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Sepsis Management: An Evidence-Based Approach., Muhammad Akbar Baig, Hira Shahzad, Bushra Jamil, Erfan Hussain 2017 Aga Khan University

Sepsis Management: An Evidence-Based Approach., Muhammad Akbar Baig, Hira Shahzad, Bushra Jamil, Erfan Hussain

Bushra Jamil

The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care ...


Association Of Hypercapnia On Admission With Increased Length Of Hospital Stay And Severity In Patients Admitted With Community-Acquired Pneumonia: A Prospective Observational Study From Pakistan., Nousheen Iqbal, Muhammad Irfan, Ali Bin Sarwar Zubairi, Safia Awan, Javaid Khan 2017 Aga Khan University

Association Of Hypercapnia On Admission With Increased Length Of Hospital Stay And Severity In Patients Admitted With Community-Acquired Pneumonia: A Prospective Observational Study From Pakistan., Nousheen Iqbal, Muhammad Irfan, Ali Bin Sarwar Zubairi, Safia Awan, Javaid Khan

Department of Medicine

Objectives: To determine whether the presence of hypercapnia on admission in adult patients admitted to a university-based hospital in Karachi, Pakistan with community-acquired pneumonia (CAP) correlates with an increased length of hospital stay and severity compared with no hypercapnia on admission.

Study Design: A prospective observational study.

Settings: Tertiary care hospital in Karachi, Pakistan.

Methods: Patients who met the inclusion criteria were enrolled in the study. The severity of pneumonia was assessed by CURB-65 and PSI scores. An arterial blood gas analysis was obtained within 24 hours of admission. Based on arterial PaCO2 levels, patients were divided into three ...


Central Role Of Il-23 And Il-17 Producing Eosinophils As Immunomodulatory Effector Cells In Acute Pulmonary Aspergillosis And Allergic Asthma, Evelyn V. Santos Guerra, Chrono K. Lee, Charles A. Specht, Bhawna Yadav, Haibin Huang, Ali Akalin, Jun R. Huh, Christian Mueller, Stuart M. Levitz 2017 University of Massachusetts Medical School

Central Role Of Il-23 And Il-17 Producing Eosinophils As Immunomodulatory Effector Cells In Acute Pulmonary Aspergillosis And Allergic Asthma, Evelyn V. Santos Guerra, Chrono K. Lee, Charles A. Specht, Bhawna Yadav, Haibin Huang, Ali Akalin, Jun R. Huh, Christian Mueller, Stuart M. Levitz

Christian Mueller

Aspergillus fumigatus causes invasive pulmonary disease in immunocompromised hosts and allergic asthma in atopic individuals. We studied the contribution of lung eosinophils to these fungal diseases. By in vivo intracellular cytokine staining and confocal microscopy, we observed that eosinophils act as local sources of IL-23 and IL-17. Remarkably, mice lacking eosinophils had a >95% reduction in the percentage of lung IL-23p19+ cells as well as markedly reduced IL-23 heterodimer in lung lavage fluid. Eosinophils killed A. fumigatus conidia in vivo. Eosinopenic mice had higher mortality rates, decreased recruitment of inflammatory monocytes, and decreased expansion of lung macrophages after challenge with ...


Perinatal Outcomes In Pregnancy With Asthma., Rashid Jooma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi 2017 Agha Khan University

Perinatal Outcomes In Pregnancy With Asthma., Rashid Jooma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Rashid Jooma

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort. Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths. Results: The mean age of asthmatics and nonasthmatics were 28 ...


