factors include female gender, short stature (height less than 160-cm), difficult airway anatomy, underlying connective tissue disorder, chronic obstructive pulmonary disease, use of a rigid stylet, inadequate intubation tube size, cuff over-inflation, emergent intubation and intubation performed by non-anesthesiologists. 1 Early recognition is important and diagnosis requires bronchoscopic confirmation.2,3 We describe a case where emergent venovenous extra-corporeal membrane oxygenation (VV-ECMO) was utilized in the management of tracheal rupture.

KEY POINTS

  • Tracheal rupture is an uncommon but severe ...


A Rare Case Of Diffuse Alveolar Hemorrhage Secondary To Dabigatran Successfully Treated With Extracorporeal Membrane Oxygenation, C. Hutchinson, F. M. West, H. Hirose 2018 Thomas Jefferson University

A Rare Case Of Diffuse Alveolar Hemorrhage Secondary To Dabigatran Successfully Treated With Extracorporeal Membrane Oxygenation, C. Hutchinson, F. M. West, H. Hirose

Department of Medicine Posters

Introduction

Dabigatran, a direct thrombin inhibitor, is used for stroke risk reduction in non-valvular atrial fibrillation and for treatment and prevention of venous thromboembolism. Minor side effects include indigestion and stomach pain. Major life threatening bleeding occurs in up to 2% of patients and is largely attributed to gastrointestinal hemorrhage. Here, we describe a case of a dabigatran related diffuse alveolar hemorrhage (DAH) treated successfully with extracorporeal membrane oxygenation.


Alcohol Drives Oxidation-Dependent Desensitization Of Airway Cilia Motility Responsiveness, Michael Price 2018 University of Nebraska Medical Center

Alcohol Drives Oxidation-Dependent Desensitization Of Airway Cilia Motility Responsiveness, Michael Price

Theses & Dissertations

Alcohol abuse, which can impair clearance of pathogens and debris from the airway, is associated with an increase in complications and a higher mortality rate during the progression of pneumonia. With prolonged alcohol exposure, mucociliary clearance (MCC), which depends on the coordinated beating of cilia, is dysfunctional. Effective MCC relies on cAMP-dependent protein kinase (PKA) activation of ciliary beat frequency (CBF). PKA activation and stimulation of CBF are blunted with chronic exposure to alcohol. This phenomenon is known as alcohol-induced ciliary dysfunction (AICD). Previous studies have shown that concomitant feeding of mice with alcohol and antioxidants prevents AICD, suggesting a ...


Granulomatosis With Polyangiitis: A 17 Year Experience From A Tertiary Care Hospital In Pakistan, Omar Irfan, Haris Khan, Zarrar Khan, Alina Ashraf, Rimsha Ahmed, Javaid Khan, Ali Bin Sarwar Zubairi 2018 Aga Khan University

Granulomatosis With Polyangiitis: A 17 Year Experience From A Tertiary Care Hospital In Pakistan, Omar Irfan, Haris Khan, Zarrar Khan, Alina Ashraf, Rimsha Ahmed, Javaid Khan, Ali Bin Sarwar Zubairi

Section of Pulmonary & Critical Care

Objective: Granulomatosis with Polyangiitis (GPA) is an autoimmune, multi-system, small and medium vessel vasculitis with granulomatous inflammation. Aim of this study was to assess the clinical and radiological presentations of patients with GPA amongst the Pakistani population. It is a single centre retrospective single observation study.

Results: Study was conducted at the Aga Khan University Hospital, Karachi with records were reviewed from January 2000 to December 2017. Definitive diagnosis was made using a combination of serological anti-neutrophil cytoplasmic antibody (ANCA) testing along with the clinical and radiological presentation. A total of 51 patients met the diagnostic criteria in the time ...


Investigation Of Reactive Oxygen Species Production In The Rat Lung Using Optical Imaging, Nina Friedly 2018 Marquette University

Investigation Of Reactive Oxygen Species Production In The Rat Lung Using Optical Imaging, Nina Friedly

Master's Theses (2009 -)

Oxidative stress, the imbalance between production of oxidants or reactive oxygen species (ROS) and antioxidant activity, plays a key role in the pathogenesis of acute and chronic lung diseases. The objective of this thesis was to develop a robust protocol for measuring the rate of H2O2 production in isolated perfused rat lungs and to determine the cellular sources of that rate using Amplex Red (AR). For a given lung, AR (25 mM) along with horseradish peroxidase (5 U/ml) and ascorbate oxidase (1U/ml) were added to a perfusate reservoir that was recirculated through the lungs and sampled at 5 ...


