Internal Medicine Commons^™

Anti-Neutrophil Cytoplasmic Antibodies: To Care Or Not To Care, Sara Shahid, Syed H Alam, Lillian Gaber, Salman Ahmed

Faculty, Staff and Students Publications

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis is a disease process with a wide range of presentations, from asymptomatic or minimally symptomatic disease with positive laboratory testing, to florid acute end-organ damage. Consensus has not been established as to the frequency and/or protocol by which ANCA testing should be repeated. We present the case of a 53-year-old woman who initially came to medical attention with persistent dyspnea and pulmonary infiltrates presumed to be due to acute exacerbation of chronic diastolic congestive heart failure. Extensive infectious disease testing was negative, but ANCA testing was positive. However, because antinuclear antibody (ANA) interference in …

Double-Blind Randomized Proof-Of-Concept Trial Of Canakinumab In Patients With Covid-19 Associated Cardiac Injury And Heightened Inflammation, Paul C Cremer, Calvin C Sheng, Debasis Sahoo, Siddharth Dugar, Robier Aguillon Prada, Tom Kai Ming Wang, Ossama K Abou Hassan, Jamie Hernandez-Montfort, David A Wolinsky, Daniel A Culver, Prabalini Rajendram, Abhijit Duggal, Danielle M Brennan, Katherine E Wolski, A Michael Lincoff, Steven E Nissen, Venu Menon

Faculty, Staff and Student Publications

AIMS: In coronavirus disease 2019 (COVID-19), myocardial injury is associated with systemic inflammation and higher mortality. Our aim was to perform a proof of concept trial with canakinumab, a monoclonal antibody to interleukin-1β, in patients with COVID-19, myocardial injury, and heightened inflammation.

METHODS AND RESULTS: This trial required hospitalization due to COVID-19, elevated troponin, and a C-reactive protein concentration more than 50 mg/L. The primary endpoint was time to clinical improvement at Day 14, defined as either an improvement of two points on a seven-category ordinal scale or discharge from the hospital. The secondary endpoint was mortality at Day 28. …

Biomarkers For Impending Risk Of Osteoporosis In Premenopausal Women, Rehana Rehman, Ali Usman, Aisha Sheikh, Rozeena Baig

Department of Biological & Biomedical Sciences

Objective: To compare 'cytokines' and 'bone turnover markers' in pre- and post-menopausal women and identify their relationship with bone mineral density (BMD) in both groups. Study Design: A cross-sectional study.
Place and duration of study: Department of Biological & Biomedical Sciences, The Aga Khan University, Karachi, Pakistan, from June 2017 to August 2019.
Methodology: Groups comprised of healthy premenopausal and postmenopausal women from the general population belonging to different ethnic groups and socio-economic status. Serum cytokines and bone turnover markers were assessed by solid-phase immunoassays, BMD (gm /cm2)] measurement was performed by dual-energy X-ray absorptiometry at the hip, lumbar spine, …

A Distinct Difference Between Air And Mucosal Temperatures In Human Respiratory Tract, Mehdi Khosravi, Ruei-Lung Lin, Ashish P. Maskey, Subodh Pandey, An-Hsuan Lin, Lu-Yuan Lee

Internal Medicine Faculty Publications

xtensive evidence indicates that several types of temperature-sensitive ion channels are abundantly expressed in the sensory nerves innervating airway mucosa. Indeed, airway temperature is known to play an important role in regulating respiratory functions. However, the actual airway mucosal temperature and its dynamic changes during the respiratory cycle have not been directly measured. In previous studies, airway tissue temperature was often estimated by indirect measurement of the peak exhaled breath temperature (PEBT). In view of the poor thermal conductivity of air, we believe that the airway tissue temperature cannot be accurately determined by the exhaled air temperature, and this study …

Integrated Single-Cell Atlas Of Endothelial Cells Of The Human Lung, Jonas C Schupp, Taylor S Adams, Carlos Cosme, Micha Sam Brickman Raredon, Yifan Yuan, Norihito Omote, Sergio Poli, Maurizio Chioccioli, Kadi-Ann Rose, Edward P Manning, Maor Sauler, Giuseppe Deiuliis, Farida Ahangari, Nir Neumark, Arun C Habermann, Austin J Gutierrez, Linh T Bui, Robert Lafyatis, Richard W Pierce, Kerstin B Meyer, Martijn C Nawijn, Sarah A Teichmann, Nicholas E Banovich, Jonathan A Kropski, Laura E Niklason, Dana Pe'er, Xiting Yan, Robert J Homer, Ivan O Rosas, Naftali Kaminski