Recombinant Aav Serotype And Capsid Mutant Comparison For Pulmonary Gene Transfer Of Alpha-1-Antitrypsin Using Invasive And Noninvasive Delivery, Rejean Liqun Wang, Thomas J. McLaughlin, Travis Cossette, Qiushi Tang, Kevin Foust, Martha Campbell-Thompson, Ashley Martino, Pedro Cruz, Scott Loiler, Christian Mueller, Terence R. Flotte 2017 University of Florida

Recombinant Aav Serotype And Capsid Mutant Comparison For Pulmonary Gene Transfer Of Alpha-1-Antitrypsin Using Invasive And Noninvasive Delivery, Rejean Liqun Wang, Thomas J. Mclaughlin, Travis Cossette, Qiushi Tang, Kevin Foust, Martha Campbell-Thompson, Ashley Martino, Pedro Cruz, Scott Loiler, Christian Mueller, Terence R. Flotte

Christian Mueller

Recombinant adeno-associated viral (rAAV) vectors have been widely used in pulmonary gene therapy research. In this study, we evaluated the transduction and expression efficiencies of several AAV serotypes and AAV2 capsid mutants with specific pulmonary targeting ligands in the mouse lung. The noninvasive intranasal delivery was compared with the traditional intratracheal lung delivery. The rAAV8 was the most efficient serotype at expressing alpha-1-antitrypsin (AAT) in the lung among all the tested serotypes and mutants. A dose of 1 x 1010 vg of rAAV8-CB-AAT transduced a high percentage of cells in the lung when delivered intratrachealy. The serum and the broncho-alveolar ...


The Presence Of Copd Does Not Influence Clinical Outcomes In Hospitalized Patients With Community-Acquired Pneumonia, Rosemeri Maurici, Alessandra Morello Gearhart, Vanessa Viríssimo Maciel, Forest Arnold, Francisco Fernandez, Annuradha K. Persaud, Stephen Furmanek, Timothy Wiemken, Julio Ramirez, Rodrigo Cavallazzi 2017 Postgraduate Program in Medical Sciences / Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil

The Presence Of Copd Does Not Influence Clinical Outcomes In Hospitalized Patients With Community-Acquired Pneumonia, Rosemeri Maurici, Alessandra Morello Gearhart, Vanessa Viríssimo Maciel, Forest Arnold, Francisco Fernandez, Annuradha K. Persaud, Stephen Furmanek, Timothy Wiemken, Julio Ramirez, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

Introduction

Community-acquired pneumonia (CAP) is a leading cause of death worldwide. Chronic obstructive pulmonary disease (COPD) is a well-established risk factor for development of CAP. What is not as clear is the impact of COPD in the outcomes of patients with CAP. In this study, we compared the outcomes of CAP in COPD and non-COPD patients.

Methods

This was a retrospective cohort study. We conducted a secondary analysis of the Community-Acquired Pneumonia Organization (CAPO) international cohort study database, which includes patients with CAP admitted to several hospitals throughout the world. Outcomes were time to clinical stability, length of hospital stay ...


Sepsis In Patients With Ventilator Associated Pneumonia Due To Methicillin- Resistant Staphylococcus Aureus: Incidence And Impact On Clinical Outcomes, Anupama Raghuram, Martin Gnoni, Timothy Lee Wiemken, Leslie Beavin, Julio A. Ramirez, Forest W. Arnold, Marcus J. Zervos, Daniel H. Kett, Thomas M. File Jr., Gary Stein, Kimbal D. Ford, Paula Peyrani, the IMPACT-HAP Investigators 2017 University of Louisville, Louisville, KY

Sepsis In Patients With Ventilator Associated Pneumonia Due To Methicillin- Resistant Staphylococcus Aureus: Incidence And Impact On Clinical Outcomes, Anupama Raghuram, Martin Gnoni, Timothy Lee Wiemken, Leslie Beavin, Julio A. Ramirez, Forest W. Arnold, Marcus J. Zervos, Daniel H. Kett, Thomas M. File Jr., Gary Stein, Kimbal D. Ford, Paula Peyrani, The Impact-Hap Investigators

The University of Louisville Journal of Respiratory Infections

Background: Sepsis is a clinical syndrome associated with organ dysfunction due to a dysregulated host response to infection. Methicillin-resistant Staphylococcus aureus (MRSA) Ventilator-associated pneumonia (VAP) is a serious infection frequently associated with sepsis. The objectives of this study were to define the incidence of sepsis and clinical failure in patients with MRSA VAP.