Constrictive Pericarditis Presenting As Bilateral Pleural Effusion: A Report Of Two Cases, Manesh Kumar Gangwani, Salman B. Mahmood,, Fariha Hasan, Javaid Khan 2018 Aga Khan University

Constrictive Pericarditis Presenting As Bilateral Pleural Effusion: A Report Of Two Cases, Manesh Kumar Gangwani, Salman B. Mahmood,, Fariha Hasan, Javaid Khan

Section of Pulmonary & Critical Care

Constrictive pericarditis is a rare presentation. We need a very high index of clinical suspicion to diagnose the disease. It most commonly presents secondary to tuberculosis (TB) in the developing world and post-radiation therapy in the developed world. Classically, it presents with symptoms of heart failure and as pericardial thickening or calcification on imaging studies. In hospital settings, constrictive pericarditis is not usually considered as a differential in patients presenting with pleural effusion. According to the literature, associated pleural effusions in cases of constrictive pericarditis could be left-sided. Herein, we present two unusual presentations of cases with bilateral pleural effusions ...


Effect Of Study Design On Sample Size In Studies Intended To Evaluate Bioequivalence Of Inhaled Short-Acting Β-Agonist Formulations, Yaohui Zeng, Sachinkumar Singh, Kai Wang, Richard C. Ahrens 2018 University of Iowa

Effect Of Study Design On Sample Size In Studies Intended To Evaluate Bioequivalence Of Inhaled Short-Acting Β-Agonist Formulations, Yaohui Zeng, Sachinkumar Singh, Kai Wang, Richard C. Ahrens

Stead Family Department of Pediatrics Publications

Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3-by-1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration-recommended 3-by-1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with ...


Validation Of An Algorithm Allowing Identification Of Primary Spontaneous Pneumothorax Cases From Administrative Databases, Eric Frechette 2018 The University of Western Ontario

Validation Of An Algorithm Allowing Identification Of Primary Spontaneous Pneumothorax Cases From Administrative Databases, Eric Frechette

Electronic Thesis and Dissertation Repository

Introduction: There is no differentiation between primary spontaneous pneumothorax (PSP) and secondary pneumothorax (SP) in the current version of the International Classification of Diseases (ICD-10). Objective: To validate the accuracy of an algorithm that identifies cases of PSP from administrative databases. Methods: The charts of 150 patients who attended the emergency room (ER) with a recorded main diagnosis of pneumothorax were reviewed. The corresponding hospital administrative data collected during previous hospitalizations and ER visits were processed through the proposed algorithm. The results were compared over two different age groups. Results: The results obtained from the PSP algorithm demonstrated a significantly ...


Indicators For Prediction Of Mycobacterium Tuberculosis Positivity Detected With Bronchoalveolar Lavage Fluid, Xi Liu, Xing-Fang Hou, Lei Gao, Guo-Fang Deng, Ming-Xia Zhang, Qun-Yi Deng, Tao-Sheng Ye, Qian-Ting Yang, Bo-Ping Zhou, Zhi-Hua Wen, Hai-Ying Liu, Hardy Kornfeld, Xin-Chun Chen 2018 Shenzhen University

Indicators For Prediction Of Mycobacterium Tuberculosis Positivity Detected With Bronchoalveolar Lavage Fluid, Xi Liu, Xing-Fang Hou, Lei Gao, Guo-Fang Deng, Ming-Xia Zhang, Qun-Yi Deng, Tao-Sheng Ye, Qian-Ting Yang, Bo-Ping Zhou, Zhi-Hua Wen, Hai-Ying Liu, Hardy Kornfeld, Xin-Chun Chen

Open Access Articles

BACKGROUND: The diagnosis of active pulmonary tuberculosis (TB) remains a challenge in clinic, especially for sputum negative pulmonary TB. Bronchoalveolar lavage fluid (BALF) has higher sensitivity than sputum for detection of Mycobacterium tuberculosis (Mtb). However, bronchoscopy is invasive and costly, and not suitable for all patients. In order to make TB patients get more benefit from BALF for diagnosis, we explore which indicator might be used to optimize the choice of bronchoscopy.

METHODS: A total of 1539 sputum-smear-negative pulmonary TB suspects who underwent bronchoscopy were recruited for evaluation. The sensitivity, specificity and accuracy of Mtb detection in sputum and BALF ...


Electronic Cigarettes Use And Perception Amongst Medical Students: A Cross Sectional Survey From Sindh, Pakistan, Nousheen Iqbal, Zain A. KHAN, Syed Muhammad Hamza Anwar, Omar Irfan, Babar Irfan, Ammar Mushtaq, Maria Bibi, Faraz Siddiqui, Javaid Khan 2018 Aga Khan University

Electronic Cigarettes Use And Perception Amongst Medical Students: A Cross Sectional Survey From Sindh, Pakistan, Nousheen Iqbal, Zain A. Khan, Syed Muhammad Hamza Anwar, Omar Irfan, Babar Irfan, Ammar Mushtaq, Maria Bibi, Faraz Siddiqui, Javaid Khan

Section of Pulmonary & Critical Care

Objective: The manufacturers of electronic cigarettes (e-cigarettes) are actively marketing their product through electronic and social media. Undergraduate medical students are expected to have better knowledge and awareness as they directly interact with patients in their training, The purpose of this study is therefore, to determine knowledge, use and perception regarding e-cigarettes among medical students from Sindh, Pakistan.

