Respiratory Tract Diseases Commons^™

A Fatal Triad: Concurrent Pulmonary Infections With Candida, Mucorales, And Aspergillus In An Immunocompromised Patient With Underlying Vasculitis And Diabetes, Paridhi Ghai, Kavitha Gopalratnam

Posters

We present a case of disseminated fungal disease involving simultaneous infections with Candida, Mucorales, and Aspergillus.

Pseudomonas Aeruginosa Exoy Enzymatic Activity Inhibits Exos-Induced Caspase-3/7 Activation But Not Cytotoxicity In Pmvecs, Connor Holm

Poster Presentations

Pseudomonas aeruginosa (P. aer.) is the most common cause of ventilator associated pneumonia (VAP) in ICU patients. Different combinations of exoenzymes (S, T, Y, and U) are found in P. aer. strains. ExoY is most often associated with VAP in ICU patients. ExoY infection of pulmonary microvascular endothelial cells (PMVECs) induces cell rounding but does not activate intracellular caspase-3/7 or cause cell death. ExoS and ExoT infection of epithelial cells leads to caspase-3/7 dependent cell death. Previous studies using epithelial cells show that ExoY alleviates the cytotoxic effects of ExoS and ExoT. Here, we sought to determine whether ExoY inhibits …

Case Report: A Case Of Tracheal Perforation, Cyrus Davati, Eric Maddock

Rowan-Virtua Research Day

Here we present the case of a 93-year-old female with a past medical history of arthritis and dementia who came to the hospital for a change in mental status and decreased responsiveness at home. The patient was intubated at home by EMS secondary to continued respiratory distress. The patient had a history of a productive cough over the past three days. The patient arrived at the emergency department with continued respiratory failure. During the ED evaluation, the patient was noted to have tracheal rupture. The patient was admitted to the ICU for severe sepsis and continued on broad spectrum IV …

Case Report: Hypercapnia's Hidden Dance: Myoclonus In A Patient With Co2 Retention, Kelsey Murray

Rowan-Virtua Research Day

Myoclonic jerking is a neurologic phenomenon characterized by sudden, involuntary muscle contractions. While often associated with neurological conditions, myoclonic jerking can also be observed in patients with significant carbon dioxide retention. This case report highlights the presentation of myoclonic jerking in a 77-year-old male with a history of sleep apnea and obesity, who presented to the emergency department with hypoxia and elevated carbon dioxide levels. Despite the lack of neurological deficits, the patient experienced intermittent myoclonic jerks of his hands, which were attributed to CO2 retention. The report underscores the importance of recognizing myoclonic jerking as a potential sign of …

Case Report: Hyperkalemia Secondary To Acute Respiratory Acidosis, Chetna Thawani

Rowan-Virtua Research Day

Hyperkalemia is a potentially life-threatening electrolyte disturbance, commonly associated with renal dysfunction, medication effects, and acid-base imbalances. While metabolic acidosis is a well-known cause of transcellular potassium shifts, respiratory acidosis is a less recognized but significant contributor. This case report presents a 74-year-old female with hyperkalemia in the setting of acute respiratory acidosis secondary to impaired ventilation from rib fractures. This case highlights the importance of recognizing respiratory acidosis as a potential cause of hyperkalemia and tailoring management to address the underlying issue

Cannabinoid Hyperemesis Syndrome Induced Pneumomediastinum In An Adolescent, Julian Coz, Christopher Schwartz, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Cannabinoid hyperemesis syndrome (CHS) is a condition characterized by cyclic episodes of severe nausea, vomiting, and abdominal pain in individuals with chronic cannabis use. Despite its increasing recognition, CHS remains underdiagnosed, particularly in adolescents, and can be associated with a range of complications, some of which are potentially life-threatening. One such complication is spontaneous pneumomediastinum (SPM), a rare but serious condition where air accumulates in the mediastinum without any clear traumatic cause. Although SPM is typically benign, it can present with significant respiratory distress and requires prompt identification and management. Here we present the case of an 18-year-old patient with …

Clinical Outcomes For Patients With Ventilator-Associated Pneumonia In Octogenarians, Nonagenarians, And Centenarians: A Population-Based Study, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Syed, Olga Sarah, Abdallah Hussein

Rowan-Virtua Research Day

We sought to examine the national inpatient sample data-base to describe in-hospital outcomes among patients over seventy who acquire ventilator-associated pneumonia after being on the ventilator for over 48 hours.