Methods: This was a secondary analysis of the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. We used the ...


Case Series Of Rare Interstitial Lung Disease (Ild)., Naveed Haroon Rashid, Saba Farooq, Mohammad Ahmed, Ali Bin Sarwar Zubairi 2017 Aga Khan University

Case Series Of Rare Interstitial Lung Disease (Ild)., Naveed Haroon Rashid, Saba Farooq, Mohammad Ahmed, Ali Bin Sarwar Zubairi

Department of Medicine

Pulmonary alveolar proteinosis (PAP) is a rare lung disease where periodic acid Schiff (PAS)-positive eosinophilic material accumulates in the alveoli of the lungs. Here we describe two cases of young males who presented with dynpnoea and weight loss. The HRCT scan of the chest in both cases showed the typical "crazy-paving" pattern and lung biopsies confirmed the diagnosis of PAP. They showed remarkable symptomatic improvement with therapeutic whole lung lavage.


Appendicular Mass – A Rare Form Of Tuberculosis, Petrisor Banu, Vlad D. Constantin, Florian Popa, Mircea Bratucu, Teodora Vladescu, Cristian Balalau 2017 Carol Davila University, Department of Surgery, Bucharest, Romania

Appendicular Mass – A Rare Form Of Tuberculosis, Petrisor Banu, Vlad D. Constantin, Florian Popa, Mircea Bratucu, Teodora Vladescu, Cristian Balalau

Journal of Mind and Medical Sciences

Tuberculosis is in the top 10 causes of death worldwide, being one of the most deadly infectious diseases. It is estimated that one of three people from the entire earth population has a latent infection with M tuberculosis. This aerobic bacterium possesses the ability to persist in host tissues for years and to begin replication once immunity declines.

The lungs are most frequent site of infection as the Mycobacterium tuberculosis is carried by aerosol droplets and is commonly transmitted by respiratory route. The second way of transmission is by contaminated food.

Intestinal contamination coexists with pulmonary tuberculosis and only 10 ...


Evidence Of Potential Bias In A Comparison Of Beta Blockers And Calcium Channel Blockers In Patients With Chronic Obstructive Pulmonary Disease And Acute Coronary Syndrome: Results Of A Multinational Study, Yaa-Hui Dong, Matthew Alcusky, Vittorio Maio, Jun Liu, Mengdan Liu, Li-Chiu Wu, Chia-Hsuin Chang, Mei-Shu Lai, Joshua J. Gagne 2017 Harvard Medical School

Evidence Of Potential Bias In A Comparison Of Beta Blockers And Calcium Channel Blockers In Patients With Chronic Obstructive Pulmonary Disease And Acute Coronary Syndrome: Results Of A Multinational Study, Yaa-Hui Dong, Matthew Alcusky, Vittorio Maio, Jun Liu, Mengdan Liu, Li-Chiu Wu, Chia-Hsuin Chang, Mei-Shu Lai, Joshua J. Gagne

Open Access Articles

OBJECTIVES: A number of observational studies have reported that, in patients with chronic obstructive pulmonary disease (COPD), beta blockers (BBs) decrease risk of mortality and COPD exacerbations. To address important methodological concerns of these studies, we compared the effectiveness and safety of cardioselective BBs versus non-dihydropyridine calcium channel blockers (non-DHP CCBs) in patients with COPD and acute coronary syndromes (ACS) using a propensity score (PS)-matched, active comparator, new user design. We also assessed for potential unmeasured confounding by examining a short-term COPD hospitalisation outcome.

SETTING AND PARTICIPANTS: We identified 22 985 patients with COPD and ACS starting cardioselective BBs ...