Results: A cross-sectional study was conducted between 1st July and 30th September 2016 at five different medical colleges situated in the second largest province of Sindh, Pakistan. The data was collected through a structured, self-administered questionnaire. Of the 500 students, the mean ...


Tuberculosis And Lung Damage: From Epidemiology To Pathophysiology, Shruthi Ravimohan, Hardy Kornfeld, Drew Weissman, Gregory P. Bisson 2018 University of Pennsylvania

Tuberculosis And Lung Damage: From Epidemiology To Pathophysiology, Shruthi Ravimohan, Hardy Kornfeld, Drew Weissman, Gregory P. Bisson

Open Access Articles

A past history of pulmonary tuberculosis (TB) is a risk factor for long-term respiratory impairment. Post-TB lung dysfunction often goes unrecognised, despite its relatively high prevalence and its association with reduced quality of life. Importantly, specific host and pathogen factors causing lung impairment remain unclear. Host immune responses probably play a dominant role in lung damage, as excessive inflammation and elevated expression of lung matrix-degrading proteases are common during TB. Variability in host genes that modulate these immune responses may determine the severity of lung impairment, but this hypothesis remains largely untested. In this review, we provide an overview of ...


Robot-Assisted Thoracoscopic Resection Of A Posterior Mediastinal Mullerian Cyst, Calvin Chao, Vijay K. Vanguri, Karl Uy 2018 University of Massachusetts Medical School

Robot-Assisted Thoracoscopic Resection Of A Posterior Mediastinal Mullerian Cyst, Calvin Chao, Vijay K. Vanguri, Karl Uy

Open Access Articles

First described in 2005, the Mullerian derived cyst in the mediastinum is a rare finding with few subsequent reports. We report a case of Mullerian cyst occurring in the mediastinum of a 49-year-old female that was resected by robot-assisted thoracoscopic surgery. To our knowledge, this is the first report of robot-assisted resection of Hattori's cyst. Histopathologic analysis revealed ciliated Mullerian-type tubal epithelium positive for paired box gene 8 (PAX8), estrogen receptor (ER), and progesterone receptor (PR), confirming Mullerian differentiation. We also review the clinical presentation, pathology, and differential diagnosis of such cysts.


A Reliable Alternative Of Fiberoptic Bronchoscope Inunanticipated Difficult Airway: Flexible Fiberoptic Cystoscope, Muhammad Sohaib, Khalid Maudood Siddiqui, Muhammad Faisal Khan 2018 Aga Khan University

A Reliable Alternative Of Fiberoptic Bronchoscope Inunanticipated Difficult Airway: Flexible Fiberoptic Cystoscope, Muhammad Sohaib, Khalid Maudood Siddiqui, Muhammad Faisal Khan

Department of Anaesthesia

No abstract provided.


Awareness, Use And Perceptions About E-Cigarettes Among Adult Smokers In Karachi, Pakistan., Maryam Sarfraz, Hamza Abdur Rahim Khan, Amna Urooba, Zainab Manan, Omar Irfan, Ramlah Nadeem, Huma Baqir, Saad Farooq, Zarrar Khan, Javaid Khan, Sarah saleem 2018 Aga Khan University

Awareness, Use And Perceptions About E-Cigarettes Among Adult Smokers In Karachi, Pakistan., Maryam Sarfraz, Hamza Abdur Rahim Khan, Amna Urooba, Zainab Manan, Omar Irfan, Ramlah Nadeem, Huma Baqir, Saad Farooq, Zarrar Khan, Javaid Khan, Sarah Saleem

Section of Pulmonary & Critical Care

OBJECTIVE: To estimate the prevalence of awareness, current use and intention to use of e-cigarettes among adult smokers.

METHODS: This cross-sectional survey was carried out at the Aga Khan University Hospital, Karachi, from July to August 2016, and comprised people aged above 18 years who had smoked more than 100 cigarettes in their lifetime. Convenience sampling method was used. A self-administered questionnaire was used to collect data. SPSS 22 was used for data analysis..

RESULTS: Of the 387 participants, 359(92.8%) were male. The overall mean age was 32.4±12.6 years. Moreover, 215(55.5%) respondents belonged ...


