Pulmonology Commons^™

Clinical Presentation, Cardiac Magnetic Resonance Findings, And Prognosis Of Patients With Arrhythmogenic Right Ventricular Cardiomyopathy - An Experience From Pakistan, Intisar Ahmed, Fateh Ali Tipoo Sultan

Section of Cardiology

Objectives: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart-muscle disease, characterized by fibro-fatty replacement and ventricular arrhythmias, that primarily affects the right ventricle (RV). We aimed to look at the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of patients with ARVC in Pakistan.
Material and methods: It is a retrospective observational study, 17 consecutive patients with CMR and other findings consistent with ARVC, were enrolled from 2010 to 2019 at a single center.
Results: Out of 17 patients, 12 (70.6%) were male with a mean age of 33.5 ± 17.5 years. Family history of sudden cardiac …

Prospects For Rnai Therapy Of Covid-19, Hasan Uludağ, Kylie Parent, Hamidreza Montazeri Aliabadi, Azita Haddadi

Pharmacy Faculty Articles and Research

COVID-19 caused by the SARS-CoV-2 virus is a fast emerging disease with deadly consequences. The pulmonary system and lungs in particular are most prone to damage caused by the SARS-CoV-2 infection, which leaves a destructive footprint in the lung tissue, making it incapable of conducting its respiratory functions and resulting in severe acute respiratory disease and loss of life. There were no drug treatments or vaccines approved for SARS-CoV-2 at the onset of pandemic, necessitating an urgent need to develop effective therapeutics. To this end, the innate RNA interference (RNAi) mechanism can be employed to develop front line therapies against …

Covid-19 And Liver Injury: A Systematic Review And Meta-Analysis, Jawad Ahmed, Tehlil Rizwan, Farheen Malik, Raniyah Akhter, Mehreen Malik, Junaid Ahmad, Abdul Wasay Khan, Muhammad A. Chaudhary, Muhammad Shariq Usman

Department of Anaesthesia

Background and Aims: The prevalence and extent of liver damage in coronavirus disease 2019 (COVID-19) patients remain poorly understood, primarily due to small-sized epidemiological studies with varying definitions of “liver injury”. We conducted a meta-analysis to derive generalizable, well-powered estimates of liver injury prevalence in COVID-19 patients. We also aimed to assess whether liver injury prevalence is significantly greater than the baseline prevalence of chronic liver disease (CLD). Our secondary aim was to study whether the degree of liver injury was associated with the severity of COVID-19.
Materials and Methods: Electronic databases (PubMed and Scopus) were systematically searched in June …

Invasive Pulmonary Infection By Syncephalastrum Species: Two Case Reports And Review Of Literature, Memoona Irshad, Nosheen Nasir, Urooj Haider Hashmi, Joveria Farooqi, Syed Faisal Mahmood

Section of Internal Medicine

Background: Syncephalastrum species belong to the class Zygomycetes and order Mucorale. These are found in the environment and tropical soil, usually presenting as colonizers and rarely cause human infection. Syncephalastrum racemosum is a species of the genus Syncephalastrum and is the most commonly identified pathogen. Most cases are reported in immunocompromised individuals, such as patients on long term steroids, poorly controlled diabetes, or patients with malignancy.
Case presentation: We are describing two cases of rare fungal infection by Syncephalastrum species causing invasive pulmonary manifestation. Both patients had compromised immune status and presented with worsening dyspnea to the emergency room. Both …

Exogenous Lipoid Pneumonia Complicated By Mineral Oil Asperation In A Patient With Chronic Constipation: A Case Report And Review, Hafiz Muhammad Jeelani, Muhammad Mubbashir Sheikh, Belaal Sheikh, Hafiz Mahboob, Anchit Bharat

School of Medicine Faculty Research

Exogenous lipoid pneumonia is a rare and frequently misdiagnosed lung disease. It occurs as an inflammatory reaction secondary to either aspiration or inhalation of lipids. Our patient had a history significant for recurrent pneumonia and the use of mineral oil for chronic constipation. A chest computed tomography showed multifocal consolidative opacities with areas of low attenuation, highly suspicious of exogenous lipid pneumonia. The diagnosis was confirmed with combined bronchoalveolar lavage and transbronchial lung biopsy that showed lipid-laden macrophages consistent with exogenous lipoid pneumonia. After thorough medication review, apart from mineral oil, no other contributing factors were found. A diagnosis of …

Facts About Mold: An Aiha Perspective For Ieq Investigators, Physicians, And Engineers, Cheri Marcham

Publications

The U.S. Centers for Disease Control and Prevention (CDC), the Institute of Medicine of the U.S. National Academy of Sciences, the American Academy of Allergy, Asthma & Immunology (AAAAI), Health Canada, and the World Health Organization all agree that living or working in a building with mold-damaged building materials results in increased risk of respiratory diseases such as asthma.

