Pulmonology Commons^™

Hepatic Chylothorax, A Rare Finding In A Patient With Subacute Hepatic Hydrothorax, Oscar Rodrigo Zamudio Herrera, Shadi Jafari-Esfahani, Fatimah Bello

Research Colloquium

Background: The presence of chyle in the pleural space is termed chylothorax. Etiologies include traumatic (iatrogenic, blunt, or penetrating injury) and non-traumatic (non-malignant and malignant). Liver cirrhosis is a rare cause of non-traumatic, nonmalignant chylothorax. We describe a case of a transudative chylothorax in a patient with cirrhosis and hepatic hydrothorax.

Case presentation: A 72-year-old woman presents with complaints of shortness of breath for 7 days, altered mental status, and abdominal distention. Patient has past medical history of diabetes, hypertension, and liver cirrhosis. On arrival, vital signs demonstrated T 96.2 F°, HR 75, RR 16, BP 143/68, and SO2 97%. …

Pneumocystis Jirovecii Pneumonia In A Newly Diagnosed Aids Geriatric Patient, Ashley Sareen, Nathan Tanner, James Fahey

Research Colloquium

Background: Approximately 40% of new HIV infections originate from people who are unaware of their diagnosis. Median time from infection to diagnosis was 3 years in 2015. Cases of newly diagnosed HIV in the geriatric population are rare.

Case Presentation: 71 year old Hispanic man with history of diabetes and anemia presenting to the hospital with generalized weakness, presyncopal episodes, shortness of breath, loose stools, and falls for past two weeks. He is a poor historian so wife contacted to provide detailed history. Patient with 100 pound weight loss in 6 months. Intravenous drug use 30 years ago, and blood …

E-Cigarette Or Vaping Use-Associated Lung Injury (Evali) In A Hispanic Male During The Covid-19 Pandemic, Juan C. Naranjo, Muhammad Jamal, Aramide Tijani, Fatimah Bello

Research Colloquium

Background: Electronic cigarette or vaping product use–associated lung injury established the relationship between vaping products and lung injury. Overlapping clinical manifestations may mimic those of other respiratory conditions including COVID-19. Multiple radiographic findings including diffuse, bilateral, ground-glass infiltrates with lower-lobe predominance, eosinophilic pneumonia, and diffuse alveolar damage have been described. It is important to consider this as an alternative diagnosis, particularly in patients with respiratory symptoms and a history of vaping in the last 90 days due to increased risk of COVID-19 infection and worse outcomes.

Case presentation: A 25-year-old male with a history of polysubstance abuse and frequent E-cigarette …

Triple Inhaler Therapy In Adolescents And Adults With Moderate And Severe Persistent Asthma, Mark S. L'Eplattenier

Graduate Dissertations and Theses

Expert guidelines, metanalysis, and multiple randomized controlled trials have demonstrated the effectiveness of long-acting inhaled antimuscarinic agents (LAMA) as an additive medication in poorly controlled moderate and severe persistent asthma. LAMAs play an essential role in blocking acetylcholine binding to muscarinic receptors and reducing bronchoconstriction and mucous production. By adding this medication to other combination inhalers - long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS), patients can utilize a triple inhaler to improve FEV_¹ values and decrease exacerbations. Current treatment guidelines allow clinicians to develop more personalized treatment plans for their asthmatic patients.

Role Of A Multidisciplinary Pulmonary Embolism Response Team And Impact Of Interventional Therapy In The Management Of Patients With Intermediate-High Risk Pulmonary Embolism, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, Eric J Lehr, George P Pappas

Articles, Abstracts, and Reports

Background: Despite emerging interventional options for pulmonary embolism (PE), the mortality rate for intermediate high-risk PE (IHR-PE) remains high and the optimal therapeutic approach unclear due to a lack of robust outcomes data. We describe the outcomes of patients presenting with IHR-PE managed by a multidisciplinary PERT program with all available reperfusion options.

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score …

Outcomes Of Patients With Intermediate Risk Pulmonary Embolism Treated With A Multidisciplinary Pulmonary Embolism Response Team. The Emergent Role Of Percutaneous Catheter Thrombectomy And The Importance Of Cardiac Surgery Engagement, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, George P Pappas, Eric J Lehr

Articles, Abstracts, and Reports

Background: Management of Intermediate Risk Pulmonary Embolism (IRPE) remains controversial due to the dynamic nature of the disease and the lack of correlative outcomes with large clot burden. We describe the outcomes of patients presenting with IRPE managed by a multidisciplinary Pulmonary Embolism Response Team (PERT).

