Pulmonology Commons^™

Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., Justin Herman, Brian Park, Bharat K. Awsare, Frances Mae West, Denine Crittendon, Lilah Evans, Mary Harach, Julie Karp, Alexis R. Peedin, Marianna Lanoue, Barbara Goldsmith, Eugene P. Warnick, Michael Baram

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.

METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min …

Multitex Rct - A Multifaceted Intervention Package For Protection Against Cotton Dust Exposure Among Textile Workers - A Cluster Randomized Controlled Trial In Pakistan: Study Protocol, Asaad Ahmed Nafees, Sara De Matteis, Muhammad Masood Kadir, Peter Burney, David Coggon, Sean Semple, Paul Cullinan

Community Health Sciences

Background: In the Pakistani textile industry the prevalence of workplace respiratory illnesses, including byssinosis, is high. The MultiTex RCT study aims to determine the effectiveness of a multifaceted intervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory symptoms among cotton textile workers, and improving their lung function.
Methods/design: We will conduct a cluster-randomized controlled trial at 28 textile mills in Karachi. The intervention will comprise: training in occupational health for all workers and managers reinforced by regular refresher sessions; the formation of workplace committees to draw up, agree and promote a health and safety plan …

The Use Of Probiotics To Prevent Ventilator-Associated Pneumonia In Adults, Michael Roper, Paige Douthett

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the efficacy and safety of preventing the acquisition of ventilator- associated pneumonia with the use of probiotic supplementation, as compared to a placebo, among hospitalized adult men and women receiving more than 24 hours of mechanical ventilation. Design: Systematic Literature Review. Methods: Systematic searches were conducted through PubMed and Scopus using the search terms “ventilator”, “probiotics”, and “prevention”. Records were excluded from the analysis if they were published before 2015, full text was not available, studies other than randomized control trial or cohort studies, and if the study population was less than 18 years old. Results: Of …

Solitary Endobronchial Papilloma: A Rare Entity, Muhammad Soban Arif Maan, Muhammad Waleed, Amir Humza Sohail, Asna Sulaiman, Javaid Ahmed Khan

Section of Pulmonary & Critical Care

No abstract provided.

Pneumothorax: What’S A Pediatric Pulmonologist To Do?, Terrence W. Carver

Manuscripts, Articles, Book Chapters and Other Papers

A pneumothorax is a collection of air in the pleural space commonly associated with respiratory symptoms. Patients may be relatively asymptomatic but may present with life-threatening distress. Confirmation of a clinically suspected pneumothorax is most often by chest x-ray when patients have been stabilized. Pneumothoraces are first categorized as primary, secondary, or iatrogenic and informs the evaluation and treatment plan. However, despite management guidelines in the literature, their applicability for pediatric patients is limited. Understanding of the historical risk factors including the acute clinical course and how radiographs, both chest X-ray and CT chest illuminate which patients are at highest …

A “Sweet” Look Into A Rare Disease: Presentation And Management Of Acute Febrile Neutrophilic Dermatosis, Christian L. Menezes Do, Joseph Moran Do, Kaitlyn Musco Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Standardizing Aminoglycoside Induced Ototoxicity Monitoring, Claire Elson, Christopher M. Oermann, Stephanie Duehlmeyer, Ellen Meier

Posters

Aminoglycoside (AG) antibiotics are essential for the treatment of cystic fibrosis (CF) lung infections. Pseudomonas aeruginosa. Nontuberculous mycobacteria. Monitoring is critical secondary to potential nephrotoxicity and ototoxicity. Children’s Mercy Kansas City (CMKC), standardized nephrotoxicity monitoring in 2016. Observed variable ototoxicity monitoring practices. Prevalence of ototoxicity, 2016 CFF Patient Registry, 1.1% in pediatric patients (less than or equal to 18 years). 2.2% in pediatric and adult population. National Institute of Deafness and Other Communication Disorders, 13% in US population equal to or less than 12 years old. A standardized AG induced ototoxicity monitoring algorithm (AIOA) was developed and implemented at CMKC …