The American Industrial Hygiene Association (AIHA) has worked to translate the advice from these public health and medical authorities into state-of-the-art inspection and sampling protocols. These protocols are captured in AIHA’s Recognition, Evaluation and Control of Indoor Mold publication, also known …

Facts About Mold: A Consumer Focus, Cheri Marcham

Publications

The U.S. Centers for Disease Control and Prevention, the Institute of Medicine of the U.S. National Academy of Sciences, the American Academy of Allergy Asthma and Immunology, Health Canada, and the World Health Organization all agree that living or working in a building with mold-damaged building materials results in an increased risk of respiratory diseases such as asthma.

The American Industrial Hygiene Association (AIHA) has worked to translate the advice from these public health and medical authorities into state-of-the-art inspection and sampling protocols. These protocols are captured in AIHA’s second edition of the Recognition, Evaluation and Control of Indoor Mold …

Clinical Characteristics And Outcomes Of Patients With H1n1 Influenza Pneumonia Admitted At A Tertiary Care Hospital In Karachi, Pakistan, Mujahid Hussain, Nosheen Nasir, Muhammad Irfan, Zahra Hasan

Section of Pulmonary & Critical Care

Introduction: Influenza viruses specifically, A and B mainly contribute to seasonal outbreaks that occur globally. However, due to limited diagnostics for influenza there is little data regarding clinical outcomes of patients with H1N1 pneumonia in our region. Our objective was to determine the clinical characteristics and outcomes of patients hospitalized with H1N1 pneumonia at a tertiary care facility in Karachi, Pakistan.
Methods: A retrospective study of adult patients admitted with influenza pneumonia from November 2017 to February 2018 at a tertiary care hospital in Karachi, Pakistan. Patient characteristics were compared between influenza A H1N1 and other types of influenza using …

Congenital Abnormalities Of The Lower Airways And Lungs, Christopher M. Oermann

Presentations

Goals and Objectives. Participants will be able to: Describe the 5 stages of fetal lung development. Summarize the prenatal identification and management of congenital abnormalities of the lower airways and lung (CALAL). Explain the classification of CALAL. Compare the clinical characteristics, pathology, and management of common CALAL. Discuss the long term prognosis of CALAL

Association Analysis Of Driver Gene-Related Genetic Variants Identified Novel Lung Cancer Susceptibility Loci With 20,871 Lung Cancer Cases And 15,971 Controls, Yuzhuo Wang, Olga Y Gorlova, Ivan P Gorlov, Meng Zhu, Juncheng Dai, Demetrius Albanes, Stephen Lam, Adonina Tardon, Chu Chen, Gary E Goodman, Stig E Bojesen, Maria Teresa Landi, Mattias Johansson, Angela Risch, Heunz-Erich Wichmann, Heike Bickeboller, David C Christiani, Gad Rennert, Susanne M Arnold, Paul Brennan, John K Field, Sanjay Shete, Loïc Le Marchand, Olle Melander, Hans Brunnstrom, Geoffrey Liu, Rayjean J Hung, Angeline S Andrew, Lambertus A Kiemeney, Shanbeh Zienolddiny, Kjell Grankvist, Mikael Johansson, Neil E Caporaso, Penella J Woll, Philip Lazarus, Matthew B Schabath, Melinda C Aldrich, Victoria L Stevens, Hongxia Ma, Guangfu Jin, Zhibin Hu, Christopher I Amos, Hongbing Shen

Faculty, Staff and Students Publications

BACKGROUND: A substantial proportion of cancer driver genes (CDG) are also cancer predisposition genes. However, the associations between genetic variants in lung CDGs and the susceptibility to lung cancer have rarely been investigated.