Faculty, Staff and Student Publications

BACKGROUND: Cellular diversity of the lung endothelium has not been systematically characterized in humans. We provide a reference atlas of human lung endothelial cells (ECs) to facilitate a better understanding of the phenotypic diversity and composition of cells comprising the lung endothelium.

METHODS: We reprocessed human control single-cell RNA sequencing (scRNAseq) data from 6 datasets. EC populations were characterized through iterative clustering with subsequent differential expression analysis. Marker genes were validated by fluorescent microscopy and in situ hybridization. scRNAseq of primary lung ECs cultured in vitro was performed. The signaling network between different lung cell types was studied. For cross-species …

Clinical Features And Outcomes Of Critically Ill Patients With Elizabethkingia Meningoseptica: An Emerging Pathogen, Abdullah Umair, Nosheen Nasir

Department of Medicine

Background: Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucose-non-fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.
Methods: We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December …

The Relation Of Abo Blood Group To The Severity Of Coronavirus Disease: A Cross-Sectional Study From A Tertiary Care Hospital In Karachi, Fazal Ur Rehman, Syed Furrukh Omair, Fatima Memon, Bakhtawar J. Rind, Danish Ahmed Memon, Syed Ahsan Ali, Bilal Ahmed, Naureen Ali

Section of Internal Medicine

Background: Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren’t available.
Objective: This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients.
Materials and methodology: Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the …

Efficacy Of A Pharmacist-Managed Diabetes Clinic In High-Risk Diabetes Patients, A Randomized Controlled Trial-"Pharm-Md", Alexandra Halalau, Melda Sonmez, Ahsan Uddin, Patrick Karabon, Zachary Scherzer, Scott Keeney

Conference Presentation Abstracts

BACKGROUND: Diabetes mellitus affects 13% of American adults. To address the complex care requirements necessary to avoid diabetes-related morbidity, the American Diabetes Association recommends utilization of multidisciplinary teams. Research shows pharmacists have a positive impact on multiple clinical diabetic outcomes. We aimed to determine impact of an education-focused pharmacist managed diabetes clinic model (PMDC) on hemoglobin A1c (HbA1c) and other diabetes core measures at 6 and 12 months follow-up. METHODS: Open-label randomized controlled trial with 1:1 allocation. Patients 18-75 years old with type 2 diabetes mellitus and most recent HbA1c ≥9% were enrolled from a single institution resident- run outpatient …

Modified Clinical Risk Score To Predict Hospital Admission And In-Hospital Mortality In Covid-19 Patients, Olga R. Gomez Rojas, Inayat Gill, Zaid Imam, Patrick Karabon, Alexandra Halalau

Conference Presentation Abstracts

BACKGROUND: The COVID-19 pandemic has resulted in over 1 million deaths globally. Prognostic tools to identify high risk patients are crucial to guide resource allocation efforts. We aimed at developing a risk assessment tool for patients with COVID-19 based on the risk factors with most significant effect on hospital admission and in-hospital mortality METHODS: We performed a retrospective analysis of patients with positive COVID-19 presenting in between 3/31/2020 – 5/15/2020 at Beaumont Health’s 8 emergency departments (ED). Data was abstracted using automated reports. The electronic health record (HER) embedded risk score previously externally validated was modified based on risk factors, …

A Novel Backward Stepwise Logistic Regression And Classification And Regression Tree Model To Predict 180-Day Clinical Outcomes In Hepatitis B Virus-Acute-On-Chronic Liver Failure Patients, Shima Ghavimi

Internal Medicine

As the era of precision and personalized medicine is gaining exponential positive gain in the field of medicine, there is a positive shift towards a more evidence-based patient care approach for patients with hepatological diseases. One factor that is crucial in any physician’s decision-making efforts involves the application of novel innovative approaches that can enhance predicting survival outcome. Acute-on-chronic liver failure (ACLF) is a perfect example of how liver can rapidly deteriorate, and the hepatitis B virus (HBV) is one crucial culprit. Patients can experience organ failure that leads to their mortality, and in this article the authors clearly described …