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score were used as risk stratification tools. Patients …

Pulmonary & Critical Care Insider: Issue 2, Bharat Bajantri Md, Sarah Ellsworth Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 2

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Summaries/Topics in this issue:

• Spontaneous Breathing Trials
• Enteral feedings
• EFFORT Protein trial
• The NUTRIREA-3 trial
• Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2 R)
• Acute hypoxemic respiratory failure (AHRF)
• Penicillin allergy
• PEN-FAST score
• Etomidate increases mortality …

A Comparison Of Bleeding Risk In Patients With Cardiovascular Disease Treated With Aspirin Versus Clopidogrel, Laboy Alyssa

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

Cardiovascular disease is the leading cause of death for men and women in the United States.⁷­­

There are four main types of CVD:

1. Coronary heart disease
2. Strokes & TIAs
3. Peripheral arterial disease
4. Aortic disease

Coronary artery disease (CAD) is the most prevalent and most common cause of atherosclerosis

Antiplatelet medications remain the cornerstone of medical therapy for primary and secondary atherosclerotic CAD prevention.

Aspirin is prescribed for:

• Individuals with a history of MI or ischemic stroke to prevent a recurrence.
• When a myocardial infarction (MI) is suspected to avoid further infarction.
• Thromboembolism prevention after hip surgeries, transient …

In Stable Phase Copd Patients Does Oral Magnesium Supplementation Vs Nothing Decrease The Number Of Copd Related Hospitalizations?, Georgina Garvey

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

- Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that leads to significant morbidity and mortality. Magnesium deficiency is known to lead to increased risk of both respiratory and cardiovascular diseases1. This deficiency can lead to an inflammatory state and increased bronchoconstriction that would exacerbate a disease state like COPD.² Magnesium deficiency is seen in aging populations and those with chronic diseases³ and has also been seen in the population of patients coming into the emergency room with acute exacerbations of COPD.⁴

- Treatment with IV magnesium has been shown to be efficacious in …

Pocus Use For Emergency Airway Management In Rural Emergency Departments, Margaret Downing

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

- Preparation and accurate prediction of difficult airways in emergent situations is necessary for successful first pass intubation

- Current methods for airway assessments require patient cooperation and may vary by provider

• Mallampati score: open mouth, protrude tongue, see what structures are visible³
• LEMON criteria: look externally, evaluate 3-3-2 rule, Mallampati score, obstruction, neck mobility
• Thyromental distance: measure thyroid cartilage to tip of chin with neck extended³

- Difficult airways have successful first pass intubation only 82.2% of the time (vs 92.4% for non-difficult airways)⁶

- Adverse effects occurred in 14.2% of patients with successful first …

Cystic Fibrosis - An Ever Evolving Challenge, Abdullah A. Orakzai, Osama Sherjeel Khan, Syeda Sarah Raza, Muhammad H. Sharif, Mehr A. Orakzai

Advances in Clinical Medical Research and Healthcare Delivery

Cystic fibrosis (CF) is a genetic disease that results from mutations in a large single gene located on chromosome 7. More than 2000 different mutations in the gene have been identified to have caused the disease. Most of these mutations are exceedingly rare and therefore not a part of CF screening or all testing panels. This case discusses an adult female with a history of asthma, bronchiectasis, pseudomonas colonization, and respiratory failure on chronic oxygen who presented to the ED with sudden onset shortness of breath, fever, chills, body aches, nonproductive cough, and headache. The patient's condition clinically improved with …

Pulmonary & Critical Care Insider: Issue 1, Bharat Bajantri Md, Sarah Ellsworth Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 1

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Summaries/Topics in this issue:

• Comparison of two commonly prescribed regimens of empiric antibiotics.
• Vancomycin and piperacillin-tazobactam (VPT)
• The efficacy and safety of Dupilumab in patients with COPD
• The BOREAS trial
• Simple aspiration versus chest …

A Commonly Misdiagnosed Rare Pulmonary Disease: Idiopathic Pleuroparenchymal Fibroelastosis, Yonas Raru, Amro K. Al-Astal, Saroj Sigdel