METHODS: We selected expression-related single-nucleotide polymorphisms (eSNP) and nonsynonymous variants of lung CDGs, and tested their associations with lung cancer risk in two large-scale genome-wide association studies (20,871 cases and 15,971 controls of European descent). Conditional and joint association analysis was performed to identify independent risk variants. The associations of independent risk variants with somatic alterations in lung CDGs or recurrently altered pathways were investigated using data …

A Silent Fatal Presentation Of Pulmonary Embolism: Reflection And Discussion., Qian Zhang, Zain U. Abideen, Khine S. Shan, Thomas Yoon, Muhammad Farooq

Abington Jefferson Health Papers

Acute pulmonary embolism is a common medical condition that clinicians face in practice. It is important to have a prompt diagnosis with proper management as it is associated with high morbidity and mortality. However, a timely diagnosis is often difficult to obtain especially when the presenting symptoms are atypical, but the consequence could be fatal. We present an 80-year-old gentleman who presented with a near-syncope episode who subsequently was found to have acute extensive bilateral pulmonary embolisms after a code blue event.

A Mysterious Paratracheal Mass: Pulmonary Agenesis., Qian Zhang, Khine S. Shan

Abington Jefferson Health Papers

A 35-year-old lady with a history of possible tuberculosis infection 15 years ago presented to the clinic with the chief complaint of cough. Incidental chest CT showed a right paratracheal and medial right apical heterogeneous soft tissue mass with central areas of calcification that warranted further investigation. A routine endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) discovered isolated lobar pulmonary agenesis as the underlying cause of the mass without findings of malignancy on pathology reports.

Compliance Of Smokeless Tobacco Supply Chain Actors And Products With Tobacco Control Laws In Bangladesh, India And Pakistan: Protocol For A Multicentre Sequential Mixed-Methods Study, Zohaib Khan, Rumana Huque, Aziz Sheikh, Anne Readshaw, Jappe Eckhardt, Cath Jackson, Mona Kanaan, Romaina Iqbal, Zohaib Akhter, Javaid Khan

Community Health Sciences

Introduction: South Asia is home to more than 300 million smokeless tobacco (ST) users. Bangladesh, India and Pakistan as signatories to the Framework Convention for Tobacco Control (FCTC) have developed policies aimed at curbing the use of tobacco. The objective of this study is to assess the compliance of ST point-of-sale (POS) vendors and the supply chain with the articles of the FCTC and specifically with national tobacco control laws. We also aim to assess disparities in compliance with tobacco control laws between ST and smoked tobacco products.
Methods and analysis: The study will be carried out at two sites …

Complex Oncological Decision-Making Utilizing Fast-And-Frugal Trees In A Community Setting-Role Of Academic And Hybrid Modeling., Ravi Salgia, Isa Mambetsariev, Tingting Tan, Amanda Schwer, Daryl Pearlstein, Hazem Chehabi, Angel Baroz, Jeremy Fricke, Rebecca Pharaon, Hannah Romo, Thomas Waddington, Razmig Babikian, Linda Buck, Prakash Kulkarni, Mary Cianfrocca, Benjamin Djulbegovic, Sumanta K Pal

Articles, Abstracts, and Reports

Non-small cell lung cancer is a devastating disease and with the advent of targeted therapies and molecular testing, the decision-making process has become complex. While established guidelines and pathways offer some guidance, they are difficult to utilize in a busy community practice and are not always implemented in the community. The rationale of the study was to identify a cohort of patients with lung adenocarcinoma at a City of Hope community site (n = 11) and utilize their case studies to develop a decision-making framework utilizing fast-and-frugal tree (FFT) heuristics. Most patients had stage IV (N = 9, 81.8%) disease …

Idiopathic Pulmonary Hemosiderosis - A Rare Cause Of Chronic Anemia, Ayesha Butt, Rashida Ahmed, Muhammad Dawood Amir Sheikh, Omar Khan, Nousheen Iqbal, Arshalooz Rahman, Javaid Khan

Medical College Documents

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease marked by alveolar bleeding and accumulation of hemosiderin in the lungs. Here we present three cases of IPH. The first case is of a 26-year-old male with anemia, hemoptysis and dyspnea. Bronchoscopy confirmed diffuse alveolar hemorrhage (DAH). A diagnosis of IPH was made after ruling out other causes of DAH and observing good response to steroids. The patient's condition improved with prednisolone and azathioprine. The second case is of 26-year-old female with severe anemia. Imaging suggested IPH and lung biopsy confirmed it. She died shortly afterwards. The third case is of a …

Incidental Findings On Ldct For Lung Cancer Screening: Prevalence And Clinical Management, Chris Mcgrath, Md, Mrinalini Venkata-Subramani, Md, Brandon Menachem, Md, Amry Majeed, Brooke Ruane, Crnp, Christine Shusted, Mph, Julie Barta, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• To define the frequency of incidental findings on low-dose CT (LDCT) scans among patients undergoing lung cancer screening.
• To determine the current reporting methods for incidental findings and measure the frequency of clinical follow-up.