Plasma Cysteine/Cystine And Glutathione/Glutathione Disulfide Redox Potentials In Hiv And Copd Patients., Walter H. Watson, Jeffrey D. Ritzenthaler, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Tom J. Burke, Yuxuan Zheng, Julio A. Ramirez, Jesse Roman

Faculty and Staff Scholarship

Chronic obstructive pulmonary disease (COPD) is prevalent in patients infected with HIV. The purpose of this study was to test the hypothesis that systemic oxidation correlates with loss of lung function in subjects with COPD, and that HIV infection can contribute to creating such an environment. Subjects were recruited at the University of Louisville in the following groups: HIV-infected (n = 36), COPD (n = 32), HIV and COPD (n = 28), and uninfected controls with normal lung function (n = 34). HIV infection was assessed by viral load and CD4 cell counts. Pulmonary function was determined by spirometry …

Cavitary Lesion In An Immunocompromised Adult, Syed Talha Qasmi, Turuvekere Jayaram, Enrique Rincon

Internal Medicine

No abstract provided.

Flare Of Rheumatoid Arthritis Associated Interstitial Lung Disease Secondary To Lung Biopsy, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Ethan S. Stern Do, Jessica Boehmler Md

Department of Medicine

No abstract provided.

Anti-Synthetase Syndrome Presenting As Rapidly Progressive Interstitial Lung Disease, Nathan Brewster Do, Amogh M. Joshi Do, Alaynna C. Kears Do, Kareem Godil Md, Jessica Boehmler Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Implications Of Frailty In Copd Exacerbations, Aimee Almanzar, Armando Cabrera, Felix Hernandez, Hector Y. Vazquez, Asma Jafri, Miriam Zylberglait Lisigurski, Livasky Concepcion, Gustavo Ferrer

Pulmonary Disease

Introduction The extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) patients are similar to symptoms of frailty, a geriatric syndrome. This study was designed to identify the relation between frailty and patient outcomes during a COPD exacerbation. Methods This retrospective study identified 10,235 patients hospitalized for COPD exacerbation, as well as 16 laboratory tests included in a frailty index that have been linked to frailty. Patients were divided into less frail (0-8 positive laboratory values) and more frail (9-16 positive laboratory values) groups. The primary composite endpoints were mechanical ventilation, ICU length of stay, readmission, and discharge status. Results Of …

Rash Provokes Catastrophic Antiphospholid Syndrome, Alaynna C. Kears Do, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Aaron J. Czysz Md

Department of Medicine

No abstract provided.

Nanoparticles In The Treatment Of Chronic Lung Diseases, Teodora G. Alexescu, Simina Tarmure, Vasile Negrean, Maria Cosnarovici, Victoria M. Ruta, Ionela Popovici, Ioana Para, Mirela G. Perne, Olga H. Orasan, Doina A. Todea

Journal of Mind and Medical Sciences

Nanoparticles, although considered a topic of modern medicine, actually have an interesting history. Currently, advances in nanomedicine hold great promise as drug carrier systems for sustained release and targeted delivery of diverse therapeutic agents. Nanoparticles can be defined as complex drug carrier systems which incorporate and protect a certain drug or particle. Nanoparticles can be administered via different routes, such as intravenous injection, oral administration, or pulmonary inhalation. Even though the use of nano-carriers via pulmonary inhalation is heavily debated, this system represents an attractive alternative to the intravenous or oral routes, due to the unique anatomical and physiological features …

Molecular Characterization Of Multidrug-Resistance In Gram-Negative Bacteria From The Peshawar Teaching Hospital, Pakistan, A. Masseron, L. Poirel, B. Jamil Ali, M. A. Syed, P. Nordmann