Case Report: Pulmonary Infarction Following Recent Pulmonary Embolism, David Marconi, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and a recent pulmonary embolism (PE) on anticoagulation presented with acute pleuritic chest pain and worsening dyspnea. Computed tomographic angiography (CTA) of the chest revealed a small distal segmental PE in the left lower lobe and an adjacent irregular consolidation, raising concern for pulmonary infarction versus pneumonia. The patient was empirically started on antibiotics for possible pneumonia and admitted for anticoagulation and supportive care. He left the hospital against medical advice (AMA) before completing treatment, but returned days later with exacerbated symptoms. This case highlights the diagnostic challenge …

Tricyclic Antidepressant (Tca) Overdose Causing Diffuse Alveolar Hemorrhage: A Case Report, Md Fateha, Jose Aragon, Joan Wiley

Rowan-Virtua Research Day

Tricyclic antidepressant (TCA) overdose is an uncommon complication that results from excessive administration of TCAs. Signs and symptoms include bradycardia, fever, dry mouth, and altered mental status. Patients can develop cardiac arrhythmia and diffuse alveolar hemorrhage, which can be fatal. This case report details a 65-year-old female who experienced a suspected TCA overdose as a suicide attempt. She had a history of depression and a previous suicide attempt. The patient was unresponsive with declining oxygen saturation, necessitating emergent intubation. Important lab findings included a decreased partial pressure of oxygen to fraction of inspired oxygen ratio (P/F ratio) and prolonged QRS …

Expanding Inducible Epithelial Resistance Against Pneumonia: Novel Virus, Novel Receptor, Michael Longmire

Dissertations and Theses (Open Access)

Pneumonia is the leading infectious cause of death worldwide and presents a continuing risk among immunocompromised patients. Our work has been focused for many years on the phenomenon of inducible epithelial resistance, where activation of the innate immune response in the airway epithelium is necessary and sufficient to produce a pathogen-killing but self-protective environment to prevent severe disease. Inducible resistance is pathogen-agnostic and has been demonstrated against an array of respiratory infections. We achieve this using a combination of pattern recognition receptor agonists – Pam2CSK4 and ODN M362 being the current formulation – which produce synergistic levels of pathogen reduction …

Examining The Role Of Corticosteroids In The Management Of Acute Interstitial Pneumonia: A Systematic Review., Carlos Valladares, Aalia Narvel, Bianna Koutsenko, Alexa Simonetti, Fatima Mossolem, Alexis Chow, Samrat Gollapudi, Usmaan Al-Shehab, Nicholas Averell, Katherine Chiapaikeo-Poco, Adam Kaplan

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Acute interstitial pneumonia (AIP), also known as Hamman-Rich syndrome, is a rapidly progressive interstitial lung disease. In addition to being challenging to diagnose, AIP is also difficult to treat. The mortality rate of AIP is greater than 70% due to the disease's rapid progression. Furthermore, survivors are likely to develop chronic interstitial lung disease as a sequela. Treatment primarily focuses on supportive care, which consists of oxygenation through mechanical ventilation, administration of broad-spectrum antibiotics, and the use of corticosteroids. Although the use of steroids as empiric treatment is controversial and results on its mortality benefit are variable, some studies …

Epigenetic Regulation And Tumor Suppressive Function Of Lncrna Ep300-As1 In Nasopharyngeal Carcinoma Through Activation Of Tfap2c Binding To Cst6: Implications For Diagnosis, Prognosis, And Therapy, Chengliang Xing, Shun Ding, Tingting Duan, Zhiqun Li, Jinren Yan, Yu Kuang, Qibing Liu, Zhonglin Mu

Integrated Health Sciences Faculty Research

The long non-coding RNA EP300-AS1 (lncRNA EP300-AS1), identified as a potential regulatory factor in various cancers, remains underexplored in nasopharyngeal carcinoma (NPC). This study investigated EP300-AS1’s regulatory mechanisms in NPC, particularly its interaction with transcription factor AP-2 Gamma (TFAP2C) and its effect on cystatin E/M (CST6) expression. Employing clinical samples and NPC cell lines, we conducted in vitro and in vivo xenograft experiments to assess the impacts of modulating EP300-AS1 expression. Techniques such as CCK8, migration, scratch, apoptosis assays, cell cycle analysis, immunoblotting, and fluorescence experiments elucidated EP300-AS1’s role in NPC. The interaction between EP300-AS1 and TFAP2C in regulating CST6 …