Marshall Journal of Medicine

Awareness among clinicians about Idiopathic pleuroparenchymal fibroelastosis (PPFE) is lacking and by the time patients are diagnosed with it, they were seen by multiple physicians and misdiagnosed multiple times. It is a rare condition that is characterized by fibrosis of the pleura and subpleural lung parenchyma, predominantly affecting the upper lobes. Most common cause of fibrosis in other processes is collagen predominant but in PPFE fibrosis is usually caused by elastic fibers. Verhoeff-Van Gieson stain from lung biopsies in patients who presented with fibrosis in the upper pleural and parenchymal areas will help in establishing the diagnosis by demonstrating the …

Neurotropic Manifestations As A Potential Risk Factor For Schizophrenia Following In Utero Exposure To Sars-Cov-2, Mir Ali R Talpur, Omar H. Elsayed, Rif S. El-Mallakh

The University of Louisville Journal of Respiratory Infections

Background: COVID-19 infection is associated with neurologic and psychiatric morbidity that suggests a direct effect of the virus or secondary effect of an inflammatory process. These neuropsychiatric consequences may increase the likelihood of schizophrenia in the offspring of women who become infected with COVID-19 during their pregnancy.

Methods: We performed a directed narrative review of the literature focusing on the proposed pathophysiological processes that lead to schizophrenia and known pathological consequences of COVID-19 infection.

Results: Schizophrenia in adult offspring has been associated with maternal infections during pregnancy by a wide range of respiratory and neurotropic pathogens. Spikes in the incidence …

Professionalism And Moral Injury In A Capitalist Healthcare System, James Peter Meza Md, Phd, Kassem Soufan Md, Michael Francis Do, Abbass Berjaoui Md

Clinical Research in Practice: The Journal of Team Hippocrates

Professionalism cautions against profit while capitalism exists for profit. This case is a structural analysis of capitalism in a clinical setting that reveals physicians to be simultaneously wage laborers and professionals. Capitalism generates profit. Professionalism views profit as a conflict of interest that erodes trust in the doctor-patient relationship. Managing these conflicting values causes moral injury for physicians, which is a driver of physician burnout.

Mechanical Thrombectomy For Intermediate Risk Pulmonary Embolism, James Peter Meza, Marissa Costello Md, Angela Moughni Md, Nicholus Yee Md

Clinical Research in Practice: The Journal of Team Hippocrates

An informed consent article using a set of publications to develop an informed consent conversation for a patient with an acute pulmonary embolism being considered for pulmonary artery thrombolysis.

On The Respiratory Syncytial Virus Vaccine, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

The Impact Of The Covid-19 Pandemic On Respiratory Syncytial Virus, Amrit Kahlon, Ravina Ramnani, Kartik Rajpal, Yusra Irshad, Sudeep Chapagain, Arushee Bhatnagar, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Impact Of An Integrated Classifier Using Biomarkers, Clinical And Imaging Factors On Clinical Decisions Making For Lung Nodules, Fayez Kheir, Juan P. Uribe, Juan Cedeno, Gustavo Munera, Harsh Patel, Ramsy Abdelghani, Atul Matta, Sadia Benzaquen, Regina Villalobos, Adnan Majid

Einstein Health Papers

BACKGROUND: An integrated classifier that utilizes plasma proteomic biomarker along with five clinical and imaging factors was previously shown to be potentially useful in lung nodule evaluation. This study evaluated the impact of the integrated proteomic classifier on management decisions in patients with a pretest probability of cancer (pCA) ≤50% in "real-world" clinical setting.

METHODS: Retrospective study examining patients with lung nodules who were evaluated using the integrated classifier as compared to standard clinical care during the same period, with at least 1-year follow-up.

RESULTS: A total of 995 patients were evaluated for lung nodules over 1 year following the …

Comparing Pleural Fluid Removal Volume And Oxygenation Change In Therapeutic Thoracentesis: Is There A Relationship?, Hannah Zazulak, Ryanne Burke, Andrea Bodine

Advances in Clinical Medical Research and Healthcare Delivery

Background: During therapeutic thoracentesis (TT), pleural fluid is typically drained to completion. Fluid removal improves oxygenation, and the amount of fluid removed is directly associated with the risk of serious complications. A relationship between the amount of fluid removed during TT and the change in oxygenation has not been found in the literature. A direct relationship was hypothesized in this study. Differences in the change in oxygenation between sexes, age, and pre-procedure oxygen support were secondarily hypothesized. This information would assist in the guidance of future TT protocols.

Methods: Subjects of this retrospective cohort study were males and females aged …