Section of Pulmonary & Critical Care

Extended-spectrum β-lactamases, carbapenemases, 16S rRNA methylases conferring pan-drug aminoglycoside resistance and colistin resistance were investigated among Gram-negative bacteria recovered from clinical samples (infections) from 200 individuals hospitalized at the Khyber Teaching Hospital of Peshawar, north Pakistan, from December 2017 to March 2018. Out of 65 isolates recovered, 19% were carbapenem resistant and 16% carried a bla NDM-1 gene, confirming the widespread distribution of NDM producers in this country. The association of the NDM carbapenem-resistance determinant, together with the extended-spectrum β-lactamase CTX-M-15 and 16S rRNA methylases, was frequent, explaining the multidrug-resistance pattern observed. All isolates remained susceptible to colistin.

A Multifaceted Approach To Improve Quarterly Visit Rates At A Pediatric Cystic Fibrosis Care Center, Paula Capel, Jessica Banks, Micaela Mckenna, Ashley Andrews, Christopher M. Oermann

Posters

Standard quality improvement methodology was used to improve quarterly visit rates among cystic fibrosis patients at Children's Mercy Kansas City Cystic Fibrosis Center.

• A family-centered, team-based approach was adopted
• A change in culture led to sustained improvement

Improved quarterly visit rates should drive improvement in outcomes including pulmonary function and nutritional status.

Improving Pneumococcal Vaccination Rates In High Risk Patients Across Multiple Specialty Divisions, Rachel Moran, Julia G. Harris, Claire Olsen, Rana El Feghaly, Liset Olarte, Douglas Blowey, Luke A. Harris

Posters

Pediatric patients with deficient immune systems or certain chronic medical conditions have an increased risk of acquiring invasive pneumococcal disease.

The 23-valent pneumococcal (PPSV23) vaccine provides protection against 23 pneumococcal serotypes and is recommended for patients aged 2 years or older who are high-risk for invasive pneumococcal disease.

Unfortunately, many high-risk patients are not properly vaccinated due to lack of provider knowledge or understanding of accountability between primary care and specialty providers.

The goal of this project was to improve PPSV23 vaccination rates by 10-20% across multiple Children's Mercy Kansas City specialty divisions.

End Tidal Carbon Dioxide Monitoring (Capnography) In The Cardiac Intensive Care Unit, Madeline Elaine Huff, Kenneth T. Shelton

School of Medicine Publications

Background: Carbon dioxide levels can be monitored throughout the respiratory cycle via capnography. In this way, capnography allows healthcare professionals to follow several respiratory factors in real-time, including respiratory depression, apnea, and hypercapnia. Postoperative patients are subjected to significant harm while receiving sedating medications without appropriate monitoring and intervention. Earlier detection of alterations to ventilation status will better enable providers to more accurately dose medications during procedures, especially in high-risk patient populations.

Methods: Patient selection included post-operative patients in the intensive care unit that were receiving sedation/analgesia, high dose or high frequency opioids, epidural or intrathecal pain management, patients that …

Yearly Trend Of Acute Venous Thromboembolism In Patients Admitted With Heart Failure In The United States., Sijan Basnet, Rashmi Dhital, Biswaraj Tharu, Dilli Ram Poudel, Anthony Donato

Reading Hospital Internal Medicine Residency

Introduction: Heart failure (HF) patients are at risk for venous thromboembolism (VTE) during the hospital stay. We aim to study the recent trend of deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE in heart failure patients from years 2000-2013. Methods: We utilized the National (Nationwide) Inpatient Sample database and selected non-pregnant patients over the age of 18 years for this purpose. We selected HF, DVT, PE, and VTE based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We used STATA for analysis. Results: We noted an increase in prevalence of DVT, PE and composite …

Statement On Imaging And Pulmonary Hypertension From The Pulmonary Vascular Research Institute (Pvri), David G. Kiely, David L. Levin, Paul M. Hassoun, Dunbar Ivy, Pei-Ni Jone, Jumaa Bwika, Steven M. Kawut, Jim Lordan, Angela Lungu, Jeremy A. Mazurek