Standardized Bronchoscopy Testing For Immunocompromised Patients, C. Nieweld, A. Gandler, K. Biblowitz, B. Menachem, J. Most

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the consistency in which the order set was followed
• Determine the length of time from finding pulmonary infiltrate to consultation
• Determine the length of time from consultation to bronchoscopy
• Determine whether a follow up note was written by pulmonary
• Determine whether management is affected based on obtained results

Exploring The Effectiveness Of Asthma Action Plans In Long-Term Asthma Management, Pankhuri Jha, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the efficacy of AAP in helping patients feel more confident in their self-management
• Improve asthma control by at least 10% after receiving an Asthma Action Plan

A Multidisciplinary Chronic Lung Disease Team In A Neonatal Intensive Care Unit Is Associated With Increased Survival To Discharge Of Infants With Tracheostomy, Taylor Hansen

Research Days

No abstract provided.

A Positive Framed Message To Improve Cpap Compliance For Patients With Osa, Frances Clark

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) affects 24% of the US population (DiNapoli, 2014). Untreated OSA causes many diseases, affects one’s quality of life, and increases mortality (Pengo et al., 2018). Continuous positive airway pressure (CPAP) is the lifelong treatment for OSA; yet 30%-80% of OSA patients are CPAP noncompliant within one year. The purpose of this EBP project was to determine if implementing a positive frame message intervention would improve CPAP compliance for newly diagnosed OSA patients. Based on the evidence, implementation of behavioral interventions, such as a positive framed message, was effective in improving CPAP compliance (Pengo et al., 2018). …

Iatrogenic Pneumothorax With Subsequent Subcutaneous Emphysema, George Michael, Eric Yuschak, My Myers

West Florida Division GME Research Day 2020

Lung cancer is the leading cause of cancer-related death in the United States, accounting for 13% of all new cancer diagnoses and 24% of all cancer deaths.1 Transthoracic CT-guided biopsy (CTGB) is commonly used as a diagnostic tool for lung cancer, with high diagnostic accuracy, sensitivity, and specificity. 2 This procedure, however, is not without its risks which include pulmonary hemorrhage and iatrogenic pneumothorax (IPNX). Emergent chest tube placement is standard care of treatment for massive or symptomatic IPNX, commonly with the use of smaller caliber chest tubes. 2 There is, however, a growing discussion over use of larger caliber …

Results Of Lung Cancer Screening In The Community., John R Handy, Michael Skokan, Erika Rauch, Steven Zinck, Rachel E Sanborn, Svetlana Kotova, Mansen Wang

Articles, Abstracts, and Reports

PURPOSE: To address doubts regarding National Lung Screening Trial (NLST) generalizability, we analyzed over 6,000 lung cancer screenings (LCSs) within a community health system.

METHODS: Our LCS program included 10 sites, 7 hospitals (2 non-university tertiary care, 5 community) and 3 free-standing imaging centers. Primary care clinicians referred patients. Standard criteria determined eligibility. Dedicated radiologists interpreted all LCSs, assigning Lung Imaging Reporting and Data System (Lung-RADS) categories. All category 4 Lung-RADS scans underwent multidisciplinary review and management recommendations. Data was prospectively collected from November 2013 through December 2018 and retrospectively analyzed.

RESULTS: Of 4,666 referrals, 1,264 individuals were excluded or …

Diaphragmatic Paralysis: A Presentation Of Spontaneous Chest Pain And Shortness Of Breath, Donna Dorriz, Hilary Lois, Candace Wise, Brady Dehart

Capital Division GME Virtual Research Day 2020

Chest pain accounts for approximately 7.6 million annual visits to emergency departments (ED) in the United States and can include a broad differential1. The workup warranted includes extensive testing with the goal of demonstrating a reassuring cardiopulmonary status. When preliminary chest pain workup is negative, the subtle features of common primary symptoms can provide insight into other less common etiologies. This case looks to highlight the rare presentation of a relatively healthy middle age male with complaint of chest pain and shortness of breath, worsened with exertion and supine position. When standard cardiopulmonary workup was negative, further specialty testing was …

The Role Of Slc7a11 In Controlling Extracellular And Intracellular Redox Environments Of Lung Fibroblasts - Potential Targets For Intervention In Aging And Idiopathic Pulmonary Fibrosis., Yuxuan Zheng