Pulmonary Surfactant Fortified With Cath-2 As A Novel Therapy For Bacterial Pneumonia, Brandon J. Baer 2017 University of Western Ontario

Pulmonary Surfactant Fortified With Cath-2 As A Novel Therapy For Bacterial Pneumonia, Brandon J. Baer

Western Research Forum

Background: Bacterial pneumonia is a leading cause of death worldwide, with high mortality rates persisting even after antibiotic treatment. Current treatments for pneumonia involve administration of antibiotics, however after the bacteria are killed they release toxic substances that induce inflammation and lung dysfunction. Host defense peptides represent a potential solution to this problem through their ability to down regulate inflammation. However, effective delivery to the lung is difficult because of the complex branching structure of the airways. My study addresses this delivery problem by using exogenous surfactant, a pulmonary delivery vehicle capable of improving spreading of these peptides throughout the ...


Stem Cell Therapy For End Stage Copd: A Cautionary Tale Of Direct-To-Consumer Advertising, Blake J. Arthurs, Scott Yaekle 2017 Wayne State University

Stem Cell Therapy For End Stage Copd: A Cautionary Tale Of Direct-To-Consumer Advertising, Blake J. Arthurs, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Weiss DJ, Casaburi R, Flannery R, LeRoux-Williams M, Tashkin DP. A placebo-controlled, randomized trial of mesenchymal stem cells in COPD. Chest. 2013;143(6):1590-1598. doi: 10.1378/chest.12-2094


It Is Reasonable To Recommended Intrapleural Alteplase For Loculated Pleural Effusions, Tricia Fernandez 2017 Wayne State University School of Medicine

It Is Reasonable To Recommended Intrapleural Alteplase For Loculated Pleural Effusions, Tricia Fernandez

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Thommi G, Shehan J, Robison K, Christensen M, Backemeyer L, McLeay M. A double blind randomized cross over trial comparing rate of decortication and efficacy of intrapleural instillation of alteplase vs placebo in patients with empyemas and complicated parapneumonic effusions. Respir Med. 2012;17(2):716-723. doi: 10.1016/j.rmed.2012.02.005


Central Role Of Il-23 And Il-17 Producing Eosinophils As Immunomodulatory Effector Cells In Acute Pulmonary Aspergillosis And Allergic Asthma, Evelyn V. Santos Guerra, Chrono K. Lee, Charles A. Specht, Bhawna Yadav, Haibin Huang, Ali Akalin, Jun R. Huh, Christian Mueller, Stuart M. Levitz 2017 University of Massachusetts Medical School

Central Role Of Il-23 And Il-17 Producing Eosinophils As Immunomodulatory Effector Cells In Acute Pulmonary Aspergillosis And Allergic Asthma, Evelyn V. Santos Guerra, Chrono K. Lee, Charles A. Specht, Bhawna Yadav, Haibin Huang, Ali Akalin, Jun R. Huh, Christian Mueller, Stuart M. Levitz

UMass Metabolic Network Publications

Aspergillus fumigatus causes invasive pulmonary disease in immunocompromised hosts and allergic asthma in atopic individuals. We studied the contribution of lung eosinophils to these fungal diseases. By in vivo intracellular cytokine staining and confocal microscopy, we observed that eosinophils act as local sources of IL-23 and IL-17. Remarkably, mice lacking eosinophils had a >95% reduction in the percentage of lung IL-23p19+ cells as well as markedly reduced IL-23 heterodimer in lung lavage fluid. Eosinophils killed A. fumigatus conidia in vivo. Eosinopenic mice had higher mortality rates, decreased recruitment of inflammatory monocytes, and decreased expansion of lung macrophages after challenge with ...


The Association Between High Flow Nasal Cannula Therapy And Intubation In Acute Respiratory Failure Patients, A Single Center Retrospective Analysis, Patrick Nolan 2017 University of Kentucky

The Association Between High Flow Nasal Cannula Therapy And Intubation In Acute Respiratory Failure Patients, A Single Center Retrospective Analysis, Patrick Nolan

DNP Projects

Abstract

Background: High flow nasal cannula therapy is becoming a more common therapy in the adult population. Multiple studies have been conducted on the potential benefits of this therapy such as increased patient tolerance of the therapy, improved secretion clearance and the ability for providers to deliver a greater range of FiO2 settings at a wider range of flow rates. With the increasing utility of this therapy, the research for best practices, setting (FiO2 and LPM) and duration of therapy to guide clinicians is lacking.