Internal Medicine, East Africa

Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements …

Indications For Lung Transplant Referral And Listing, Omar Shweish, Goutham Dronavalli

Faculty, Staff and Student Publications

Lung transplantation is a valuable therapeutic option for many patients with severe lung disease who have exhausted other medical or surgical therapies. However, since lungs are not a manufacturable organ like artificial heart valves or left ventricular assist devices, and since they are a limited resource compared to number of patients requiring the organs, the Department of Health and Human Services set the Final Rule of organ allocation in 1998. This led to development and implementation of Lung Allocation Score (LAS) in 2005. The score broadly divides lung diseases into 4 diagnostic criteria with a coefficient factor given to each …

A Comparison Of Lung Function Values Among A Scuba Diver Population And In Comparison To A Non-Diver Population, Gabriel C. Hutson, Jeremy D. Rentsch, Erin M. Eaton

Journal of the South Carolina Academy of Science

The purpose of this study was to investigate possible correlations between lung function values (PEF, IRV, ERV, and FVC) among a diver population, as well as in comparison to a non-diver population. Independent variables for both populations were biological sex, age, and weekly physical activity. Independent variables for the diver population were dive tenure, number of logged dives, certification level, and gas mixture used. A spirometry test was conducted to collect lung function values of both populations. Data from this study suggest a statistically significant relationship between diver and non-diver sex and FVC, diver age and ERV, diver sex and …

Mechanisms Of Simvastatin Myotoxicity: The Role Of Autophagy Flux Inhibition., Arya Emami, Shahla Shojaei, Simone C. Da Silva Rosa, Mahmoud Aghaei, Ehsan Samiei, Amir Reza Vosoughi, Forouh Kalantari, Philip Kawalec, James Thliveris, Pawan Sharma, Amir A. Zeki, Mohsen Akbari, Joseph W. Gordon, Saeid Ghavami

Center for Translational Medicine Faculty Papers

Statins are some of the most widely used drugs worldwide, but one of their major side effects is myotoxicity. Using mouse myoblast (C2C12) and human alveolar rhabdomyosarcoma cell lines (RH30) in both 2-dimensional (2D) and 3-dimensional (3D) cell culture, we investigated the mechanisms of simvastatin's myotoxicity. We found that simvastatin significantly reduced cell viability in C2C12 cells compared to RH30 cells. However, simvastatin induced greater apoptosis in RH30 compared to C2C12 cells. Simvastatin-induced cell death is dependent on geranylgeranyl pyrophosphate (GGPP) in C2C12 cells, while in RH30 cells it is dependent on both farnesyl pyrophosphate (FPP) and GGPP. Simvastatin inhibited …

The Role Of Diagnostic Bronchoscopy In Refractory Asthma Management, Christopher Mcgrath, Md, Tuhina Raman, Md, Jessica Most, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Refractory asthma is an uncommon entity, manifesting in less than five percent of asthmatics and characterized by high medication requirements, persistent symptoms, frequent exacerbations, and significant airflow obstruction despite standard medical therapy.[1] Bronchoscopy may be an effective tool for identifying refractory asthma phenotypes.[3] The objective of this case series is to demonstrate the use of bronchoscopy to personalize treatment among a population of refractory asthmatics.

Temporal Gene Expression Of Mesenchymal Cells In The Pediatric Lung, Quinlen F. Marshall, Soumyaroop Bhattacharya, Gautam Bandyopadhyay, Ravi Misra, Thomas Mariani, Gloria Pryhuber

Chemistry Student Work

INTRODUCTION: The newborn lung undergoes vast biochemical and physiological changes during adaptation from the intrauterine to the extrauterine environment. Lung morphogenesis continues from birth into early childhood, mediated by dynamic gene expression and a diversity of pulmonary cell types (Whitsett, JA. et al. Physiol. Rev, 2019). Murine models demonstrate that pulmonary mesenchymal cells exhibit remarkable heterogeneity in function and morphology during development, however, confirmation of their role is lacking in human neonates and early childhood (Guo, M. et al. Nat. Comm, 2019). In addition, many current human genomic studies of lung maturation suffer from limited sample size, limiting …