Markers Of Growth And Nutrition In Children With Acquired Chylothorax Post Chd Surgery, Kevin N. Marzotto, Karin R. Videlefsky, Meghan P. Howell, Thomas R. Kimball, Frank A. Pigula, Kurt D. Piggott

School of Medicine Faculty Publications

Background: Acquired chylothorax is an established complication of CHD surgery, affecting 2-9% of patients. CHD places a child at risk for failure to thrive, with subsequent chylothorax imposing additional risk. Objective: We conducted a retrospective chart review to ascertain quantitative markers of nutrition and growth in children affected by chylothorax following CHD surgery between 2018 and 2022 compared to controls. Methods: We utilised electronic medical record system, EPIC, at Children's Hospital, New Orleans, targeting subjects < 18 years old who underwent CHD surgery between 2018 and 2022 and developed a subsequent chylothorax. Study subjects were identified using the 10th revision of the International Classification of Diseases codes (ICD-10 codes: J94.0, I89.8, and J90.0). Each chylothorax case (n = 20) was matched by procedure type and age to a control with no chylothorax (n = 20). Data were recorded in REDCap and analysed using SPSS. Results: After removal of outliers, we analysed 19 total matched pairs. There was no statistical difference in growth velocity (p = 0.12), weight change (operation to discharge) (p = 0.95), weight change (admission to discharge) (p = 0.35), Z-score change (operation to discharge) (p = 0.90), Z-score change (admission to discharge) (p = 0.21), serum protein (p = 0.88), or serum albumin (p = 0.82). Among cases, linear regression demonstrated no significant association between maximum chylous output and growth velocity (p = 0.91), weight change (operation to discharge) (p = 0.15), or weight change (admission to discharge) (p = 0.98). Conclusions: We did not observe statistically significant markers of growth or nutrition in children with chylothorax post-CHD surgery compared to those without chylothorax. Multisite data collection and analysis is required to better ascertain clinical impact and guide clinical practice.

Complement Activity And Autophagy Are Dysregulated In The Lungs Of Patients With Nonresolvable Covid-19 Requiring Lung Transplantation, Pooja Shivshankar, Stacey L Mueller-Ortiz, Aleksey Y Domozhirov, Weizhen Bi, Scott D Collum, Marie-Francoise Doursout, Manish Patel, Isabella N Lefebvre, Bindu Akkanti, Simon Yau, Howard J Huang, Rahat Hussain, Harry Karmouty-Quintana

Faculty, Staff and Student Publications

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic has challenged the current understanding of the complement cascade mechanisms of host immune responses during infection-induced nonresolvable lung disease. While the complement system is involved in opsonization and phagocytosis of the invading pathogens, uncontrolled complement activation also leads to aberrant autophagic response and tissue damage. Our recent study revealed unique pathologic and fibrotic signature genes associated with epithelial bronchiolization in the lung tissues of patients with nonresolvable COVID-19 (NR-COVID-19) requiring lung transplantation. However, there is a knowledge gap if complement components are modulated to contribute to tissue …

Longitudinal Changes In Positive Airway Pressure Device Use After Metabolic Surgery: A 3-Year Matched Cohort Study Of National Claims Data, Michael Kachmar, Elizabeth Wall-Wieler, Yuki Liu, Feibi Zheng, Prachi Singh, Vance L. Albaugh

School of Medicine Faculty Publications

BACKGROUND: Metabolic surgery (MS) is the most durable treatment of obesity and can treat obstructive sleep apnea (OSA). OBJECTIVES: To compare trajectories of positive airway pressure (PAP) device use between individuals who had MS and similar individuals who did not have MS (non-MS). SETTING: Merative MarketScan Research Databases - a US-based commercial claims database. METHODS: Those who underwent MS were matched 1:1 with nonoperative controls on baseline demographic and health characteristics. PAP use trajectories were examined in the 3years after the index dates and stratified by baseline PAP use. RESULTS: A total of 8772 adults who had MS were matched …

Characteristics And Outcomes Of Adults Hospitalized With Respiratory Syncytial Virus, Brian S. Shaw, Cara Slaton, Ian P. Murphy, Michael Mcalister, Daniel Egan, Kwabena Ayesu

The University of Louisville Journal of Respiratory Infections

Background: Respiratory syncytial virus (RSV) is a negative sense single-stranded RNA virus (ssRNA) that primarily causes respiratory infections in both children and older adults. We examined clinical characteristics and outcomes of hospitalized adult patients who tested positive for RSV.