Aim: 1) Does high flow nasal cannula therapy reduce the need for intubation or re-intubation ...


Tissue Factor Expression, Regulation, And Signaling In Human Airway Cells, Michael D. Davis 2017 Virginia Commonwealth University

Tissue Factor Expression, Regulation, And Signaling In Human Airway Cells, Michael D. Davis

Theses and Dissertations

Rationale: Tissue Factor (TF) is a transmembrane glycoprotein that canonically functions as the initiator of the coagulation cascade. Increased levels of TF have been associated with inflammatory airway diseases. Since lipopolysaccharide (LPS) is known to elicit and inflammatory response in airway epithelium, we hypothesized that airway epithelial cells release TF when exposed to LPS. Since TF aids in local wound healing, we also hypothesized that inhibition of TF would decrease NHBE growth. The specific aim of this work was to evaluate the effects of LPS exposure on TF production and release from airway epithelia and determine the signaling pathways involved ...


Clinical Manifestations And Outcomes Of Pulmonary Aspergillosis: Experience From Pakistan., Nousheen Iqbal, Muhammad Irfan, Ali Bin Sarwar Zubairi, Kauser Jabeen, Safia Awan, Javaid Khan 2016 Aga Khan University

Clinical Manifestations And Outcomes Of Pulmonary Aspergillosis: Experience From Pakistan., Nousheen Iqbal, Muhammad Irfan, Ali Bin Sarwar Zubairi, Kauser Jabeen, Safia Awan, Javaid Khan

Department of Medicine

Introduction: Pulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan.

Methods: To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan.

Results: Of the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 ...


The Role Of Nicotine, A7 Nicotinic Acetylcholine Receptors And Extracellular Matrix Remodeling In Pulmonary Fibrosis., Glenn Ward Vicary 2016 University of Louisville

The Role Of Nicotine, A7 Nicotinic Acetylcholine Receptors And Extracellular Matrix Remodeling In Pulmonary Fibrosis., Glenn Ward Vicary

Electronic Theses and Dissertations

The median survival for idiopathic pulmonary fibrosis (IPF) patients from diagnosis is a dismal 3 years. This condition is characterized by pulmonary fibroproliferation and excess production and disordered deposition of extracellular matrix (ECM) proteins resulting in obliteration of the original tissue architecture, loss of lung function and eventual death due to respiratory failure. The main hindrance to the development of effective treatments against pulmonary fibrosis is the late detection of its progression and is often of unknown cause. Tobacco smoke represents the most important environmental factor linked to the development of pulmonary fibrosis, with over 60% of IPF patients current ...


Comments On The Editorial On Ild Published In The September 2016 Issue Of Jpma, Ali Bin Sarwar Zubairi 2016 Aga Khan University

Comments On The Editorial On Ild Published In The September 2016 Issue Of Jpma, Ali Bin Sarwar Zubairi

Department of Medicine

No abstract provided.


Clinical Outcomes Of Pneumocystis Pneumonia From A Tertiary Care Centre In Pakistan., Ali Bin Sarwar Zubairi, Hira Shahzad, Afia Zafar 2016 Aga Khan University

Clinical Outcomes Of Pneumocystis Pneumonia From A Tertiary Care Centre In Pakistan., Ali Bin Sarwar Zubairi, Hira Shahzad, Afia Zafar

Department of Medicine

Objective: To assess the predisposing immunocompromised states, administration of pneumocystis jirovecii pneumonia prophylaxis, the disease course and outcomes of patients with pneumocystis jirovecii pneumonia.

Methods: The retrospective study was conducted at the Aga Khan University Hospital in Karachi. The medical records of patients diagnosed with pneumocystis jirovecii pneumonia from January 1995 to October 2015 were retrieved. Baseline characteristics, clinical course, treatment, and mortality rates were noted. SPSS 19 was used for data analysis.

Results: Of the 37 patients, 24(64.9%) were men and 13(35.1%) were women. The overall mean presenting age was 47.08±16.21 years ...


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