Electronic Theses and Dissertations

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by extracellular matrix deposition by fibroblasts. Aging and oxidative stress increase the susceptibility to IPF. Redox couples, cysteine/cystine (Cys/CySS) and glutathione/glutathione disulfide (GSH/GSSG), and their redox potentials (E_h) quantify oxidative stress. Fibroblasts from old mice maintain more oxidized extracellular E_h(Cys/CySS) than young mice. Microarray shows down-regulation of Slc7a11 potentially mediates this age-related oxidation. Slc7a11 is the key component of system X_c^-, an antiporter that imports CySS and exports glutamate. The first aim of this dissertation is to investigate the mechanistic link between Slc7a11 …

When Treating Sick Joints Harms Lungs, Ixekizumab Induced Pleural Effusion, Rami Batarseh, Kyle Smith, Mohammed Al-Ourani, Amro K. Al-Astal

Marshall Journal of Medicine

Immunological therapies have provided a multitude of new and effective treatment strategies for various disease states. While monoclonal antibody therapy benefits many patients, side effects are widely variable. here we present a case of pleural effusion complicating psoriatic arthritis treatment.

Development Of Drive-Through And Mail-In Systems For Obtaining Surveillance Respiratory Specimens In A Pediatric Cystic Fibrosis Center, Ellen Meier, Paula Capel, Christopher M. Oermann

Posters

Routine surveillance cultures are an essential part of health maintenance for people with cystic fibrosis (CF). The Cystic Fibrosis Foundations (CFF) recommends that respiratory cultures be obtained every three months. The CF Care Center at Children’s Mercy Kansas City (CMKC) also obtains respiratory cultures when there is an acute change in respiratory symptoms. The COVID-29 pandemic resulted in ambulatory clinic closures and an inability to obtain surveillance respiratory cultures. A creative solution for obtaining respiratory cultures was needed during the pandemic.

How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp

The University of Louisville Journal of Respiratory Infections

No abstract provided.

When Rationing Becomes Part Of Clinical Decision-Making, Christopher A. Hopper, Mitra Bahaee

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical practice-based reflection on Noack DP, Newton G. Compared to maximal current management standards, oscillating positive expiratory pressure devices have not been shown to improve clinically relevant outcomes in COPD patients with acute exacerbation. Clin. Res. Prac. 2017;3(2):eP1516. doi: 10.22237/crp/149886732.

Engagement Of Private Healthcare Providers For Case Finding Of Tuberculosis And Diabetes Mellitus In Pakistan, Shifa Salman Habib, Sana Rafiq, Wafa Zehra Jamal, Shaikh Muhammad Ayub, Rashida Abbas Ferrand, Aamir Khan, Syed Mohammad Asad Zaidi

Community Health Sciences

Background: The rising co-epidemic of tuberculosis (TB) and diabetes mellitus (DM) is a challenge for constrained health systems in low and middle-income countries. Diabetes is a known risk factor for tuberculosis and associated with poor tuberculosis treatment outcomes, while tuberculosis is associated with worsening glycemic control. We investigated the performance of bi-directional TB and DM case finding approaches through a private-sector engagement model in Karachi, Pakistan.
Methods: Between July 2016 and July 2018, private health care providers were engaged to generate referrals for bi-directional TB and DM screening at private diagnostic and treatment centers in Karachi, Pakistan. Individuals diagnosed with …

Evaluation Of Computer Aided Detection Of Tuberculosis On Chest Radiography Among People With Diabetes In Karachi Pakistan, Shifa Salman Habib, Sana Rafiq, Syed Mohammad Asad Zaidi, Rashida Abbas Ferrand, Jacob Creswell, Bram Van Ginneken, Wafa Zehra Jamal, Kiran Sohail Azeemi, Saira Khowaja, Aamir Khan

Community Health Sciences

Pakistan ranks fifth among high tuberculosis (TB) burden countries and also has seventh highest burden for diabetes mellitus (DM). DM increases the risk of developing TB and contributes to adverse TB treatment outcomes hence screening and integrated management for both diseases in high burden countries is suggested. Computer-Aided Detection for TB (CAD4TB) can potentially be used as triage tool in low resource settings to pre-screen individuals for Xpert MTB/RIF testing. The aim of this study was to evaluate the diagnostic accuracy and performance of CAD4TB software in people with diabetes (PWD) enrolled in a TB screening program in Karachi, Pakistan. …