Methods: This was a multicenter, retrospective, descriptive study that examined adult patients admitted with a positive RSV test over two years across eight hospitals in Orlando, Florida.

Results: A total of 120 patients were included, of which 88 (73%) were 60 years old and older. Overall, patients with RSV infection were caucasian (62%) with a median age of 70 years and …

A Qualitative Assessment Of Changes In Occupational Exposures Among Healthcare Facility Workers, David Gimeno Ruiz De Porras, Jenil Patel, Sadie Conway, Lisa Pompeii, Laura E Mitchell, Arch Carson, Lawrence W Whitehead, Inkyu Han, Jan-Paul Zock, Paul K Henneberger, Riddhi Patel, Joy De Los Reyes, George L Delclos

Faculty, Staff and Student Publications

Adult-onset asthma, notably prevalent among healthcare professionals, especially nurses, is often attributed to occupational factors such as exposure to cleaning agents. Studies consistently underscore the substantial role of such exposure in work-related asthma among hospital staff. We aimed to (a) identify and characterize current practices in cleaning and aerosolized medication administration; (b) assess changes in practices since a similar 2003 study of Texas healthcare workers; and (c) identify factors contributing to diverse exposures within healthcare job categories. We conducted focus groups with 38 participants in 6 healthcare settings, analyzing current practices, changes since 2003, and factors contributing to exposure diversity. …

Patient-Reported Outcomes: Comparing Functional Avoidance And Standard Thoracic Radiation Therapy In Lung Cancer, Spencer Poiset, Joseph Lombardo, Edward Castillo, Richard Castillo, Bernard Jones, Moyed Miften, Brian Kavanagh, Adam Dicker, Cullen Boyle, Nicole Simone, Benjamin Movsas, Inga Grills, Chad Rusthoven, Yevgeniy Vinogradskiy, Lydia Wilson

Department of Radiation Oncology Faculty Papers

PURPOSE: Novel methods generate functional images using image processing techniques combined with four-dimensional computed tomography (4DCT) data (4DCT-ventilation). 4DCT-ventilation was implemented in a phase II, multicenter functional avoidance clinical trial. The work compares functional avoidance patient-reported outcomes (PROs) against historical standards.

METHODS: Patients with locally advanced lung cancer undergoing curative-intent chemoradiation were accrued. 4DCT-ventilation imaging was generated and functional avoidance treatment plans created reduced dose to functional lung. PRO instruments included Functional Assessment of Cancer Therapy Lung questionnaire and accompanying subscales (including the Trial Outcome Index [TOI]), EuroQol-5 Dimension (EQ-5D), and EQ-Visual Analog Scale (EQ-VAS). The average change from baseline …

From Lost Balance To Leaky Chyle: A Case Report Of Traumatic Chylothorax, Taylor Johnson, Glenn Carlos

South Atlantic Division GME Research Day 2025

No abstract provided.

Electronic And Regular Cigarettes Induce Transcriptional And Physiological Changes In Cardiomyocytes, Hesham Basma, Kajari Dhar, Jason Payne, Stephen I. Rennard, Brian D. Lowes

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Cigarette smoking is an important etiology for cardiac diseases and electronic cigarettes are increasing in popularity. In the current study, we assessed physiological and transcriptional changes in human induced pluripotent stem cell derived cardiomyocytes (iPS-CMs) after exposure to electronic cigarette extract (ECE) and conventional cigarette extract (CSE).

METHODS: iPS-CMS were plated on multi-electrode array plates (MEA), electrical and contractile properties were determined by Maestro Edge and computer assisted video analysis (MuscleMotion). Transcriptional profiles were accessed by direct digital mRNA detection of heart failure targeted genes.

RESULTS: Both ECE and CSE extracts significantly prolong beat period from baseline compared to …