Determining The Perception And Willingness Of Primary Care Providers To Prescribe Advanced Diabetes Technologies, Alexander O’Donovan, Sean M. Oser, Jessica Parascando, Arthur Berg, Donald E. Nease Jr., Tamara K. Oser

Journal of Patient-Centered Research and Reviews

Advanced diabetes technologies have produced increasingly favorable outcomes compared to older treatments. Disparities in practice resources have led to a treatment disparity by clinical setting, where endocrinologists typically prescribe far more such technologies than primary care providers (PCPs). Fully automated artificial pancreas systems (APS), which combine technologies to deliver and adjust insulin dosing continuously in response to automatic and continuous glucose monitoring, may be more straightforward for PCPs to prescribe and manage, therefore extending their benefit to more patients. We aimed to assess willingness of PCPs to prescribe advanced diabetes technologies through a cross-sectional survey of PCPs from 4 geographically …

Cross-Sectional Analysis Of Patient-Centered Language Use In Journals Publishing Research Focused On Heart Failure, Vivian Pham, Benjamin Greiner, Ryan Ottwell, Matt Vassar, Micah L. Hartwell

Journal of Patient-Centered Research and Reviews

Purpose: Detrimental effects of using non–patient-centered language (nPCL) have been reported for diabetes, mental illness, and obesity, and both the American Medical Association (AMA) and International Committee of Medical Journal Editors (ICMJE) recommend using patient-centered language in medical literature. Heart failure is a common yet stigmatized disease, and nPCL may further propagate stigma. This study analyzed current use of nPCL in journals focused on heart failure research and also examined whether the journals steer authors to adhere to AMA or ICMJE guidelines regarding nPCL.

Methods: Following systematic search of PubMed for heart failure-related articles published from May 1, 2018, to …

Rapid Development Of Methicillin-Resistant Staphylococcus Aureus (Mrsa) Purulent Pericarditis In The Setting Of Endocarditis, Samiullah Arshad, Naoki Misumida

Internal Medicine Faculty Publications

Methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis is a rare but potentially fatal complication of MRSA bacteremia. We describe a case of a 27-year-old patient with active intravenous drug use, who presented with fever, chills, and dyspnea and was found to have tricuspid valve endocarditis. Echocardiogram on admission showed no pericardial effusion. The patient became hypotensive, with worsening dyspnea, in the following 3 days. A computed tomography scan of the chest was repeated and showed a large pericardial effusion. The patient underwent pericardiocentesis and pericardial drain placement. Antibiotics were continued, with resolution of effusion. Early pericardiocentesis of a large purulent pericardial …

Chronic Inflammatory Demyelinating Polyneuropathy As A Paraneoplastic Manifestation Of Colorectal Carcinoma: What Do We Know?, Talal Almas, Muhammad Ali Niaz, Yasar Sattar, Tarek Khedro, Ali Kanawati, Katia Yazji, Reema Alsufyani, Yousef Al-Khatib, Absam Akbar, Emad Mansoor

Medical College Documents

No abstract provided.

Clinical Outcomes Of Molecular Tumor Boards: A Systematic Review, Kara L. Larson, Bin Huang, Heidi L. Weiss, Pamela C. Hull, Philip M. Westgate, Rachel W. Miller, Susanne M. Arnold, Jill M. Kolesar

Markey Cancer Center Faculty Publications

PURPOSE: We conducted this systematic review to evaluate the clinical outcomes associated with molecular tumor board (MTB) review in patients with cancer.