Identification Of Policy Priorities To Address The Burden Of Smokeless Tobacco In Pakistan: A Multimethod Analysis, Kamran Siddiqi, Ziauddin Islam, Zohaib Khan, Faraz Siddiqui, Masuma Mishu, Omara Dogar, Vandana Shah, Javaid Khan, Subhash Pokhrel, Romaina Iqbal

Section of Pulmonary & Critical Care

Introduction: We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders' views as to which of these identified priorities are most important.
Methods: In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders' views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy …

The Case For Patient Navigation In Lung Cancer Screening In Vulnerable Populations: A Systematic Review., Christine S Shusted, Julie A Barta, Michael Lake, Rickie Brawer, Brooke Ruane, Teresa E Giamboy, Baskaran Sundaram, Nathaniel R Evans, Ronald E Myers, Gregory C Kane

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Patient navigation has been proposed to combat cancer disparities in vulnerable populations. Vulnerable populations often have poorer cancer outcomes and lower levels of screening, adherence, and treatment. Navigation has been studied in various cancers, but few studies have assessed navigation in lung cancer. Additionally, there is a lack of consistency in metrics to assess the quality of navigation programs. The authors conducted a systematic review of published cancer screening studies to identify quality metrics used in navigation programs, as well as to recommend standardized metrics to define excellence in lung cancer navigation. The authors included 26 studies evaluating navigation metrics …

Relationship Of Patient Self-Administered Copd Assessment Test To Physician Standard Assessment Of Chronic Obstructive Pulmonary Disease In A Family Medicine Residency Training Program, Jessica E. Burchette, Ivy A. Click, Leigh Johnson, S. Alicia Williams, Brett Tyler Morgan

Journal of Patient-Centered Research and Reviews

Assessing the global impact of chronic obstructive pulmonary disease (COPD) on a patient’s life can be difficult to perform in the clinical setting due to time constraints and workflow challenges. The primary objective of this study was to compare disease impact ratings between patient self-administered COPD Assessment Test (CAT) and physician standard office assessment. This prospective study was conducted at a family medicine residency clinic in northeast Tennessee. The study included two study groups: 1) adult patients seen at the clinic during the 3-month study period with an active diagnosis of COPD, and 2) their physicians. Physicians’ assessment of the …

Nicotine Replacement Therapies To Decrease Withdrawal Symptoms And Improve Patient Experience, Cheryl Pawloski, Holly Stewart, Devon Gillis, Dena Whitesell, Maya Bulman, Christopher Racine, Raymond Serrano, Leslie Gatcombe-Hynes, Elizabeth Mullany, Amy Mcauliffe, Jayne Weisberg, Amy Sparks, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Operations Transformation

Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal.

A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels …

Bitter Taste Receptors For Asthma Therapeutics., Ajay P. Nayak, Sushrut D. Shah, James V. Michael, Deepak A. Deshpande

Center for Translational Medicine Faculty Papers

Clinical management of asthma and chronic obstructive pulmonary disease (COPD) has primarily relied on the use of beta 2 adrenergic receptor agonists (bronchodilators) and corticosteroids, and more recently, monoclonal antibody therapies (biologics) targeting specific cytokines and their functions. Although these approaches provide relief from exacerbations, questions remain on their long-term efficacy and safety. Furthermore, current therapeutics do not address progressive airway remodeling (AR), a key pathological feature of severe obstructive lung disease. Strikingly, agonists of the bitter taste receptors (TAS2Rs) deliver robust bronchodilation, curtail allergen-induced inflammatory responses in the airways and regulate airway smooth muscle (ASM) cell proliferation and mitigate …