Antibiotic Therapy In Preventing Exacerbations Of Severe Chronic Obstructive Pulmonary Disease, Jamie Trautner 2018 University of North Dakota

Antibiotic Therapy In Preventing Exacerbations Of Severe Chronic Obstructive Pulmonary Disease, Jamie Trautner

Physician Assistant Scholarly Project Papers

Chronic obstructive pulmonary disease (COPD) is a progressive disease that has no cure but is treatable. The treatment goal is to have adequate symptom control, decreased exacerbations, prevent hospitalizations and maintain an independent quality of life. The above are attainable by lifestyle changes and pharmacotherapy. The review of literature is to determine if the benefits of long-term antimicrobial therapy outweigh the risks in the treatment of severe COPD. The search included PubMed, Cochrane and Clinical Key databases. Keywords searched include: chronic obstructive pulmonary disease, antibiotics, macrolides, antibacterial, azithromycin, bronchodilators, standard therapy, COPD exacerbations, adverse effects, and long-term. The gold standard ...


Antibiotic Therapy In Preventing Exacerbations Of Severe Chronic Obstructive Pulmonary Disease, Jamie Trautner 2018 University of North Dakota

Antibiotic Therapy In Preventing Exacerbations Of Severe Chronic Obstructive Pulmonary Disease, Jamie Trautner

Physician Assistant Scholarly Project Posters

• Chronic obstructive pulmonary disease (COPD) is a progressive disease that has no cure but is treatable. The treatment goal is to have adequate symptom control, decreased exacerbations, prevent hospitalizations and maintain an independent quality of life.

• The review of literature is to determine if the benefits of long-term antimicrobial therapy outweigh the risks in the treatment of severe COPD.

• The gold standard for pharmacotherapy consists of inhaled corticosteroids and bronchodilators (long-acting beta2agonist (LABA).

• Adding azithromycin to standard therapy for patients with frequent exacerbations showed a 27% reduction in exacerbation frequency.

• With prolonged use of antimicrobials there is an increased risk ...


Decreased Mortality Of Pulmonary Arterial Hypertension In Duchenne Muscular Dystrophy And Down Syndrome, Mitchell Volin 2018 University of North Dakota

Decreased Mortality Of Pulmonary Arterial Hypertension In Duchenne Muscular Dystrophy And Down Syndrome, Mitchell Volin

Physician Assistant Scholarly Project Posters

The genetic cause of significant disorders like Down syndrome (DS) and Duchenne muscular dystrophy (DMD) is well documented. Pulmonary arterial hypertension (PAH), a co-morbid condition, is tied to mortality among these groups. Individuals with the ability to communicate their symptoms and actively participate in treatment are at an advantage with subsequent benefit. DS and DMD significantly decrease physical ability and communication capacity. Genetic research has allowed for earlier identification of, or predisposition for, the development of PAH. Work has also progressed toward manipulation at the genetic level to decrease the severity and even eradicate the cardiopulmonary disorder. This information is ...


Decreased Mortality Of Pulmonary Arterial Hypertension In Duchenne Muscular Dystrophy And Down Syndrome, Mitchell Volin 2018 University of North Dakota

Decreased Mortality Of Pulmonary Arterial Hypertension In Duchenne Muscular Dystrophy And Down Syndrome, Mitchell Volin

Physician Assistant Scholarly Project Papers

The genetic cause of significant disorders like Down syndrome (DS) and Duchenne muscular dystrophy (DMD) is well documented. Pulmonary arterial hypertension (PAH), a co-morbid condition, is tied to mortality among these groups. If undetected or untreated, in DS, this condition can lead to complications with coronary and lung disease later in life. If undetected or untreated in DMD it can hasten the inevitable prognosis of the disease. Individuals with the ability to communicate their symptoms and actively participate in treatment are at an advantage with subsequent benefit. DS and DMD significantly decrease physical ability and communication capacity.

Genetic research has ...


Health Systems Readiness For Adopting Mhealth Interventions For Addressing Non-Communicable Diseases In Low- And Middle-Income Countries: A Current Debate, Anam Feroz, Muhammad Masood Kadir, Sarah Saleem 2018 Aga Khan University

Health Systems Readiness For Adopting Mhealth Interventions For Addressing Non-Communicable Diseases In Low- And Middle-Income Countries: A Current Debate, Anam Feroz, Muhammad Masood Kadir, Sarah Saleem

Community Health Sciences

In low-and-middle-income countries, epidemiologic transition is taking place very rapidly from communicable diseases to non-communicable diseases. NCDs mortality rates are increasing faster and nearly 80% of NCDs deaths occur in LMICs. Existing weak health systems of LMICs are undergoing a devastating human and economic toll as a result of increasing treatment costs and losses to productivity from NCDs. At the same time, the increasing penetration of mobile phone technology and the spread of cellular network and infrastructure have led to the introduction of the mHealth field. While mHealth field offers a great promise to prevent and control non-communicable diseases in ...


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