METHODS: A systematic search of PubMed was performed to identify studies reporting clinical outcomes in patients with cancer who were reviewed by an MTB. To be included, studies had to report clinical outcomes, including clinical benefit, response, progression-free survival, or overall survival. Two reviewers independently selected studies and assessed quality with the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group or the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies depending on the type …

Impact Of Duration Of Antibiotic Prophylaxis On Rates Of Surgical Site Infection (Ssi) In Patients Undergoing Mastectomy Without Immediate Reconstruction, Comparing A Single Prophylactic Dose Versus Continued Antibiotic Prophylaxis Postoperatively: A Multicentre, Double-Blinded Randomised Control Trial Protocol, Abida K. Sattar, Nida Zahid, Hania Shahzad, Rufina Soomro, Omema Saleem, Syed Faisal Mahmood

Department of Surgery Docs

Introduction: In breast surgeries, prophylactic antibiotics given before the surgical incision as per Joint Commission Surgical Care Improvement Project guidelines have been shown to decrease the rate of postoperative infections. There is, however, no clear consensus on postoperative antibiotic prophylaxis in patients undergoing mastectomy with indwelling drains. This trial protocol proposes to study the difference in rates of surgical site infection (SSI) with or without continuation of postoperative antibiotics in patients undergoing mastectomy without immediate reconstruction and with indwelling drains.
Methods and analysis: In this multicentre, double-blinded clinical trial, all patients undergoing mastectomy (without immediate reconstruction) will receive a single …

Therapeutic Efficacy Of A Potent Anti-Venezuelan Equine Encephalitis Virus Antibody Is Contingent On Fc Effector Function, Vanja Krneta-Stankic, Mark E Corkins, Adriana Paulucci-Holthauzen, Malgorzata Kloc, Andrew B Gladden, Rachel K Miller

Faculty, Staff and Student Publications

E-cadherin junctions facilitate assembly and disassembly of cell contacts that drive development and homeostasis of epithelial tissues. In this study, using Xenopus embryonic kidney and Madin-Darby canine kidney (MDCK) cells, we investigate the role of the Wnt/planar cell polarity (PCP) formin Daam1 (Dishevelled-associated activator of morphogenesis 1) in regulating E-cadherin-based intercellular adhesion. Using live imaging, we show that Daam1 localizes to newly formed cell contacts in the developing nephron. Furthermore, analyses of junctional filamentous actin (F-actin) upon Daam1 depletion indicate decreased microfilament localization and slowed turnover. We also show that Daam1 is necessary for efficient and timely localization of junctional …

Collet-Sicard Syndrome Due To Concurrent Extramedullary Intracranial Plasmacytoma And Jugular Venous Sinus Thrombosis In Multiple Myeloma, Dilraj Sokhi, Caroline Wangui Mithi, Farah Ebrahim, Adil Salyani, Sheila Waa, Riyat Malkit

Internal Medicine, East Africa

In a patient with Collet- Sicard syndrome and multiple myeloma, both extramedullary plasmacytomas and internal jugular vein- sigmoid sinus thrombosis should be consid- ered as they can coexist.

A Prospective Observational Study Of Community Acquired Pneumonia In Kenya: The Role Of Viral Pathogens, Jamila Nambafu, Mary Achakolong, Fridah Mwendwa, Jumaa Bwika, Felix Riunga, Samuel Gitau, Hanika Patel, Rodney Adam

Internal Medicine, East Africa

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. In sub-Saharan Africa, many studies of community acquired pneumonia in adults have focused on HIV-infected patients and little attention has been given to risk factors and etiologic agents in an urban area with a more moderate HIV prevalence.

Methods: We prospectively enrolled 77 patients admitted to a 280 bed teaching hospital in Kenya with radiographically confirmed community acquired pneumonia from May 2019 to March 2020. The patients were followed for etiology and clinical outcomes. Viral PCR testing was performed using …

Pharmacotherapy In Coronavirus Disease 2019 And Risk Of Secondary Infections: A Single-Center Case Series And Narrative Review, Michael Behal, Brooke Barlow, Breanne Mefford, Melissa L. Thompson Bastin, J. Chris Donaldson, Melanie Laine, Brittany D. Bissell

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: Since the onset of the coronavirus disease 2019 pandemic, immune modulators have been considered front-line candidates for the management of patients presenting with clinical symptoms secondary to severe acute respiratory syndrome coronavirus 2 infection. Although heavy emphasis has been placed on early clinical efficacy, we sought to evaluate the impact of pharmacologic approach to coronavirus disease 2019 within the ICU on secondary infections and clinical outcomes.

DATA SOURCES: PubMed (inception to March 2021) database search and manual selection of bibliographies from selected articles.

STUDY SELECTION AND DATA EXTRACTION: Articles relevant to coronavirus disease 2019, management of severe acute respiratory …